MEMORIAS

#SIENTELAEXPERIENCIA

LAVC’18
La Conferencia De Educación Continua En
Medicina Veterinaria Más Importante De
Latinoamérica

EDITOR
Cari Sarmiento, Roy
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Comité
Presidente y Fundador del LAVC
Dr. Jorge Guerrero Ramirez, Perú
Dirección de Operaciones
Dr. Kamilio Luisovich, Perú
Dirección de Marketing
Dr. Neptalí Rodríguez, Perú
Asist. Maribi Sarmiento, Perú
Asistente de Tecnología e Informática
Sñr. Roy Cari, Perú
Comité cientifico del LAVC
Dra. Norma Labarthe, Brazil,
Dr. Hector Guzman, Peru,
Dr. Jose Cavero, Peru,
Dr. Fernando Chavez, Peru.
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CON EL APOYO
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Índice

Comité ......................................................................................................................... 1
Índice ........................................................................................................................... 3
Medicina de animales de compañía y Mascotas Exóticas ................................ 4
1.1. Eliza Mazzaferro ......................................................................................... 5
1.2. Jennifer Devey .......................................................................................... 32
1.3. Bonie Campbell ......................................................................................... 71
1.4. Matt Winter.............................................................................................. 100
1.5. Carlos Pinto ............................................................................................ 125
1.6. Ernie Ward .............................................................................................. 134
1.7. Camila Pardo .......................................................................................... 162
1.8. Doug Mader ............................................................................................ 172
1.9. Don J. Harris ........................................................................................... 196
Medicina de Rumiantes ................................................................................... 224
2.1. Christine Navarre .................................................................................... 225
2.2. Carlos Pinto ............................................................................................ 252
Posters ............................................................................................................. 266
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MEDICINA DE
ANIMALES DE
COMPAÑÍA Y
MASCOTAS
EXÓTICAS
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Índice
ELIZA MAZZAFERRO
Elisa M. Mazzaferro, MS, DVM, PhD,
DACVECC Cornell University Veterinary
Specialists Stamford, CT, USA

1.1.1. Acute Abdomen Diagnosis Surgery and Post Op Care Final.......................................... 6

1.1.2. Anesthesia and Pain Management of the Critical Patient Final .................................. 10
1.1.3. Emergency Management of Congestive Heart Failure final ....................................... 16
1.1.4. Emergency Management of Head and Spinal Trauma Final ....................................... 19
1.1.5. Fluid Therapy Its More Than Just Lactated Ringers Final ............................................ 23
1.1.6. Hypoadrenocorticism Insidious and Deadly Final ....................................................... 28
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Acute Abdomen Diagnosis Surgery and

Post Op Care Final

PRESENTATION: Acute abdomen is defined as the sudden onset abdominal discomfort or pain
due to a variety of conditions involving intraabdominal organs. Many animals present with the
primary complaint of lethargy, anorexia, ptyalism, vomiting, retching, diarrhea, hematochezia,
crying out, moaning, or abnormal postures. Abnormal postures can include generalized
rigidity, walking tenderly or as if “on eggshells”, or a prayer position in which the front limbs
are lowered to the ground while the hind end remains standing. In some cases, it may be
difficult to initially distinguish between true abdominal pain or referred pain from
intervertebral disk disease. Rapid progression and decompensation of the patient’s
cardiovascular status can lead to stupor, coma, and death in the most extreme cases, making
rapid assessment, treatment and definitive care extremely challenging.

SIGNALMENT AND HISTORY vaccinated recently? Has there been any

change in your pet’s appetite? Have you
Often the patient’s signalment and history
noticed any weight loss or weight gain?
can increase your index of suspicion for a
Have you noticed any increase or decrease
particular disease process. A thorough
in water consumption or urination? Does
history is often overlooked or postponed in
your animal chew on bones or toys? Have
the initial stages of resuscitation of the
you noticed any toys, socks, underwear, or
patient with acute abdominal pain. Often,
other items missing from your household?
asking the same question in a variety of
Is there a possibility of any trauma including
methods can elicit an answer from the client
being hit by a car or kicked by a larger
that may lead you to the source of the
animal or person? Have you noticed a
problem and the reason for acute
change in your pet’s defecation habits?
abdominal pain. Important questions to
Have you seen any vomiting or diarrhea?
ask the client include: What is your chief
What does the vomitus or diarrhea look
complaint or reason that you brought your
like? Is the vomitus in relation to eating? Is
animal in on emergency? When did the
there any blood or mucous in the vomitus
signs first start or when was your animal last
or diarrhea? When was the last time your
normal? Do you think that the signs have
animal vomited or had diarrhea? When
been the same, better, or getting worse?
your animal vomits, do they actively retch
Does your animal have any ongoing or past
with abdominal contractions, or is it more
medical problems? Have similar signs
passive like regurgitation? What is the color
occurred in the past? Does your animal
of the feces? Is it black or red in color? Does
have access to any known toxins or does he
the vomit smell malodorous like feces?
or she run loose unattended? Has your
animal ingested any garbage, compost, or IMMEDIATE ACTION
table scraps recently? Are there any other
Physical Examination As with any other
animals in your household and are they
emergency, the clinician must follow the
acting sick or normal? Has your animal been
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A,B,C’s of therapy, treating the most life- inspect the skin and underlying structures
threatening problems first. First, a for bruising and ecchymoses. Auscult the
perfunctory physical examination should be abdomen for the presence or absence of
performed. Examination of the abdomen borborygmi to characterize gut sounds.
should ideally be performed last, in case Next, perform percussion and ballottement
inciting a painful stimulus precludes you to evaluate for the presence of a gas-
from evaluating other organ systems more distended viscus or peritoneal effusion.
thoroughly. Briefly observe the patient from Finally, perform first superficial, then deep
a distance. Are there any abnormal palpation of all quadrants of the abdomen,
postures? Is there respiratory distress? Is noting abnormal enlargement, masses, or
the animal ambulatory and if so, do you whether focal pain is elicited in any one
observe any gait abnormalities? Do you area. Once the physical examination has
observe any ptyalism or attempts to vomit? been performed, initial therapy in the form
Auscult the patient’s thorax for crackles that of analgesia, fluid resuscitation, and
may signify aspiration pneumonia antibiotics should be implemented.
secondary to vomiting. Examine the
patient’s mucous membrane color and
capillary refill time, heart rate, heart TREATMENT
rhythm, and pulse quality. Many patients in
pain have tachycardia that many or may not Treatment for any patient with acute
be accompanied by dysrhythmias. If a abdomen and shock is to treat the
patient’s heart rate is inappropriately underlying cause, maintain tissue oxygen
bradycardic, consider hypoadrenocorticism, delivery, and prevent end-organ damage
whipworm infestation, or urinary and failure.
obstruction or trauma as a cause of Analgesia The administration of analgesic
hyperkalemia. Assess the patient’s agents to any patient with acute abdominal
hydration status by evaluating skin turgor, pain is one of the most important therapies
mucous membrane dryness, and whether in the initial stages of case management. A
the eyes appear sunken in their orbits. A list of analgesic drugs for use in the patient
brief neurologic examination should consist with acute abdomen is listed in Table 1.
of whether the patient is actively having a
seizure, or whether mental dullness, stupor, Fluid Resuscitation Many patients with
coma, or nystagmus are present. Posture acute abdominal pain are clinically
and spinal reflexes can assist dehydrated or are in hypovolemic shock
secondary to hemorrhage. Careful titration
in making a diagnosis of intervertebral disk of intravenous crystalloid and colloid fluids
disease versus abdominal pain. Perform a including blood products are necessary
rectal examination to evaluate for the based on the patient’s perfusion
presence of hematochezia or melena. parameters including heart rate, capillary
Finally, examination of the abdomen should refill time, blood pressure, urine output and
proceed, first with superficial, then deeper packed cell volume. Fluid therapy should
palpation. Visually inspect the abdomen for also be based on the most likely differential
the presence of external masses, bruising, diagnoses, with specific fluid types
or penetrating injuries. Reddish administered according to the primary
discoloration of the periumbilical area is disease process. In dogs, a shock volume of
often associated with the presence of fluids is calculated based on the total blood
intraabdominal hemorrhage. It may be volume of 90 ml/kg/hour. In cats, shock
necessary to shave the fur to visually fluid rate is based on plasma volume of 44
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ml/kg/hour. In most cases, any crystalloid supplemental oxygen in the form of nasal,
fluid can be administered at an initial nasopharyngeal, hood, or transtracheal
volume of ¼ of a calculated shock dose, then oxygen administration is extremely
titrated according to whether the patient’s important.
cardiovascular status responds favorably or
DIAGNOSTIC PROCEDURES
not. In cases of acute abdomen secondary
to known or suspected Complete Blood Count A complete blood
hypoadrenocorticism, severe whipworm count should be performed in all cases of
infestation, or urinary tract obstruction or acute abdominal pain to determine if life-
rupture, 0.9% sodium chloride fluid without threatening infection. Coagulating testing
added potassium is the fluid of choice. (Prothrombin time, activated partial
When hemorrhage is present, the thromboplastin time) should be considered
administration of whole blood or packed if a coagulopathy or disseminated
red blood cells may be indicated if the intravascular coagulation are suspected. In
patient is clinical for anemia, and showing cases of sepsis, infection, or severe non-
clinical signs of lethargy, tachypnea, and septic inflammation, the white blood cell
weakness. Fresh frozen plasma is indicated count may be normal, elevated, or low. A
in cases of hemorrhage secondary to peripheral blood smear should be examined
Vitamin K antagonist rodenticide and evaluated for the presence of toxic
intoxication or hepatic failure, or in cases of neutrophils, eosinophils, atypical
suspected disseminated intravascular lymphocytes, nucleated red blood cells,
coagulation (DIC). platelet estimate, anisocytosis, and blood
parasites. A falling PCV in the face of red
Antibiotics The empiric use of broad-
blood cell transfusion is suggestive of
spectrum antibiotics is warranted in cases
ongoing hemorrhage.
of suspected sepsis or peritonitis as a cause
of acute abdominal pain. Ampicillin Biochemistry Panel A biochemistry panel
sulbactam (22 mg/kg IV Q6 – Q8 hours) and should be performed to evaluate organ
enrofloxacin (10 mg/kg once daily) are the system function. Azotemia with elevated
combination treatment of choice to cover BUN and creatinine may be associated with
gram-negative, grampositive, aerobic, and pre-renal dehydration, impaired renal
anaerobic infections. Alternative therapies function, or post-renal obstruction or
include a 2nd-generation cephalosporin leakage. The BUN can also be elevated
such as Cefotetan (30 mg/kg IV TID) or when gastrointestinal hemorrhage is
Cefoxitin (22 mg/kg IV TID), or added present. Serum amylase may be elevated
anaerobic coverage with Metronidazole (10 with decreased renal function, or in cases of
– 20 mg/kg IV TID). Aminoglycoside pancreatitis. A normal amylase, however,
antibiotics should be avoided in a does not rule out pancreatitis as a source of
hypotensive, hypovolemic or dehydrated abdominal pain. Serum lipase may be
patient due to the risk of causing acute elevated with GI inflammation or
kidney injury. pancreatitis. Like amylase, a normal lipase
does not rule out pancreatitis. Total
Oxygen Supplementation Tissue oxygen
bilirubin, alkaline phosphatase, and ALT
delivery is dependent on a number of
may be elevated with primary cholestatic or
factors including arterial oxygen content
hepatocellular diseases, or due to
and cardiac output. If an animal has had
extrahepatic causes including sepsis.
vomiting and subsequent aspiration
pneumonitis, treatment of hypoxemia with
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Urinalysis A urinalysis should be obtained to determine the cause of the peritoneal

via cystocentesis whenever possible, except effusion.
in cases of suspected pyometra or
Abdominal Ultrasound Abdominal
transitional cell carcinoma. Azotemia in the
ultrasonography is often useful in place of
presence of a nonconcentrated
or in addition to abdominal radiographs.
(isosthenuric or hyposthenuric) urine is
The sensitivity of abdominal
suggestive of primary renal disease.
ultrasonography is largely operator
Secondary causes of apparent renal
dependent. Indications for immediate
azotemia and lack of concentrating ability
surgical intervention include loss of blood
also occur in cases of hypoadrenocorticism
flow to an organ, linear bunching or
and Gram-negative sepsis. Renal tubular
plication of the intestinal tract,
casts may be present in cases of acute renal
intussusception, pancreatic phlegmon or
ischemia or toxic insult to the kidneys.
abscess, a fluid-filled uterus suggestive of
Bacteriuria and pyuria may be present with
pyometra, gastrointestinal obstruction,
infection and inflammation. When a
intraluminal GI foreign body, dilated bile
urinalysis is obtained via free catch or
duct, or gall bladder mucocoele, or gas
urethral catheterization, the presence of
within the wall of the stomach or gall
bacteriuria or pyuria may also be associated
bladder (emphysematous cholecystitis).
with pyometra, vaginitis, or
The presence of peritoneal fluid alone does
prostatitis/prostatic abscess. Lactate
not warrant immediate surgical
Serum lactate is a biochemical indicator of
intervention without cytologic and
decreased organ perfusion, decrease
biochemical evaluation of the fluid present.
oxygen delivery or extraction, and end-
organ anaerobic glycolysis. Elevated serum
lactate > 6 mmol/L has been associated with
increased sensitivity in cases of GDV, and ABDOMINOCENTESIS
increased patient morbidity and mortality in Abdominal paracentesis
other disease processes. Rising serum (abdominocentesis) often is the deciding
lactate in the face of adequate fluid factor in whether to perform immediate
resuscitation is a negative prognostic sign. surgery or not. Abdominocentesis is a
sensitive technique for detecting peritoneal
effusion when >6 ml/kg of fluid is present
ABDOMINAL RADIOGRAPHS within the abdominal cavity. Abdominal
effusion collected should be saved for
Abdominal radiographs should be
bacterial culture, and evaluated
performed as one of the first diagnostic
biochemically and cytologically based on
tests when deciding whether medical
your index of suspicion of the primary
versus surgical management should be
disease process. If creatinine, urea nitrogen
pursued. The presence of gastric
(BUN) or potassium is elevated compared
dilatationvolvulus, linear foreign body,
with that of serum, uroabdomen is present.
pneumoperitoneum, pyometra, or splenic
Elevated abdominal fluid lipase or amylase
torsion warrants immediate surgical
compared with serum supports a diagnosis
intervention. If a loss of abdominal detail
of pancreatitis. Elevated lactate compared
secondary to peritoneal effusion, additional
with serum lactate, or an abdominal fluid
diagnostic tests including abdominal
glucose < 50 mg/dL is highly sensitive and
paracentesis (abdominocentesis) and
specific for bacterial/septic peritonitis. The
abdominal ultrasound should be performed
presence of bile pigment or bacteria is
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supportive of bile and septic peritonitis, medical approach to case management.

respectively. Free fibers in abdominal fluid Other conditions require immediate surgery
along with clinical signs of abdominal pain following rapid stabilization. Other
strongly support gastrointestinal conditions can initially be managed
perforation, and requires immediate medically until the patient is
surgical exploration. hemodynamically more stable, then may or
may not require surgical intervention at a
Diagnostic Peritoneal Lavage (DPL) In the
later time.
event of a negative abdominocentesis, but
peritoneal effusion, or bile or
gastrointestinal perforation are suspected,
EXPLORATORY LAPAROTOMY/CELIOTOMY
a diagnostic peritoneal lavage can be
performed. Peritoneal dialysis kits are Whenever there is penetrating abdominal
commercially available, but are often injury, evidence of intra- and extracellular
expensive and impractical. bacteria in peritoneal fluid,
pneumoperitoneum on radiographs, or
biochemical evidence of septic peritonitis,
DIFFERENTIAL DIAGNOSES uroabdomen or bile peritonitis, an
exploratory laparotomy should be
Differential diagnoses for acute abdominal
performed. The best means to accurately
pain, vomiting, and diarrhea are numerous.
and thoroughly explore the abdominal
Broad categories include primary
cavity is to open the abdomen on midline
gastrointestinal disease (viral, bacterial,
from the level of the xyphoid process
parasitic, pancreatitis, gastrointestinal
caudally to the pubis for full exposure, then
foreign body/obstruction, inflammatory
perform evaluation of all organs in every
bowel disease, intussusception, neoplasia,
quadrant in a systematic manner. Specific
gastrointestinal ulceration/perforation,
problems such as gastric or splenic torsion,
gastric or colonic torsion), versus other
enteroplication, foreign body removal, etc.
diseases (liver lobe torsion, hepatic abscess,
should be addressed, then the abdomen
bile peritonitis, gall bladder mucocoele,
copiously lavaged with warmed sterile
ureteral obstruction, uroabdomen,
saline or Lactated Ringers solution. The
pyelonephritis, splenic torsion, pyometra,
fluid should be suctioned thoroughly from
prostatitis, prostatic abscess, neoplasia,
the peritoneal cavity so as to not impair
hemoabdomen).
macrophage function. In cases of septic
peritonitis, the abdomen should have a
closed suction drain placed for further
MANAGEMENT drainage during the post-operative period.
Animals that present with acute abdominal The routine use of antibiotics in irrigation
pain can be divided into three broad solutions is contraindicated, as the
categories, depending on the primary cause antibiotics can irritate the peritoneum and
of pain, and the initial definitive treatment. delay healing.
Some diseases warrant a nonsurgical,
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Anesthesia and Pain Management of the

Critical Patient Final

PRESENTATION: General anesthesia involves the careful and judicious use of compounds that
induce sensory deprivation to noxious stimuli, muscle relaxation, and in most cases,
unconsciousness. In critically ill patients, there often is a delicate balance between loss of
consciousness and cardiovascular and respiratory compromise, requiring careful monitoring
techniques to ensure patient safety. Fortunately, many animals that present to you in an
emergency setting will be young, healthy animals that may require anesthesia to repair minor
trauma. Other cases, however, will present to you with potentially life-threatening critical
illnesses, making anesthesia more challenging and somewhat risky. Many anesthetic agents
induce some degree of cardiovascular and respiratory depression. The goal of this presentation
is to describe anesthetic protocols for both healthy and unhealthy animals.

THE PHYSICAL EXAMINATION adequate blood pressure? Is there any sign

of ongoing hemorrhage or severe
The physical examination is one of the most
electrolyte loss? In most cases, the answers
important aspects of preparation prior to
to these questions can be obtained from a
inducing anesthesia. In critically ill patients,
thorough and systematic physical
a careful physical examination should be
examination, starting with the basic ABC’s
performed just prior to inducing anesthesia,
of emergency medicine. The animal must
as clinical status may have changed
have a patent Airway, to deliver oxygen into
dramatically since initial presentation, often
the lungs while Breathing, and the oxygen
changing your choice of anesthetic
can be delivered to tissues during the
protocols. Questions to ask yourself
process of normal Cardiac function and
include: Is the patient’s airway patent? Does
Circulation. Once the ABC’s have been
the animal require mechanical or assisted
evaluated and stabilized, other diagnostics
ventilation? Is the animal morbidly obese or
can then be performed.
have an intraabdominal mass that will
change efficacy of ventilation once the
patient is placed in dorsal recumbancy?
BLOODWORK AND ELECTROLYTES
Does the animal have a sucking chest
ABNORMALITIES
wound, rib fractures, pleural effusion, or
potential for pneumothorax? Are there Following physical examination, bloodwork
pulmonary contusions that may be affected should be performed to evaluate the
by large volumes of intravenous fluids? Are patient’s oxygen carrying capacity, renal
the animal’s respirations effective or and hepatic function, and coagulation
ineffective? Is the animal in a state of status. Every effort should be made to
circulatory shock? Is there a normal normalize values prior to inducing
circulating blood volume? Is the heart anesthesia. However, in many cases, until
beating efficiently, or is there a cardiac the underlying problem is definitively
murmur or dysrhythmia? What is the addressed, patient clinical status may not
clinical status of the animal? Is there an improve despite very aggressive efforts.
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These types of cases present the most such as atropine and glycopyrollate increase
challenge for the veterinary practitioner in heart rate by inhibiting vagal stimulation.
deciding how to induce general anesthesia Glycopyrollate though, has less of a chance
without potentially doing more harm. of inducing tachyarrhythmias. Atropine
Patients with traumatic uroabdomen reduces respiratory secretions and can
should be stabilized prior to inducing cause second-degree heart block. Atropine
general anesthesia. Every effort should be crosses the blood-brain and placental
made to decrease serum potassium to less barriers, while glycopyrollate does not. This
than 7 mmol/L before any anesthesia is has important implications when providing
induced. Treatment protocols include anesthesia for the periparturient dam in
administering regular insulin (0.25 units/kg need of a C-section, anesthesia that can
IV) and dextrose (2 gm dextrose IV per unit potentially affect the outcome of the
of insulin, followed by 2.5 – 5% dextrose CRI neonates. Opioids, used in combination
to prevent hypoglycemia), intravenous with a phenothiazine tranquilizer such as
sodium bicarbonate (0.25 – 1.0 mEq/kg), or acepromazine, provide neuroleptanalgesia.
calcium gluconate (0.5 – 1.0 ml/kg 10% Morphine provides excellent analgesia
solution IV). The electrocardiogram should without inducing severe cardiovascular
be monitored closely for the appearance of compromise. Potential complications of
atrial standstill and inappropriate morphine and other opiate drugs include
bradycardia. Secondly, drainage of bradycardia (which can be reversed or
intraabdominal fluid can be accomplished prevented by using an anticholinergic
by placement of an intraabdominal catheter agent), and hypoventilation. Morphine
attached to a closed collection system. A administration can also induce vomiting and
red rubber tube or an Argyle chest tube can ileus in ambulatory patients. In recumbent
be placed using a local anesthetic such as patients, though, the use of morphine is
lidocaine (0.5 – 1.0 mg/kg). Once secured, justified by decreasing doses of induction
the drain can be left in place until definitive agents and inhalant drugs required to
repair of the urinary tract can be performed maintain general anesthesia. Butorphanol,
at the time of surgery. Anemic or a mu antagonist, kappa agonist, also can be
hemorrhaging patients should have a used as a premedication when used in
combination of crystalloid and colloidal combination with a phenothiazine
support. In cases of hemoabdomen and tranquilizer such as acepromazine. Used
gastric dilation-volvulus, synthetic alone, however, butorphanol’s sedative
hemoglobin can be administered as a bolus effects are fairly unreliable and short-lived.
or as a slow trickle (1 – 2 ml/kg/hour) to Additionally, due to its receptor affinity,
provide both colloidal support and improve using butorphanol early in the course of
oxygen carrying capacity. anesthesia may prevent more potent drugs
such as morphine and fentanyl from
Preanesthetic Agents There are several
providing adequate analgesia in the early
rationales for using pre-anesthetic
post-operative time period, depending on
medications. One of the most important
the length of surgery. For these reasons,
reasons for using premedications is to
this author does not routinely use
decrease the total amount of anesthesia
butorphanol, favoring more potent and
required to induce and maintain general
more reliable opioids such as morphine and
anesthesia. The use of a balanced
fentanyl. Fentanyl, a pure opioid agonist, is
anesthetic approach provides many
potent opioid with a very short duration of
benefits for the patient, particularly those
action. It should be used in very critical
that are critically ill. Anticholinergic drugs
patients for analgesia, then as part of an
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induction protocol. When used as a agents such as ketamine (5.5 mg/kg IV, 10 –
premedication, induction of general 30 mg/kg IM), opioids such as fentanyl (10
anesthesia should occur shortly thereafter, mcg/kg IV), or in combination with
within approximately 20 minutes, or the etomidate (0.5 – 1.5 mg/kg IV). Ketamine is
drug should be given as a constant rate a dissociative anesthetic agent that will
infusion until general anesthesia is induced. initially cause a catecholamine-induced
Phenothiazine tranquilizers, namely increase in cardiac output. In critically ill
acepromazine, should be given to healthy patients that have maximized sympathetic
animals as part of the premedication tone, however, ketamine can decrease
protocol. Acepromazine’s antagonism of cardiac contractility; therefore its use is
alpha-adrenergic activity can potentially relatively contraindicated. Ketamine, when
induce vasodilation with subsequent used pre-intra- and post-operative, can
hypotension, so should be used with decrease activation of NMDA receptor-
caution. Other untoward side effects that mediated “wind-up” and decrease post-
have been reported include reduction of operative pain even days after surgery. Its
seizure threshold in predisposed animals. use in combination with other analgesic
Thus, its use is relatively contraindicated in agents is therefore beneficial, especially in
such patients. A potentially beneficial side controlling post-operative orthopedic pain.
effect of acepromazine is decreasing Propofol (4 – 7 mg/kg IV) is another drug
catecholamine-induced dysrhythmias. that can be used to induce general
Alpha-2 agonists such as xylazine and anesthesia. Unrelated to other
medetomidine induce intense peripheral pharmacologic agents, propofol induces
vasoconstriction, AV nodal block, rapid anesthesia. Recovery from Propofol is
bradycardia, and decrease in cardiac also very rapid in most cases. Potential
output. For these reasons, alpha-2 agonists untoward effects of this drug include
should never be administered to emergency vasodilation and hypotension, and apnea.
and critical care patients for absolutely any In cats, Propofol should not be used on
reason. The alpha-2 agonists may have consecutive days due to the potential for
their place in healthy animals, but should
development of Heinz body anemia. In the
not be used in emergent settings.
most critically ill patients, Etomidate can be
administered along with Diazepam with
minimal effects on cardiovascular status.
ANESTHETIC INDUCTION

Anesthetic induction should occur rapidly.

The most critically ill patients often will ANESTHESIA MAINTENANCE AND
benefit from preoxygenation prior to MONITORING
induction. An intravenous catheter should
Immediately after successful induction of
be in place prior to induction, for
anesthesia, anesthesia should be
maintenance of vascular access.
maintained with an appropriate gas
Benzodiazepene tranquilizers such as
anesthetic agent. For short procedures in
diazepam (0.3 – 0.5 mg/kg IV) or midazolam
cardiovascularly stable patients, Propofol
can be used. Diazepam induces more
can be administered as a constant rate
reliable tranquilization and is less expensive
infusion (6 – 20 mg/kg/hour). It must be
than the more costly midazolam. If given
remembered, however, that Propofol has
alone, diazepam can potentially induce
no analgesic properties; therefore, if a
excitement; therefore, this drug is often
painful procedure is to be performed,
used in combination with dissociative
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appropriate analgesia should be (0.05 – 0.4 mcg/kg/min IV CRI) can also be

administered prior to recovery from administered. It is important to remember
anesthesia. Proper anesthetic monitoring that agents that induce peripheral
including pulse oximetry, vasoconstriction may increase blood
electrocardiogram, temperature, pressure but not necessarily improve renal,
capnography, and blood pressure should be cerebral, and coronary blood flow. In any
performed and recorded for even patient with tachy- or bradyarrhythmias
“apparently routine” procedures. In many such as AV block, bradycardia, or sinus or
critical patients, pre-, intra- and post- ventricular tachycardia, attempts should be
anesthetic hypotension is a potential hazard made to treat the dysrhythmia.
that should be carefully addressed. First, Anticholinergic drugs such as atropine or
the level of gas anesthesia should be glycopyrollate should be administered to
decreased. Secondly, a fluid bolus (5 – 10 treat cardiovascularly unstable
ml/kg) can be administered IV. All patients bradyarrhythmias. In some cases, if the
under general anesthesia should have heart rate is 50, and the animal’s blood
vascular access. If a patient is hypotensive pressure is stable and normal, treatment
and hemodilution or true anemia is a may not be necessary, However, if the
concern, synthetic colloids such as animal is bradycardic and hypotensive,
Hydroxyethyl starch can be administered as interventions should be implemented.
an IV bolus (5 ml/kg). Alternatively, Sinus tachycardia can adversely affect blood
component blood products such as whole pressure by decreasing the amount of time
blood, packed red blood cells, or fresh the heart has to fill. Decrease in diastolic
frozen plasma can be administered filling will result in a decreased cardiac wall
depending on the primary problems at stretch available for rebound, the force
hand. If decreasing anesthetic depth and necessary for normal myocardial
fluid bolus does not sufficiently increase contraction. Therefore, filling the
blood pressure, use of a positive inotrope cardiovascular space with fluids, and in
such as dobutamine (2 – 20 mcg/kg/min IV some cases, INCREASING anesthetic depth if
CRI) can be administered. Dopamine at the animal is actually feeling the procedure,
lower doses (2 – 10 mcg/kg/min IV CRI) may be necessary to decrease heart rate.
stimulates cardiac contractility through Ventricular dysrhythmias should be treated
beta-adrenergic stimulation. Dobutamine, with a combination of crystalloid/colloid
primarily a beta- agonist, stimulates cardiac therapy, oxygen, and drugs such as
contractility and as such, indirectly lidocaine (2 mg/kg IV bolus, followed by 50
increases blood pressure. Dobutamine – 100 mcg/kg/minute IV CRI) or
increases blood pressure more reliably than procainamide. Procainamide can contribute
dopamine. Ephedrine is a synthetic to refractory hypotension, and is not the
sympathomimetic drug that stimulates both antiarrhythmic of choice in a patient with
alpha- and beta-adrenergic receptors to hypotension.
stimulate catecholamine release. Bolus
injection of ephedrine (0.1 – 0.25 mg/kg IV)
has a longer duration of action than POST-OPERATIVE ANALGESIA
dobutamine, thus does not require
administration as a constant rate infusion. Post-operative analgesia should be
If none of the above options are successful, performed with the thought that the
vasopressor agents such as dopamine (> 10 patient should never ever be allowed to be
mcg/kg/minute IV CRI), epinephrine (0.05 – painful. Constant rate infusions of fentanyl
0.4 mcg/kg/min IV CRI), and norepinephrine (1 – 7 mcg/kg/hour), morphine (0.1
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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mg/kg/hour in dogs, 0.01 mg/kg/hour in attention seeking behavior. When I suspect

cats) can be administered with ease. an animal may be painful or dysphoric, I
Additionally, at the suggested doses, the perform a thorough physical examination,
drugs cause minimal cardiovascular including palpation of the surgical site. If
depression or ileus. Intermittent bolus the patient reacts to surgical site
injections can also occur, provided that the manipulation, I immediately give an
drugs are administered according to an additional dose of analgesia. If no apparent
exact schedule, not given when the patient pain is present with surgical site
begins acting apparently painful or “PRN”. manipulation, but the patient quiets when
Local anesthetic agents can be placed in the being handled, anxiety or attention-seeking
wounds prior to wound closure for post- behavior is diagnosed. I will add an
operative analgesia. Additionally, anxiolytic agent to the treatment protocol,
intrapleural lidocaine (1 mg/kg) or provided that hypotension is not a concern.
bupivacaine (0.5 – 1.0 mg/kg) can be If the patient neither responds to pain nor
administered via thoracostomy tubes for attention and anxiolytic agents, I make sure
additional pain relief. Transdermal fentanyl that the patient’s urinary bladder is empty
patches are effective in controlling patient and there isn’t a need to urinate or
discomfort, but do not immediately take defecate. Only after all of these choices
effect, thus requiring other types of have failed will I consider reversing an
analgesia until adequate blood levels of opioid drug with naloxone.
fentanyl are reached, usually 16 – 24 hours
after placement of the patch. Some
clinicians advocate placing the fentanyl CONCLUSIONS: “WHAT’S THE BOTTOM
patch on the evening prior to surgery, to LINE?”
ensure adequate blood levels are obtained
for the immediate post-operative period. In the emergent situation, there may not be
Using combination multimodal approach to enough time to take a “wait and see if this
therapy such as a constant rate infusion of works” kind of approach. One of the most
ketamine (0.5 mg/kg IV bolus at time of important things to remember is that gas is
anesthetic induction, then 10 poison. Many animals, particularly those
mcg/kg/minute intraoperatively, then 2 that are critically ill, are exquisitely sensitive
mcg/kg/minute post-operatively as a CRI), a to the cardiorespiratory effects of inhalant
nonsteroidal anti-inflammatory drug such anesthetic gases. For this reason, when an
as carprofen or ketoprofen, epidural animal is hypotensive, one of the first things
morphine, along with opioids helps to to consider is turning down the anesthetic
ensure that the patient never becomes vaporizer. If there is concern about an
painful. At the time of discharge, a animal waking up during the anesthesia and
combination of opioids and/or Nonsteroidal surgery, balanced anesthesia with constant
anti-inflammatory drugs should be rate infusions of fentanyl or fentanyl and
considered for continued analgesia in the ketamine can be administered, to decrease
post-operative recovery period. It is the total amount of anesthetic gas required
sometimes difficulty to distinguish between to maintain an adequate plane of
pain, anxiety, and opioid dysphoria. anesthesia without causing hypotension
Physical examination parameters such as and cardiovascular compromise. Next, (or
heart and respiratory rate, pupil size and sometimes simultaneously), a crystalloid
responsiveness, should all be checked, but (10 ml/kg) or colloid (5 ml/kg) fluid bolus
are often indistinguishable from pain, can be administered, to fill up the
anxiety, need to urinate or defecate, or vasodilated vascular beds. When a blood
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vessel dilates, a state of relative increase in blood pressure, then positive

hypovolemia occurs, in which there is inotropes (dobutamine and/or ephedrine)
inadequate circulating volume to maintain and vasopressors (dopamine) can be
vascular tone and cardiac preload. If there administered. Having an “anesthetic book”
is insufficient myocardial stretch, the force that contains charts of all of the necessary
of contraction is limited, and thus, can drugs, instructions on how to dilute each
result in impaired cardiac output and a drug, resulting concentration, and volume
decrease in systemic blood pressure. Many of the diluted drug to administer to each
anesthetic agents render the cardiovascular patient based on body weight can save a lot
system incapable of compensatory changes of time and quick arithmetic in an emergent
such as vasoconstriction, so blood pressure situation.
and thus tissue perfusion and oxygen
References available from author upon
delivery become compromised. If
request.
decreasing the anesthetic depth and
administration of fluids does not cause an
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Emergency Management of Congestive

Heart Failure final

PRESENTATION: Congestive heart failure (CHF) is unfortunately a common problem that

presents to the veterinary small animal practitioner. Clinical signs may include weakness and
exercise intolerance, cough, lethargy, inappetance, vomiting, diarrhea, and syncope or collapse.
A presumptive diagnosis often is made on the patient’s primary presenting complaints,
signalment, a thorough history, and physical examination findings. One of the most important
concepts to remember in the diagnosis and management of any patient with CHF is to minimize
patient stress and do no harm.

PHYSICAL EXAMINATION from the nares and mouth and have

concomitant pulmonary crackles and a
A careful physical examination is essential in
rapid restrictive respiratory pattern. A
the diagnosis and management of the
cardiac murmur or dysrhythmia is often
patient in CHF. In some cases, the patient
present in cases of severe mitral
should be placed in an oxygen cage or
insufficiency, but in some cases, the heart
receive flow-by oxygen supplementation,
may be difficult to hear beyond harsh
and observed carefully from a distance.
pulmonary crackles. Pulse quality may be
Observe the patient’s respiratory rate and
supportive of low output cardiac failure.
effort, and posture from afar. Next,
Pulses may be absent in cases of severe low
approach the patient, and perform a
output failure, or in cases of arterial
systematic examination, and evaluate the
embolism. Jugular venous distension and
mucous membrane color and capillary refill
jugular pulses may be visible in cases of
time? Look carefully at the thoracic inlet
right-sided heart failure. Heart sounds may
and jugular groove for jugular venous
be muffled to absent in cases of pleural or
distension or a jugular pulse? Auscult the
pericardial effusion. Hepatomegaly and a
heart for murmurs or dysrhythmias.
fluid wave may be present on abdominal
Simultaneously palpate the inguinal region
palpation in cases of right-sided heart
for a femoral pulse, checking for synchrony
failure. Distal extremity coolness and
and pulse quality. Auscult all lung fields for
hematochezia on rectal examination may
pulmonary crackles or wheezes. Palpate the
be present due to low cardiac output.
abdomen for hepatomegaly and a
ballotable fluid wave. Does compression of
the cranial abdomen and liver result in
jugular venous distension? Palpate the
distal extremities. Are they warm to the EMERGENCY THERAPY
touch, or do they feel cold due to poor
peripheral circulation? Patients with Emergency management of the patient in
fulminant pulmonary edema from left sided CHF consists improving systemic oxygen
CHF may have blood-tinged fluid coming delivery and minimizing patient stress.
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Oxygen delivery is a function of both oxygen decrease in pulmonary vascular pressures.

uptake by the respiratory system, cardiac Nitroglycerine paste is not absorbed as
output, and hemoglobin concentration. readily across the skin as was once
The mainstay of therapy for treatment of previously thought, and has largely fallen
congestive heart failure is to provide out of favor for use in veterinary patients
supplemental oxygen and decrease fluid with CHF. In patients with refractory
buildup within the lungs. pulmonary edema that is not responding to
traditional diuretic therapy, sodium
Oxygen
nitroprusside should be considered, as long
Flow-by oxygen should be administered to as the patient is not hypotensive. Sodium
patients with congestive heart failure as a nitroprusside is a balanced arteriolar and
physical examination is taking place. Flow- venous dilator that decreases both
by oxygen is well-tolerated, and requires pulmonary and systemic vascular
minimal physical restraint. Because flow-by resistance. The drug is administered as a
is a relatively inefficient method of constant rate infusion (2 – 10
providing an increase in the fraction of mcg/kg/minute IV, titrated to effect).
inspired oxygen, other methods including Because of its potent hypotensive effects,
oxygen hoods, oxygen cages, nasal, arterial blood pressure must be monitored
nasopharyngeal and tracheal oxygen closely throughout the infusion.
insufflation should be considered for
Morphine
longterm therapy. Humidified oxygen flow
rates can be administered at 50 – 100 Morphine is an opioid agonist that is useful
ml/kg/minute. in patients with congestive heart failure. In
dogs, low dose (0.025 – 0.05 mg/kg IV)
Diuretics
morphine dilates the splanchnic vasculature
Aside from supplemental oxygen and increases venous capacitance, allowing
supplementation, furosemide is one of the drainage of fluid from the pulmonary
most important therapies for management parenchyma. Morphine provides the
of the patient with congestive heart failure additional benefits of allowing slower,
and pulmonary edema. Furosemide can be deeper respirations, and decreasing anxiety
administered as a bolus (4 – 8 mg/kg IV or in patients with congestive heart failure.
IM), or as a constant rate infusion (0.66 – 1
Positive Inotropes Dobutamine is a
mg/kg/hour IV) to promote diuresis and
synthetic beta-adrenergic agonist that is
decrease pulmonary vascular overload and
used as a positive inotrope, specifically in
pulmonary edema. The goal of diuretic
patients with DCM. At lower doses,
treatment is to repeat the therapy every 30
dobutamine improves cardiac contractility
– 60 minutes until the patient’s body weight
with minimal effects on chronotropy or
has decreased by 5 – 7%. Once the patient’s
heart rate. At higher, doses, however,
respiratory rate and effort has normalized,
dobutamine can be pro-arrhythmogenic.
oral furosemide can be started.
Dobutamine can be administered at a dose
Nitric Oxide Donors of 2 – 20 mcg/kg/minute. Potential side
effects include tachyarrhythmias (at higher
Nitric oxide donors should be initiated as a doses), facial twitching, and seizures. In
primary initial therapy in any patient with animals with severe myocardial
fulminant congestive heart failure. Nitric dysfunction, treatment often includes 48
oxide donors cause dilation of the hours on a dobutamine constant rate
pulmonary vasculature and a relative infusion (5-10 mcg/kg/min). Pimobendan
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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(0.25 mg/kg PO BID) has been used with Irrespective of the underlying cause,
success dogs for both emergency and long- patients with CHF must be managed
term management of dogs with CHF carefully and aggressively following initial
secondary to DCM and mitral valve diagnosis. Supplemental oxygen, potent
insufficiency. Pimobendan is a diuretics, and nitric oxide donors continue
phosphodiesterase-III inhibitor that to be the mainstay of therapy in both cats
sensitizes the myocardium to calcium, and and dogs during the initial management of
improves inotropic activity in addition to CHF. Patients that do not respond to
causing arteriolar and venous dilation. In standard therapies may require additional
addition to its use as a long-term inodilator drug protocols, including positive inotropic
in the treatment of dogs with CHF, and intravenous vasodilatory drugs. Careful
Pimobendan is also recommended for use monitoring of the patient’s heart rate and
in emergency therapy of CHF, as it can have rhythm, arterial blood pressure, respiratory
an onset of effects within one hour. rate and effort, and pulse oximetry or
arterial oxygen saturation should be
performed to evaluate the patient’s
CONCLUSIONS response to therapy.
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Emergency Management of Head and

Spinal Trauma Final

INTRODUCTION Severe head and spinal injury are among the most challenging problems that
present to the small animal practitioner. Often, neurologic injury is accompanied by other
serious life-threatening problems including pneumothorax, pulmonary contusions,
hemoabdomen and fractures. Many of the animals have sustained multiple trauma and are in
hypovolemic shock at the time of presentation. Head injury may be so severe that localization
of head or spinal lesions, then considering an accurate prognosis are difficult. The treatment of
any patient with head and spinal injury involves making an accurate assessment to identify the
extent of injury, prevention of further damage to the brain and spinal cord, and maintenance of
cerebral perfusion pressure and end-organ function. Many cerebral injuries and spinal injuries
with intact deep pain perception can carry an overall favorable prognosis with aggressive nursing
care and tincture of time. Other types of injuries such as thoracolumbar spinal injury with loss of
deep pain sensation are more clear-cut, but offer a less favorable prognosis.

TRIAGE AND INITIAL STABILIZATION OF patient. Intravenous crystalloid and colloid

THE HEAD/SPINAL TRAUMA PATIENT fluids should be titrated based on the
patient’s arterial blood pressure and
The assessment and treatment approach
response to treatment. Careful
for any patient that has sustained severe
administration of intravenous crystalloid
trauma should be based on the ABC’s, or
fluids at ¼ of the calculated shock volume of
“airway, breathing, and circulation”.
fluids (shock volume is 90 ml/kg in dogs and
Examine the patient for a patent airway.
44 ml/kg in cats) should be administered as
Note the patient’s respiratory status and
rapidly as possible with careful and frequent
listen carefully to thorax. The absence of
reassessment of the patient’s blood
lung sounds with rapid restrictive
pressure. Alternatively, hydroxyethyl starch
respiration may be associated with a
(5 ml/kg IV) can be administered as a rapid
pneumothorax or diaphragmatic hernia.
bolus. The goal is to restore systolic blood
Harsh crackles with cyanosis and respiratory
pressure to 90 – 100 mm Hg, diastolic blood
difficulty can be associated with pulmonary
pressure to > 40 mm Hg, and mean arterial
contusions. Tachycardia can be associated
blood pressure to 60 – 80 mm Hg. This
with pain, anxiety, and hypovolemic shock.
approach serves to restore cerebral blood
The patient’s blood pressure should be
flow and flow to vital organs such as the
measured, and intravenous fluids should be
heart and kidneys, as well. Hypertonic
administered to restore circulating blood
saline has also been used in combination
volume and cerebral perfusion pressure.
with synthetic colloids such as hydroxyethyl
The maintenance of cerebral perfusion
starch in the successful treatment of head
pressure and cerebral oxygen delivery is of
trauma. The potent hyperosmolar effect of
paramount importance in any head trauma
IV hypertonic saline acts to pull fluid from
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the intracellular and interstitial fluid to the use of steroids in head injury are
compartments into the intravascular space those patients with severe facial,
within 3 minutes of administration. The oropharygeal, and ocular trauma in which
effect is very short-lived, and lasts steroid use is necessary to decrease edema
approximately 20 – 30 minutes. When used to maintain a patent airway. Any trauma
in combination with a colloid such as patient that exhibits abnormal neurologic
hydroxyethyl starch, the fluid is retained in postures should be confined to a backboard
the intravascular space for a longer period for stabilization and to prevent further
of time. Hypertonic saline (7.5%, 3 - 5 ml/kg injury during the initial triage period.
for dogs, and 2 – 4 ml/kg in cats hypertonic Extensor rigidity of the forelimbs with
saline with 5 – 10 ml/kg colloid) has been flaccid paralysis of the hindlimbs is
shown to restore extracellular sodium characteristic of Schiff-Sherrington posture,
concentrations and decrease neutrophil and is commonly associated with an injury
chemotaxis to limit secondary brain injury in between T3 and L3. The loss of deep pain
the head trauma patient. The patient’s perception in such patients carries a grave
oxygenation status should be monitored prognosis. Intact deep pain perception with
closely with pulse oximetry or arterial blood Schiff-Sherrington has been associated with
gas analyses. Ideally, the patient’s arterial spinal shock and not necessarily due to
partial pressure of oxygen (PaO2) should be transaction of the spinal cord, and can carry
maintained above 80 mm Hg, and oxygen a slightly more favorable prognosis,
saturation as measured by pulse oximetry depending on the exact location and extent
above 90% SaO2. Supplemental oxygen of the injury. Flaccid paralysis of the
should be administered by mask, hood, or forelimbs with the hindlimbs tucked up
flow-by in any patient with head trauma. close to the body and opisthotonus is
The placement of nasal oxygen catheter(s) associated with severe injury to the
can result in patient discomfort and cerebellum, and is known as decerebellate
subsequent sneezing. Sneezing can increase rigidity. Extensor rigidity of all four limbs
intracranial pressure, so nasal oxygen and opisthotonus is known as decerebrate
catheters should be avoided. A minimum rigidity, and carries a very grave prognosis.
data base of PCV/TS, glucose, azostick, and
lactate can be useful for baseline
measurements and may help predict NEUROLOGIC EXAMINATION
outcome. Hyperglycemia has been shown
to be a negative prognostic indicator in Once the patient’s ABC’s have been
humans and dogs with severe head injury. accurately assessed and problems
Glucose acts as a substrate for anaerobic addressed. A complete neurologic
metabolism during periods of cerebral examination can be performed. Pupil size
ischemia, and can lead to cerebral acidosis. and response to light, presence or absence
For this reason, the administration of of menace, physiologic nystagmus,
glucose-containing fluids (D5W, 0.45% NaCl mentation, ambulation, and reflexes should
+ 2.5% dextrose) and any steroid is be evaluated in a step-bystep approach,
contraindicated in the head trauma patient. starting from nose to tail. Mental status is
often difficult to accurately assess until
Steroid use has not been documented to hypovolemic shock has been successfully
provide any benefit in traumatic brain treated and perfusion has normalized. A
injury, and can cause hyperglycemia that patient’s mentation can be categorized as
can potentially worsen secondary brain normal, depressed, obtunded, stuporous,
injury and cerebral edema. One exception or comatose. A depressed patient may
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appear mentally dull and be slow to react to functioning motor and sensory tracts
external stimuli including noise and touch. through the spinal cord to the cerebral
As mental status worsens, an obtunded cortex. Additionally, if the patient attempts
patient will be depressed, and slower to to move during the evaluation, motion at
respond to external stimuli. A stuporous the fracture site can be perceived as painful
patient appears unconscious, but will without functioning sensory pathways to
respond to painful or noxious stimuli. Coma the rear limbs. Less than 5 – 8% of animals
is the most severe change in mentation, in with loss of deep pain perception regain
which the patient is unconscious and motor function and continence, and thus,
completely unresponsive to a noxious prognosis for return to function must be
stimulus. The presence of coma alone does considered poor, at best. Radiographs
not necessarily mean a poor long-term should be performed if depressed skull or
prognosis. The patient’s mentation should spinal fractures are suspected. Patients
be evaluated in combination with the with suspected spinal fractures should
patient’s pupil size when gauging severity of never be moved from lateral position in
condition in order to make a prognosis. order to take dorsoventral or ventrodorsal
Miotic pupils are associated with forebrain radiographs. A lateral radiograph of the
lesions. Mydriatic dilated pupils or loss of suspected fracture site should be
papillary light reflexes are associated with a performed. In many cases, disruption of the
rostral brainstem lesion, and carry a much articular facets, compression fractures, or
more guarded prognosis when in obvious disruption of the spinal column can
combination with stupor or coma. be visualized. Some injuries, however, may
Anisocoria, or unequal pupil size, can be be difficult to accurately assess without an
associated with either intracranial lesions, orthogonal view. Rather than move the
or extracranial lesions of the eye, brachial patient and potentially cause further
plexus, or vagosympathetic trunk. For disruption and injury to the fracture, a
example, a patient with normal mentation, ventrodorsal radiograph view can be
miosis, and anisocoria can potentially have obtained by turning the bucky at a 90
anterior uveitis secondary to a corneal degree angle and placing an x-ray cassette
abrasion, brachial plexus injury, or injury to behind the patient. Radiographs are a
the lateral neck affecting the sensitive imaging modality for diagnosis of
vagosympathetic trunk on the side intracranial hemorrhage or edema. The use
ipsilateral to the miotic pupil, with no of computed tomography (CT) and
intracranial lesion at all. Animals with Schiff- magnetic resonance
Scherrington posture should be placed on a
imaging (MRI) are more sensitive at
flat backboard or other flat surface and
detecting intracranial lesions. An MRI is
strapped down to prevent movement and
considered to be the best imaging modality
potential disruption of a partially displaced
for detection of fibrocartilagenous emboli
spinal fracture/luxation. Procedures to
(FCE).
assess balance and muscle strength such as
hopping and wheelbarrowing should not be
performed until spinal trauma has been
completely ruled out. Reflexes and deep TREATMENT OF HEAD AND SPINAL
pain perception should be evaluated. TRAUMA
Withdrawal of the hind limbs in a patient The various forms of recommended
with SchiffScherrington posture is a local treatment for head and spinal trauma
reflex arc only, and should not be remains a subject of wide debate and
interpreted as perception of pain and
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controversy. The treatment of severe head mannitol use to the patient with traumatic
trauma in a patient that is obtunded, head injury that is obtunded, stuporous, or
stuporous, or in a coma involves comatose, or exhibits a decline in mental
maintenance of cerebral perfusion and status despite aggressive treatment to
oxygen delivery and decreasing cerebral restore and maintain intravascular volume
edema. Mannitol (0.5 – 1.0 g/kg IV over 10 and normal blood pressure. Steroid use
- 15 minute) acts both as an osmotic diuretic has dramatically fallen out of favor for the
and free radical scavenger in the patient treatment of traumatic brain injury.
with traumatic brain injury, and serves to Glucocorticosteroids were thought to
decrease cerebral edema and secondary stabilize neuronal membranes. However,
brain injury after the time of impact. The steroids also decrease immune defense
use of mannitol had fallen out of favor in the mechanisms, disrupt glucose homeostasis,
past because of the potential risk of contribute to negative nitrogen balance and
worsening intracranial hemorrhage. The insulin resistance, and can worsen
benefits of mannitol far outweigh the intracranial acidosis. Additionally, steroid
unsubstantiated risks, particularly in the use has demonstrated equivocal results.
traumatically head injured patient. The benefits of steroid use are
Mannitol administration is not necessary in unsubstantiated, and are far outweighed by
patients that are normal or depressed with their risks, and as such, are contraindicated
an obvious skin abrasion or laceration on at this time.
the face or head. This author reserves
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Fluid Therapy Its More Than Just Lactated

Ringers Final

Total body water constitutes approximately intake and excretion are kept in balance by
60% of a patient’s body weight in normal the activity of sodium and chloride and
individuals, although this value can vary serum osmolality. Osmoreceptors in the
slightly with age, gender, and obesity. hypothalamus sense sodium and chloride
Approximately 67% of total body water is concentration in the vascular space. As
located intracellularly. The remaining 33% serum sodium rises due to increased
of total body water is located sodium intake or fluid loss in excess of
extracellularly, in the intravascular and solute, serum osmolality rises. An increase
interstitial extravascular spaces. A very in serum osmolality stimulates the release
small amount of fluid, known as of arginine vasopressin (antidiuretic
transcellular fluid, is located in the hormone) to be released from the
compartments of the gastrointestinal tract, hypothalamus. Antidiuretic hormone
within synovial fluid of joints, and the stimulates the opening of water channels in
cerebrospinal tract. Within the body, all the collecting duct of the renal tubules, and
fluid is in a constant state of flux in between thus stimulates water reabsorption. Once
compartments. The movement of fluids water is retained in the vascular space,
from space to space is largely governed by sodium, urea, and glucose, the major
the concentration of electrolytes, proteins, contributors of serum osmolality, are
and other osmotically active particles diluted, and serum osmolality decreases.
relative to the amount of fluid within each Hypothalamic excretion of ADH ceases once
compartment. The balance of fluids and serum osmolality returns to normal.
electrolytes are necessary for normal body During a state of equilibrium, a patient’s
functioning and cellular processes. daily water intake equals water loss,
Normally, fluid intake is in the form or drink creating no net loss or gain of fluid under
and foodstuffs. Water is also produced normal conditions. Daily fluid requirements
during the oxidation of food materials. Fluid are based on the metabolic water
can be lost during excessive panting, requirements of a patient in a state of
vomiting, diarrhea, and urination. Sensible equilibrium. For each kilocalorie of energy
fluid losses in the form of urine, vomit, and metabolized, 1 ml of water is consumed.
feces can be measured, and constitute Metabolic energy requirements are
approximately 2/3 of the body’s daily calculated based on the linear formula:
maintenance fluid requirements. Insensible Kcal/day = [(30 x body weightkg) +70] By
fluid loss is largely estimated from substituting Kcal for 1 mL H2O, the
evaporation from the respiratory tract. following formula can be used to estimate a
Insensible losses can be excessive in patient’s daily metabolic water
situations of excessive panting, salivation, requirements: ml/day = [(30 x body
or from evaporation or hemorrhage from weightkg) + 70] Recent studies have
surgical sites. In normal individuals, fluid indicated that metabolic energy
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requirements rarely increase during states circulating volume, transcompartmental

of critical illness except in cases of sepsis. fluid shift from the interstitial to
Because our patients frequently pant and intravascular compartments occurs within
may have excessive evaporative losses or one hour of fluid loss. When fluid loss is so
sensible fluid losses in the form of vomiting, severe that intravascular fluid volume is
diarrhea, wound exudates, body cavity affected, hypovolemia can result in clinical
effusions, daily fluid requirements may be signs of tachycardia, prolonged capillary
greater than that calculated above. The refill time, decreased urine output, and
formula should be used as a guideline, and hypotension. The vascular space is very
careful assessment and measurement of sensitive to changes in the amount of
ongoing losses should be added to the circulating volume. During states of
patient’s daily fluid therapy as needed, to normovolemia, the degree of wall tension is
prevent further dehydration. The degree of sensed by baroreceptors in the carotid body
interstitial dehydration can subjectively be and aortic arch, sending a pulsatile
estimated based on a patient’s body weight, continuous feedback via vagal afferent
mucous membrane dryness, skin turgor, stimuli to decrease heart rate. In the early
degree of sunkeness of the eyes, and stages of hypovolemic shock, a decrease in
mentation. Subjectively, if a patient has a vascular wall stretch or tension is sensed by
history of fluid loss in the form of vomiting baroreceptors in the carotid body and aortic
or diarrhea, but no external evidence of arch, causing blunting of tonic vagal
mucous membrane dryness of skin tenting, stimulation, and allows sympathetic tone to
dehydration estimate is less than 5%. A increase heart rate and contractility to
patient is said to be 5% dehydrated when normalize cardiac output in the face of
mild skin tenting, and mucous membrane decreased circulating volume. Later,
dryness is present. Clinically, 7% decreased blood flow and delivery of
dehydration is manifested as increased skin sodium to receptors in the juxtaglomerular
tenting, dry oral mucous membranes, and apparatus of the kidneys cause activation of
mild tachycardia with normal pulse quality. the reninangiotensin-aldosterone axis,
A patient is 10% dehydrated with increased stimulating sodium and fluid retention to
skin tenting, dry oral mucous membranes, replenish intravascular volume.
tachycardia, and decreased pulse pressure
is present. Finally, a patient is said to be 12%
dehydrated when skin tenting, and mucous FLUID REPLACEMENT: HYPOVOLEMIA
membrane dryness is markedly increased, VERSUS DEHYDRATION
the eyes appear dry and sunken, and
alteration of consciousness is observed. The When clinical signs of hypovolemic shock
parameters are largely subjective, because are present, intravascular fluids must be
they can also be affected by loss of body fat replaced in an emergency phase of fluid
and increased age. resuscitation. Calculated shock volumes of
fluids are 90 ml/kg/hour for dogs, and 44
The later stages of dehydration are also ml/kg/hour for cats. A simple guideline to
accompanied by parameters consistent follow is to replace ¼ of the calculated
with hypovolemic shock. Other factors, intravascular fluid deficit, or the “shock
including hemorrhage and third spacing of volume” as rapidly as possible, then
body fluids can also result in a decrease in reassess perfusion parameters- heart rate,
intravascular circulating volume, resulting blood pressure, capillary refill time, and
in signs of hypovolemia. With severe urine output. In dogs, a simple method to
hypovolemia of more than 15% of calculate ¼ shock volume i is to take the
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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animal’s weight in pounds and add a zero, volumes, maintenance fluids can be
giving you the amount of fluid in milliliters supplemented, provided that no signs of
to administer as a bolus as quickly as dehydration or ongoing fluid loss are
possible. Approximately 80% of the present. An objective way of assessing
crystalloid volume fluid infused will re- whether fluids volume is adequate is to
equilibrate and leave the intravascular assess body weight in a regular basis
space within 1 hour of its administration. A throughout the day. Acute losses in body
constant rate infusion of crystalloid is weight are commonly associated with fluid
recommended to provide continuous fluid losses, and can be used to determine
support in patients that are dehydrated and whether the patient is at risk of once again
have ongoing losses. In some cases, the fluid becoming dehydrated.
required to restore intravascular and
interstitial volume can cause hemodilution
and dilution of oncotically active plasma ISOTONIC FLUIDS, HYPOTONIC FLUIDS,
proteins, resulting in interstitial edema AND HYPERTONIC FLUIDS
formation. In such cases, a combination of
a crystalloid fluid along with a colloid There is a wide variety of fluids are available
containing fluid can help restore colloid for use by the veterinary practitioner. A
oncotic pressure and prevent interstitial crystalloid fluid contains crystals or salts
edema. Once immediate life-threatening that are dissolved in solution. Specific
intravascular fluid deficits are replaced, crystalloid fluids are indicated in certain
additional fluid is provided based on the disease states, and may be contraindicated
estimated percent interstitial dehydration in others. Therefore, whenever a crystalloid
and maintenance needs. Dehydration fluid is used, one must carefully consider it
estimates can be calculated based on the to be another drug in the armamentarium,
fact that 1 milliliter of water weighs and justify its use or potential disuse in each
approximately 1 gram. Dehydration patient. Basic categories of crystalloid fluids
estimates in liters can then be calculated by include isotonic, hypotonic, and hypertonic
the formula: Body weight in kg x estimated solutions, depending on the concentration
percent dehydration x 1000 ml/liter. This and type of solute present relative to
provides you with the number of liters normal body plasma. Isotonic fluids have
deficit. A frequent mistake when tonicity, or solute relative to water, similar
replenishing fluid deficits is to arbitrarily to that of plasma. Examples of isotonic
multiply a patient’s daily water requirement fluids include 0.9%
by a factor of 2 or 3 to replenish (normal) saline, Lactated Ringer’s solution,
intravascular and interstitial deficits. This Normosol-R, and Plasmalyte-A. Isotonic
practice frequently underestimates the fluids are indicated to restore fluid deficits,
patient’s actual fluid needs, and does little correct electrolyte abnormalities, and
to treat intravascular volume depletion and provide maintenance fluid requirements.
interstitial dehydration. Instead, it is better Hypotonic solutions are fluids whose
to perform the calculation and add this to tonicity is less than that of serum. Examples
daily maintenance fluid requirements and of hypotonic fluid solutions include 0.45%
ongoing losses, to maintain hydration in saline, 0.45%NaCl + 2.5% dextrose, and 5%
your hospitalized patients. Eighty per cent dextrose in water (D5W). Hypotonic fluids
of the calculated fluid deficit can be are indicated when treating a patient with
replaced in the first 24 hours. After diseases processes that cause sodium and
successful treatment of hypovolemic shock water retention, namely, congestive heart
and replacement of estimated dehydration
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failure and hepatic disease. Infusion of intravascular space to correct hypovolemia.

hypotonic fluids is also indicated when Their use is absolutely contraindicated if
severe hypernatremia exists and you need interstitial dehydration is present.
to slowly correct a free water deficit. To Hypertonic solutions such as 3% or 7%
calculate a patient’s free water deficit, use saline have solute in excess of fluid relative
the following formula: Free water deficit = to plasma. Hypertonic saline should be
0.4 x lean body weight x [patient serum administered in bolus increments of 3 – 7
Na/140 – 1] The free water deficit should be ml/kg as a rapid infusion. Because the net
corrected slowly, to not cause iatrogenic effect of hypertonic saline solution lasts
cerebral edema. Ideally, the patient’s only approximately 20 minutes, hypertonic
sodium should not decrease by more than saline must always be infused along with a
15 mEq/L during a 24-hour period. crystalloid solution to prevent further
Hypertonic solutions act to draw fluid from interstitial dehydration.
the interstitial fluid compartment into the

Electrolyte Composition (mEq/L) of Commonly Used Isotonic and Hypotonic Crystalloid

Fluids

0.9% Saline 0.45% NaCl Lactated Ringer’s Normosol-R

Sodium 154 77 130 140

Chloride 154 77 109 98

Potassium 0 0 4 5

Calcium 0 0 3 0

Magnesium 0 0 0 3

pH 7.386 5.7 6.7 7.4

Buffer none none lactate 28 acetate 27

gluconate 23

Colloids Examples of artificial colloids include

Hetastarch, Vetstarch, Pentastarch, and
A colloid solution contains negatively
Voluven. Whenever a colloid is
charged large molecular weight particles
administered along with a crystalloid,
that are osmotically active, drawing sodium
calculated crystalloid fluid requirements
around their core structures. Wherever
should be decreased by 25% - 50%, to avoid
sodium is, water follows. By drawing
intravascular volume overload. Natural
sodium around the particle, water is thus
colloid solutions include whole blood,
held within the vascular space. Colloids
packed red blood cells, and plasma. Fresh
replace intravascular fluid deficits only.
whole blood is indicated when loss of both
Therefore, colloids are always administered
red blood cells and plasma has occurred.
along with crystalloids, to restore both
The Rule of Ones states that one ml of fresh
intravascular and interstitial fluid volume.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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blood infused per one-pound body weight recommend that the total daily dose of
will increase the patient’s packed cell hetastarch should not exceed 20 – 30
volume by one per cent, provided that no ml/kg/day. Following the administration of
ongoing losses are present. Packed red hetastarch boluses, it should be
blood cells can be administered when administered as a constant rate infusion (20
anemia is present in sufficient quantity to – 30 ml/kg/day IV) until the patient is able
cause clinical signs of anemia, including to maintain its albumin and colloidal
lethargy, inappetance, tachycardia and support on its own. Concentrated human
tachypnea. Fresh frozen plasma can be albumin and concentrated canine albumin
administered at 10 – 20 ml/kg/day to solutions are now available for use in
replenish clotting factors and provide veterinary patients. Both immediate and
antiprotease activity during inflammatory delayed rare Type 3 hypersensitivity
conditions. Fresh frozen plasma can be used reactions have been documented in healthy
to replace small amounts of albumin, in and hypoalbuminemic dogs following
cases of hypoalbuminemia, however, is not administration of concentrated human
efficient as administering purified albumin. Reactions that occurred that
concentrated canine-specific (when include fever, vomiting, acute anaphylaxis,
available) or 25% human albumin. Frozen urticaria, angioneurotic edema, and
or fresh frozen plasma (20 ml/kg IV) needs delayed vasculitis, polyarthopathies,
to be infused for every 0.5 g/dL glomerulonephritis and death in both
healthy and critically ill animals. Although
increase in plasma albumin, provided that
there are studies which have demonstrated
no ongoing losses are present. The goal of
adverse reactions and the development of
albumin administration is to raise the
anti-human albumin antibodies after
patient’s serum albumin to 2.0 g/dL, then
concentrated human albumin infusion in
provide the remainder of colloidal support
dogs, there also have been studies which
with synthetic colloids. Hetastarch is a
have documented improved clinical
polymer of amylopectin suspended in a
outcome when concentrated human
lactated ringer’s solution. The average
albumin was infused into critically ill
molecular weight of Hetastarch is 69,000
animals that were refractory to other more
Daltons. Larger particles are broken down
mainstream therapies, including pressors,
by serum amylase, and last in circulation for
synthetic colloids, and fresh frozen plasma
approximately 36 hours. Because
transfusions. Concentrated 25% human (2
Hetastarch can bind with von Willebrand’s
ml/kg IV in dogs over 4 hours; pre-treat with
factor, mild prolongation of a patient’s APTT
1 mg/kg diphenhydramine IV). should be
and ACT may be observed, but do not
considered in any patient with refractory
contribute to or cause clinical bleeding.
hypoalbuminemia (< 2.0 g/dL) or
Hetastarch should be administered in
hypotension unresponsive to other
incremental boluses of 5 – 10 ml/kg in dogs,
synthetic colloids, pressors, and inotropes.
and 5 ml/kg in cats. Because rapid
The perceived benefits of albumin infusion
administration of hetastarch can cause
and risks of not infusing albumin must be
histamine release and vomiting in cats, the
weighed against the potential risks of its
bolus should be administered slowly over a
administration. Clients must be aware of
period of 15 – 20 minutes. Some authors
the potential risks of complications.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Hypoadrenocorticism Insidious and Deadly

Final

INTRODUCTION : The hypothalamic-pituitary-adrenal axis is a key player in the maintenance of

protein metabolism, mineral and acid-base homeostasis, immune function, blood pressure,
gastrointestinal function, erythropoiesis, and mentation. Hypoadrenocorticism (Addison’s
disease) can result from either lack of cortisol production from the adrenal glands, or result from
lack of CRF or ACTH stimuli from the hypothalamus or pituitary glands. The majority of cases of
hypoadrenocorticism in dogs result from immune-mediated lymphocytic plasmacytic destruction
of the adrenal cortex. Adrenocortical destruction typically results in a lack of both glucocorticoid
from the zona fasciculata and lack of mineralocorticoid production from the zona glomerulosa.
However, in some dogs, destruction of the zona fasciculata can occur before destruction of the
zona glomerulosa, resulting in clinical signs of glucocorticoid deficiency alone before clinical signs
associated with loss of mineralocorticoids. This is known as “atypical primary
hypoadrenocorticism”. Secondary adrenocortical deficiency (“secondary Addison’s”) is
associated with a loss of either corticotropin releasing factor (CRF) from the hypothalamus, or
lack of production or release of adrenocorticotropic hormone (ACTH) from the posterior pituitary
gland. In secondary adrenocortical deficiency, loss of trophic stimulation of the zona fasciculata
results in a loss of glucocorticoid (cortisol) release and spares the zona glomerulosa. Thus,
mineralocorticoid activity is maintained. Secondary hypoadrenocorticism has been described
following craniocerebral trauma, or can occur spontaneously.

ALDOSTERONE medullary interstitium, further impairing

the kidney’s ability to reabsorb sodium,
The actions of aldosterone serve to
chloride and water. Eventually,
promote expansion of intravascular
intravascular volume depletion can result in
volume. Sodium is reabsorbed in exchange
decreased stroke volume, decreased
for potassium in the distal convoluted
cardiac output, and hypotension.
tubule, promoting sodium and water
resorption and potassium excretion. Lack of Hyperkalemia develops due to
stimulation of aldosterone release, either decreased excretory ability in the distal
from destruction of the zona glomerulosa or convoluted tubules of the kidney. Hydrogen
from lack of trophic stimuli from secondary ion excretion, too, is impaired, leading to
hypoadrenocorticism results in a decreased metabolic acidosis. Hyperkalemia is
ability to resorb sodium and water, as well exacerbated by glucocorticoid deficiency.
as impaired potassium excretion. Loss of Hyperkalemia causes a decrease in
sodium and water cause eventual myocardial excitability, decreased or
hyponatremia and hypovolemia. Retention delayed conduction, and a prolonged
of potassium causes hyperkalemia and can refractory period. Atrial cells are especially
result in cardiac dysrhythmias as serum sensitive to the effects of hyperkalemia, and
potassium becomes increasingly elevated. develop an idioatrial rhythm, often called
Chronic sodium loss depletes the atrial standstill. Characteristic
concentration gradient of the renal electrocardiographic changes associated
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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with hyperkalemia include prolonged P-R cardiovascular collapse, with an obtunded

interval, widened QRS complexes, spiked t- patient in severe hypovolemic shock,
waves, and eventual loss of p waves. bradycardia, hypothermia, with diarrhea.
Severe muscle tremors have been
Glucocorticoids Loss of
documented as a clinical sign in two
glucocorticoid activity has numerous
Standard poodles. Critical intervention is
detrimental effects on homeostasis,
necessary in such cases to have a positive
including abdominal pain, weight loss,
outcome.
muscle atrophy, vomiting, diarrhea,
impaired hepatic gluconeogenesis and
glycogenolysis, impaired erythropoiesis,
LABORATORY ABNORMALITIES
and lack of ability to handle stress. The net
effect of decreased or absent glucocorticoid Laboratory abnormalities can be found on a
activity is a resting hypoglycemia, vomiting, complete blood count and biochemistry
anorexia, weight loss, peripheral muscle panel. Normally, glucocorticoids released
wasting, possible regurgitation secondary during times of stress cause a peripheral
to megaesophagus, normocytic lymphopenia, neutrophilia, and what is
normochromic nonregenerative anemia commonly known as a “stress leukogram”.
from bone marrow suppression, weakness, The absence of a stress leukogram in a
dehydration, and in extreme cases, vomiting patient with diarrhea and
hypotension and collapse. This is of dehydration or collapse should be a signal
particular importance in dogs with primary to investigate for hypoadrenocorticism,
atypical hypoadrenocorticism, even if characteristic electrolyte
characterized by lack of glucocorticoid abnormalities are not present (secondary
activity alone, with normal serum hypoadrenocorticism or primary atypical
electrolyte levels. hypoadrenocorticism). In some (but not all)
cases, peripheral eosinophilia may be
present. In some animals, a normocytic
PRESENTATION AND CLINICAL SIGNS normochromic nonregenerative anemia will
be present from GI blood loss and lack of
The most severe form of
glucocorticoid-induced erythropoiesis.
hypoadrenocorticism is associated with
Other changes on a serum biochemistry
severe acute vomiting, diarrhea, weakness,
panel can include hypoglycemia),
and collapse, sometimes with a waxing and
hypocholesterolemia, hypoalbuminemia,
waning history of nonspecific clinical signs.
hypercalcemia and azotemia. In many
Some clients will complain about “not doing
cases, BUN elevations are disproportionate
well”, intermittent inappetance or “she’s a
to the observed elevation in creatinine due
picky eater”, intermittent vomiting or
to GI blood loss. Prerenal azotemia also
“sensitive stomach”, diarrhea, lethargy, or
occurs from dehydration, and decreased
weight loss, particularly during times of
renal perfusion secondary to decreased
stress, such as grooming appointments,
cardiac output. Classic electrolyte
trips to the veterinarian or kennel, having
abnormalities include hyponatremia,
visitors in the household, or when the
hypochloremia, and hyperkalemia, but are
owners have left the animal with a pet
not always present (secondary Addison’s
sitter. Other patients may not have any
with loss of pituitary ACTH release or
recognizable clinical signs at all. Physical
“primary atypical” Addison’s, where
examination abnormalities can range from
aldosterone production is preserved). In
mild lethargy and dehydration to complete
dogs, the normal sodium:potassium ratio is
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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> 27 (> 24 in cats). In patients with lack an release cortisol. In cats, the protocol is
aldosterone deficiency, however, the slightly different, with blood samples
sodium:potassium ratio is less than 27, obtained at ½ and 1 hour post-ACTH
although this is not pathognomonic for administration. Caution should be
hypoadrenocorticism per se. The gold exercised before performing an ACTH
standard for diagnosis of stimulation test, however, as most
hypoadrenocorticism remains the ACTH glucocorticoids except for Dexamethasone
stimulation test. As ACTH stimulation or dexamethasone sodium phosphate will
testing has become increasingly more cross-react with cortisol
expensive, a baseline cortisol can be radioimmunoassays. Blood samples should
performed as an initial screening test for be obtained and the ACTH stimulation test
hypoadrenocorticism. Baseline cortisol performed before glucocorticoids are
levels greater than 2 ug/dL help to rule out administered. Investigations have
hypoadrenocorticism without the added documented that a single dose of the above
expense of using Cosyntropin. compounds will not interfere significantly
with the ACTH stimulation test.

Primary atypical hypoadrenocorticism is

Urinalysis Urinalysis usually reveals
characterized by low or undetectable pre-
a isosthenuric or hyposthenuric urine in the
and post-ACTH cortisol levels with normal
face of dehydration, leading to the
to elevated ACTH levels.
differential diagnoses of
hypoadrenocorticism or acute renal failure.
In primary Addisonian animals, the chronic
EMERGENCY TREATMENT
loss of solute in the urine from
hypoaldosteronemia causes a chronic Treatment largely consists of treating the
medullary wash-out and loss of renal clinical signs of hypovolemic shock,
concentrating abilities, even once serum correcting electrolyte and acid-base
electrolytes have been replenished. It may abnormalities, preventing septicemia
take weeks before the urine specific gravity secondary to bacterial translocation from
returns to normal. The presence of ongoing the GI tract, antiemetics, and treating any
azotemia and hyposthenuria in an animal secondary conditions such as aspiration
may also be associated with renal damage pneumonia. Critically ill hypovolemic
secondary to hypovolemic shock and patients should have rapid correction of
hypoxic insult to the kidneys, leading to intravascular volume deficit using
concurrent acute kidney injury or AKI. crystalloid fluids. This author usually starts
with ¼ of the calculated shock volume and
then reassesses perfusion parameters
Definitive Diagnosis Definitive including heart rate, blood pressure, urine
diagnosis of hypoadrenocorticism is made output, and capillary refill time. In animals
using the ACTH stimulation test, considered with chronic sodium depletion
the gold standard for making this diagnosis. characterized by severe hyponatremia (Na <
In dogs, a baseline serum cortisol sample is 120 mEq/liter), sodium replacement should
obtained, synthetic ACTH (Cosyntropin 0.25 be corrected slowly and with caution, to
mg) administered intravenously or avoid rapid increase in serum sodium by no
intramuscularly, then a second sample more than 0.5 mEq/liter/hour or 15
obtained 1 hour later to see if there is mEq/liter in a 24 hour period. Overzealous
“stimulation” of the adrenal gland to and too rapid correction of serum sodium to
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

normal levels has resulted in a syndrome of mg/kg IV once daily, maropitant 1 mg/kg
central pontine myelinolysis, in which SQ/IV once daily should be administered.
idiogenic osmoles and oxidative damage to Phenothiazine antiemetics such as
neurons occurs, and results in cerebral chlorpromazine should be avoided in
edema. Central pontine myelinolysis is hypotensive patients due to their alpha-
characterized by generalized weakness, antagonist effects).
ataxia, mental depression and head
pressing in animals several days following
correction of severe hyponatremia. If CHRONIC THERAPY
serum sodium is less than 120 mmol/liter, a
more cautious fluid to administer is Chronic therapy for hypoadrenocorticism
Lactated Ringer’s (130 mEq/liter sodium) or consists of replacing mineralocorticoid and
Normosol-R (140 mEq/liter sodium). glucocorticoids at physiologic doses.
Although these two fluids also contain a Fludrocortisone acetate (Florinef®) can be
small amount of potassium, intravascular administered daily (0.1 – 0.3 mg/kg/day),
volume correction and administration of although this can be quite expensive in large
drugs to protect the heart from the effects breed or giant dogs. Florinef has both
of hypokalemia (see below) will offset the mineralocorticoid and glucocorticoid
potential risk of exacerbating hyperkalemia. activity, thus, additional glucocorticoid
replacement is not necessary. Some dogs
with become polyuric and polydipsic on
their maintenance dose of Florinef because
Treatment of Hyperkalemia:
of its potent glucocorticoid actions. An
Hyperkalemia can be treated with regular
alternative therapy is the use of
insulin (0.5 units/kg regular insulin IV) and
Desoxycorticosterone pivalate (DOCP, 2.2
dextrose (1 gram dextrose per unit insulin
mg/kg IM; Percorten, Novartis Animal
administered, followed by 2.5 - 5% dextrose
Health) as an intramuscular repository
as a constant rate infusion to prevent
injection every 25 days. Since DOCP has no
hypoglycemia), calcium gluconate (0.5 – 1.0
glucocorticoid activity, additional GC
ml/kg 10% calcium gluconate over 20 – 30
administration in the form of daily
minutes) or calcium chloride (1.5 – 3.5 ml
Predniso(lo)ne (0.2 mg/kg/day) also must
total of IV calcium chloride), or sodium
be administered. This form of treatment is
bicarbonate (0.25 mEq/kg IV). The effects
less expensive than Florinef, and works
observed on the patient’s ECG rhythm from
quite well, in this author’s experience. With
administration of calcium gluconate and
DOCP, electrolytes should initially be
insulin-dextrose are observed within
checked at 12 and 24 days post-injection, as
minutes of administration, and typically last
some patients may require up to 0.3 mg/kg
for 20 – 30 minutes.
every 3 – 4 weeks. In one retrospective
study, the mean total dose of both Florinef
and DOCP increased over the course of
Other ancillary therapies: Broad
treatment in all dogs with
spectrum antibiotics should be
hypoadrenocorticism. The overall long-term
administered in patients with severe
prognosis for patient with
melena or hemorrhagic diarrhea.
hypoadrenocorticism after initial treatment
Antiemetics can be administered, too, to
for a hypo-adrenal crisis is good, provided
combat nausea and vomiting
that the owners are diligent in maintaining
(Metoclopramide 1 – 2 mg/kg/day as a
daily and monthly glucocorticoid and
constant rate infusion, Dolasetron 0.6
mineralocorticoid supplementation.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Índice
JENNIFER DEVEY
Jennifer J. Devey, DVM, Diplomate ACVECC
Saanichton, British Columbia
jenniferdevey@gmail.com

1.2.1. The Ultimate Trauma – Big Dog – Little Dog ............................................................... 33

1.2.2. Respiratory Emergencies - The Blue Patient ............................................................... 39
1.2.3. How To Make The Right Decisions In The First 10 Minutes ........................................ 46
1.2.4. Gizmos And Gadgets ................................................................................................... 52
1.2.5. Acute Pancreatitis ....................................................................................................... 58
1.2.6. Toxicologic Emergencies ............................................................................................. 63
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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The Ultimate Trauma – Big Dog – Little

Dog

INTRODUCTION: Little dogs presenting with bite wounds inflicted by larger dogs can be
exceedingly challenging to manage. Appropriate wound care provided in a timely manner can
help prevent morbidity and mortality. The seriousness of wounds should not be underestimated
and in many cases aggressive surgical treatment is indicated as soon as the patient is
cardiovascularly stable. In some situations the patient may never become cardiovascularly stable
without surgery. Secondary problems with wound healing and patient morbidity may relate to
inappropriate wound handling during the initial stages. Problems with sepsis secondary to
wounds come from inadequate debridement of necrotic tissue, insufficient irrigation,
inappropriate choice of antibiotics and inadequate resuscitation.

FIRST AID STABILIZATION AND who arrived unconscious and not breathing
RESUSCITATION may have an avulsion of the distal trachea
and unless the lungs are ausculted post
Evaluation of the patient should begin
intubation this may not be detected.
always with the ABC’s (airway, breathing,
Auscultation also will allow the clinician to
circulation). The wound may be the obvious
assess the presence of a possible pleural
injury but it may be minor compared to an
space abnormalities. If the patient has a
unseen injury such as airway disruption or
sucking chest wound and is critical a chest
pneumothorax. Patients with serious
tube may need to be placed through the
wounds should always be provided with
wound immediately.
supplemental oxygen (flow by, baggie or a
non-tight fitting mask) on presentation. If it A large bore intravenous catheter should be
is determined that the patient is not in inserted and fluids started if the patient is in
shock the oxygen can be discontinued. If the shock. A second catheter may be required.
animal cannot breathe an airway will need Fluid therapy may consist of a combination
to be established. In the case of severe oral, of crystalloids, synthetic colloids and blood
pharyngeal or cranial cervical trauma a products depending on the status of the
tracheostomy may be indicated. If the patient. Blood volume and blood pressure
patient is able to breathe adequately but should be normalized unless the clinician is
there is a significant amount of hemorrhage providing hypotensive resuscitation due to
present, the clinician may need to make a concerns for ongoing internal abdominal
decision as to whether or not to anesthetize hemorrhage. Blood volume ideally should
the animal and gain control of the airway be estimated through measurement of
since ongoing hemorrhage could potentially central venous pressure but since central
lead to an airway obstruction. Once an catheters are rarely placed during
injured patient is intubated the lungs should resuscitation, the distention of the jugular
be ausculted bilaterally to ensure air is vein when the vein is held off at the thoracic
moving though both lung fields. The patient inlet can be used as a subjective evaluation
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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of central venous pressure. The hematocrit patients who will require surgery. Local
should be maintained as close to 30% as anesthetics (lidocaine, bupivicaine) can be
possible. Autotransfusion may be required injected as local or regional blocks.
in the patient with a significant Intercostal blocks will help improve
hemoabdomen. Albumin should be ventilation in dogs with fractured ribs. Pain
maintained greater than 2.0 g/L (20 g/dL) related to the acidic nature of the local
with fresh frozen plasma. Patients at risk for anesthetic can be modified by warming the
or confirmed to be coagulopathic may need drug to body temperature or by adding 10%
to receive plasma during the resuscitation of the volume as sodium bicarbonate.
phase. Small dogs in particular are prone to Nonsteroidal antiinflammatory drugs
hypothermia and fluids should be warmed. generally should be avoided. Some of the
COX-2 specific drugs may prove to be safe
Analgesics are always indicated once the
to use in more critical patients; however,
patient has been evaluated and
they are not recommended in patients with
resuscitation has been started. Not only is
hypovolemia, compromised
pain detrimental to the overall well being of
gastrointestinal perfusion (related to
the patient but also it is detrimental to the
circulatory disturbances or underlying
healing process. Catecholamine release can
disease processes), and renal disease.
lead to vasoconstriction and poor flow to
the wound area. There are two key Active bleeding from wounds will need to
concepts: the first is that pain kills and the be controlled. Capillary oozing and most
second is that no patient is too critical to venous hemorrhage can be controlled with
receive analgesics. Doses may need to be pressure bandages. Pressure should be
decreased to 25 to 50% of normal in critical applied as a temporary measure to control
patients but all should receive appropriate arterial hemorrhage but definitive control
analgesia. Patients with chest trauma using a hemostat followed by ligation or
should always have their pain aggressively electrosurgery should be achieved as soon
controlled, since thoracic pain can interfere as possible.
significantly with ventilation potentially
Gloves should be worn whenever wounds
leading to hypercarbia and hypoxia. Opioids
are evaluated since infections often come
are the primary class of drug used; they can
from the hospital environment as well as
be given intravenously, intramuscularly,
the nurses’ and doctors’ hands. The wound
subcutaneously, or epidurally. In general
should be kept as clean as possible by
pure mu agonists are preferred; however, in
covering it with a sterile dressing. Wounds
very critical patients butorphanol may be
should be kept moist using sterile water-
preferred initially due to its minimal
soluble gel or saline-soaked gauze since
cardiorespiratory side effects. The
desiccation interferes with wound healing.
intravenous route is preferred over the
If the wound is over the chest wall a patch
intramuscular route (painful over time) and
bandage should be placed over the wound.
subcutaneous route (absorption is
The ventral aspect of the bandage should
unpredictable). If the intramuscular route is
not be adhered to the chest wall. This will
used the injection should be given in the
prevent a tension pneumothorax from
epaxial muscles since blood flow to this
developing if the patient has a lung
muscle bed is more consistent even in the
laceration. If the wound is associated with a
face of alterations in tissue perfusion.
fracture then a padded bandage or
Constant rate infusions of fentanyl or
temporary splint should be applied until the
morphine are indicated in patients with
patient can be completely evaluated. This
significant pain and are very useful in
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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helps prevent further mechanical injury to wound that may be associated with an open
the tissues from the tearing effects of bone fracture, joints, and thoracic or abdominal
fragments. It also helps to prevent further cavities. Abdominal ultrasound is very
injury to the bone and provides comfort to useful for detecting free fluid within body
the patient. Radiographs can be taken cavities and may help diagnose
through most bandage materials; therefore, intraabdominal injuries. A FAST scan is
an attempt always should be made to indicated in any patient with signs of
stabilize fractures prior to taking abdominal trauma. If ultrasound is not
radiographs. Broad spectrum antibiotics available or results of the ultrasound exam
should be administered pending cultures. are not clear then diagnostic peritoneal
lavage should be performed if there is a
Aggressive attempts should be made to
wound is over the region of the abdominal
maintain normothermia, especially in
cavity and it is not certain if the abdomen
smaller animals since hypothermia can lead
was penetrated or not.
to cardiac arrhythmias, hypotension,
coagulation problems, and sluggish blood WOUND ASSESSMENT
flow. Warming pads, fluid warmers, warm
Proper assessment of most wounds
air circulating blankets, oat bags, warmed
requires some form of analgesia at a
bubble wrap, and warming the inspired air
minimum and may require general
are measures that can be taken to try and
anesthesia. The injury is painful and even if
maintain the patient’s body temperature.
the patient is stoic attention should be paid
DIAGNOSTIC TESTS to providing adequate analgesia. All wounds
should be widely clipped in order to be able
The type of diagnostic tests required will be
to assess them properly. This includes
dictated by the type of wound. Whenever
abrasions and bruises. Frequently, animals
there are concerns for significant
that are bitten have been impaled by both
hemorrhage (based on history or physical
mandibular and maxillary teeth. If bite
exam), a packed cell volume and total
marks are seen only on one side of the limb
protein always should be performed to
or trunk then the other side should be
assess for the presence of anemia and/or
shaved to search for the wound.
hypoproteinemia. Blood work should
consist of a minimum of a packed cell ANESTHESIA
volume, total solids, electrolytes, glucose,
The goal of anesthesia in all patients is to
blood urea nitrogen – or preferably
ensure amnesia and analgesia. Analgesic
creatinine - and a blood gas if the animal has
drugs should be continued intraoperatively.
a wound that will require exploration and
If the patient seems to be responding to
repair under anesthesia. Albumin and
surgical stimuli additional analgesics may be
coagulation parameters should be assessed
indicated as opposed to just more inhalant
in patients with more severe injuries. Ideally
anesthetic to mask the actual problem. This
a complete blood cell count and a chemistry
will help ensure a smoother recovery. In
panel should be evaluated with older and
critical patients neurolept anesthesia
more critical patients. An electrocardiogram
(combination of an opioid and a
should be performed in any patient with an
tranquilizer) may be all that is required to
auscultable arrhythmia or chest trauma. A
provide adequate anesthesia. While some
TFAST scan or thoracentesis to check for air
drugs such as ketamine provide some
and blood should be performed in every
analgesia it should be kept in mind that
patient that has a wound over the thoracic
many drugs that are commonly used, such
cavity. Radiographs are indicated in any
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as propofol and isoflurane, have no catheter since drug volumes are often very
analgesic properties. small and need to be given close to the
catheter to ensure rapid absorption.
Critical patients should be preoxygenated
and intravenous anesthetic agents should OVERVIEW OF SURGICAL MANAGEMENT
be used in all patients to ensure rapid
All wounds should be widely clipped in
induction. Once the patient is intubated the
order to be able to assess them properly.
lungs should be ausculted bilaterally to
This includes abrasions and bruises.
ensure the air is moving through all lung
Frequently, animals that are bitten have
fields. Drugs that decrease cardiac output or
been impaled by both upper and lower
cause vasodilation should be avoided
teeth (especially canine teeth). If bite marks
whenever possible. This includes inhalants
are seen only on one side of the limb or
such as isoflurane and sevoflurane which
trunk then the other side should be shaved
are two of the most potent vasodilators
to search for the wound.
available to veterinarians. Once the patient
is intubated positive pressure ventilation All penetrating wounds should be surgically
should be instituted. Positive pressure explored. This is especially important in the
ventilation should be continued until the case of bite wounds since the teeth may
patient is ventilating well on its own only have made a puncture mark in the skin
postoperatively based on assessment of but as the animal was shaken there may
capnometry or blood gases. In the author’s have been extensive tearing damage done
experience hypoventilation is one of the to underlying tissues. Wounds that
major causes of instability during surgery as penetrate the abdominal cavity may have
well as postoperative recovery problems. caused hollow or solid organ damage. The
exception to this may be the penetrating
Close monitoring is essential during
thoracic wound. In the author’s experience
anesthesia. Physical exam parameters as
these patients have a high incidence of
well as more advanced monitoring are
mortality if they are taken to surgery within
indicated. Capnometry should be
the first 6-12 hours. If the patient can be
continually assessed intraoperatively and
stabilized medically it may be appropriate
during recovery. Blood pressure monitoring
to delay surgical intervention.
preferably using a Doppler ultrasonic flow
detector is indicated. Hypotension (systolic The goal of surgical management of wounds
blood pressure less than 100 mm Hg and should be to explore and remove any
diastolic pressure less than 60 mm Hg) foreign material, control hemorrhage, and
should be aggressively controlled. remove necrotic tissue. Many wounds will
Vasoconstrictive agents should be used only require the use of general anesthesia;
if absolutely necessary since they may however, more superficial wounds that do
decrease tissue perfusion and cause not require extensive debridement can be
hypoxia. Electrocardiography should be managed under sedation and local
assessed continually for evidence of tall T anesthesia.
waves (greater than one-quarter the R wave
amplitude) indicating myocardial hypoxia The wound should be widely clipped and
and premature ventricular contractions. surgically prepped. This is very important
since the extensive nature of the trauma
It is important to ensure that appropriate can be easily underestimated based on
venous access is available intraoperatively if external visualization. As a general rule at
drugs need to be administered periodically. least 10-15 cm (4-6 inches) should be
T-ports should be placed on at least one clipped and prepped around the wound to
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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allow for exploring subcutaneous dissection generate 15 PSI which appears to be safe.
and placement of drains. One study demonstrated that use of a 35 ml
syringe and needles from 16-22 ga in size
The skin should be incised in order to be
routinely generated pressures well above
able to visualize and assess the entire
15 PSI which could lead to barotrauma.
wound. Most mistakes in wound care are
Irrigation should not be done blindly or up
made from a lack of knowledge about the
into holes since this may force infection or
extent of the trauma because the wound
foreign material further into the wound or
was not adequately explored. Foreign
potentially into healthy tissues.
material should be removed as it is
encountered. Tissues should be debrided Accurate hemostasis is important since the
back to bleeding edges whenever possible presence of blood can act as a medium for
using sharp dissection. This is especially bacterial growth and the presence of a
important with fat and muscle. Bone and hematoma can interfere with wound
ligament should be removed if the surgeon healing. Hemostasis generally is achieved by
is certain it is nonviable but if there is any use of direct pressure, suturing of wounds
doubt the tissue should remain since (compression of vessels), electrosurgery,
removal may interfere with subsequent ligation of vessels, use of vascular clips,
function of the affected area. Skin edges of omental packing, superglue, hemostatic
wounds should be debrided using sharp agents or removal of the organ that may be
dissection back to bleeding edges unless bleeding. There are numerous products
this might cause problems with wound available for hemostasis many of which are
closure. Scissors generally should not be based on gelatin, fibrin, bovine thrombin,
used for debridement since they may cause seaweed, kaolin and a variety of other
crushing of the tissue, which can natural products that have hemostatic
compromise circulation to the wound edges qualities.
and cause problems with healing.
Wounds should be irrigated again prior to
Wound and body cavity irrigation form an closing the skin to remove any additional
important part of any surgical procedure. foreign material and blood. The presence of
“Dilution is the solution to pollution.” The blood provides an ideal medium for
use of sterile isotonic solutions is preferred. bacterial proliferation. If there is any doubt
Tap water has been used to irrigate wounds about viability of tissues the wound should
without complication; however, tap water is not be closed initially. Instead wet-to-dry
hypotonic which may negatively impact dressings should be placed and the wound
tissues. Antibiotics should not be added to should be revaluated on a daily basis. Daily
irrigation fluids since this the concentration debridement should be performed as
is often diluted too much to be effective and necessary until the health of the tissues is
extreme care should be exercised when assured. Wounds should be cultured prior
adding disinfectants to irrigation fluids. to closure since multiple species of bacteria
Body cavities should be irrigated with sterile have been identified in dog bite wounds and
isotonic fluid only. Irrigation can be no one antibiotic has been shown to be
provided using mechanical lavage systems effective.
designed for wound irrigation or using a 1
The amount of suture left in wounds should
litre fluid bag pressurized to 300 mm Hg.
be minimized. Skin sutures should not be
The ideal pressure that should be achieved
placed tightly since again this may
is unknown but most agree on a pressure of
compromise circulation. Wounds should
7-8 PSI. Some commercial irrigators
not be closed under tension since this will
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compromise wound healing. Skin can either tissues and help improve patient comfort
be mobilized by undermining of healthy and mobility. Contaminated or infected
tissues or grafting should be used as wounds should have wet-to-dry dressings
needed. placed until the wound is clean. When wet-
to-dry bandages are removed they will help
Dead space can only be closed effectively
mechanically debride remaining foreign
using active suction drains or bandages.
material and necrotic tissue. These
Both drains and bandages will help enhance
dressings should be compromised of wide-
wound healing and prevent seroma
meshed gauze, which will entrap particulate
formation. Sutures can be used to
matter, soaked in 0.9% saline. Bandages
approximate tissues but cannot close dead
should be placed over all surgical incisions
space. Using sutures to “close dead space”
for at least 24 hours until a fibrin seal has
should be avoided since it can create
formed.
compartmentalization and the amount of
foreign material (suture) left in the wound
is increased.
POSTOPERATIVE CARE
Two types of drains exist – passive and
Postoperatively these patients will require
active. Passive drains such as Penrose drains
close monitoring and treatment with a
allow wound exudate to drain by gravity or
minimum of fluid therapy, analgesics, and
overflow. The most serious complication
antibiotics. Analgesics should be given on a
associated with Penrose drains is the risk of
scheduled basis but should also be given as
ascending infection and ideally Penrose
needed since every patient’s injury and
drains ideally should be covered with a
tolerance to pain is different. Supplemental
sterile dressing. Active drains remove
oxygen and/or ventilatory support may also
wound fluids by application of negative
be required. Urinary catheters should be
pressure. Drains are attached to a suction
placed in patients with difficulties with
bulb that is primed by removal of air. These
either ambulation or urination. Other
are available commercially in various styles
treatment such as chest tube aspiration and
and sizes. Drain suction bulbs are emptied
care, care of suction drains and bandage
as necessary – usually 2-4 times per day and
changes will vary depending on the type of
cytology is evaluated as indicated. Drains
injury and the surgery performed.
are left in place until they are no longer
Monitoring will be dictated by the
functional or until they are no longer
underlying trauma and status of the patient;
needed. Drainage will slow down within 72
however, a minimum of temperature, heart
hours in most wounds. If a large amount of
rate, respiratory rate and effort, and blood
dead space was created the drains may
pressure should be assessed hourly until the
need to stay in place for up to 5-14 days.
patient is normothermic and stable. Critical
BANDAGES patients will require blood work
postoperatively; the tests will vary with the
Bandages are designed to protect the
patient. Enteral nutritional support should
wound and encourage wound healing. They
be started within 6 to 12 hours which may
can also provide support to underlying
require placement of a feeding tube.
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Respiratory Emergencies - The Blue

Patient

INTRODUCTION: Respiratory distress most frequently is associated with a condition that is

causing hypoxia although these patients may also be hypercarbic. Respiratory distress is a more
appropriate term to use in veterinary medicine than dyspnea which is defined as the subjective
awareness of altered or uncomfortable respiratory functioning. Patients may be experiencing
problems with getting oxygen into the alveoli which can be a result of upper airway obstructive
or disruptive abnormalities or chest wall integrity problems such as fractured ribs, sucking chest
wounds or a diaphragmatic hernia. It can be caused by difficulties with lung expansion caused
by pleural space disease (pneumothorax, pyothorax, chylothorax) or lower airway problems such
as pulmonary edema and pneumonia.

PHYSICAL EXAMINATION should alert the clinician to the fact that

there may be an almost 80% airway
Increased respiratory rate can indicate
occlusion. The trachea should be evaluated
respiratory distress. This obviously needs to
in all patients. Once the trachea has been
be differentiated from unrelated conditions
ausculted the neck should be palpated
such as pain or anxiety. Increased
noting tracheal position and
respiratory effort should always be taken as
tracheal/peritracheal integrity. The
a sign of respiratory distress. Open mouth
presence of subcutaneous emphysema in
breathing and simply being able to easily
the cervical or thoracic region in a cat that
observe chest wall movement and auscult
has a history of a recent anesthetic or
lung sounds (unless an electronic
trauma to this region often is associated
stethoscope is being used) should be
with a ruptured trachea. This can be
considered abnormal until proven
associated with a pneumomediastinum and
otherwise.
pneumopericardium, which can become a
The patient’s posture should be noted. Dogs tension situation if there is no escape valve
and cats with increased respiratory effort to the exterior of the animal. Auscultation
secondary to injury or disease often are of the trachea is often a more direct window
unwilling to lie down although the cat may into lower airway pathology than
sit in sternal but refuse to curl up or lay in transthoracic auscultation
lateral recumbency. Any cat lying in lateral
The breathing pattern should be closely
recumbency with signs of respiratory
observed. Symmetry of chest movement
distress should be assumed to be close to
and the presence of any abdominal
arrest until proven otherwise. Nostril flaring
component to the breathing pattern should
indicates increased respiratory effort but
be noted. Rapid shallow respiration
does not necessarily indicate pathology.
typically is associated with pain (especially
related to chest wall trauma) or pleural
space disease where the patient is unable to
Wheezing, crackles, and stridor all indicate expand its lungs. Pneumothorax,
abnormalities. The presence of stridor hemothorax, chylothorax, and pyothorax all
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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can be associated with a restrictive collapse and the abdomen should be

breathing pattern. If paradoxical chest wall examined with this in mind.
movement is observed a flail chest should
Cyanosis is an indication of hypoxemia or a
be suspected. Increased chest wall
PaO2 of less than 60 mm Hg. Cyanosis can be
expansion often is associated with lower
difficult to detect if the patient has a
airway disease although can indicate a
hemoglobin less than 5 g/dl or with certain
collapsing trachea. Prolonged or forced
fluorescent overhead lights.
expiration is associated with trapping of air
in the lower airways such as occurs with RADIOGRAPHS
allergic bronchitis or other diseases causing
bronchospasm. Respiratory muscle Radiographs are an essential component of
abnormalities are associated with a the evaluation process for the patient with
significantly increased effort on inhalation respiratory compromise; however, they
with decreased chest wall expansion. This is should not be a priority in the unstable
most commonly seen with neuromuscular patient. Stabilizing the patient is always the
diseases and diaphragmatic hernia. Patients first priority. Care should be taken to ensure
with paradoxical abdominal movement positioning does not compromise the
have severe respiratory compromise. These patient’s ability to breathe. The radiograph
patients also should be assumed to be close should be evaluated systematically to
to collapse due to exhaustion and ensure abnormalities are not missed. The
ventilatory failure until proven otherwise. bones, soft tissues surrounding the thorax,
pleural space, trachea and large airways,
The chest should be ausculted for the lungs, mediastinum, heart, great vessels
presence of breath sounds, areas of and diaphragm all require assessment. In
dullness, crackles or wheezes in at least 4 patients with upper airways diseases the
quadrants (upper and lower right and left cervical trachea and pharynx may require
sides). Crackles indicate alveolar exudate – radiographic evaluation. Sedation may be
typically pulmonary edema or pneumonia. required for diagnostic radiographs but this
Crackles may be very difficult to auscult in should be done with extreme caution in the
cats. Wheezes are consistent with compromised patient. Dynamic studies
obstructive lower airway disease. Foreign often provide valuable information.
bodies in the lower airways also can cause
similar sounds. Areas of dullness may
indicate severe pulmonary infiltrate, pleural Ultrasound
fluid, intrathoracic masses, or the presence
of abdominal contents in the thorax. The Point of care thoracic ultrasound can
heart should always be ausculted after provide a rapid, efficient means of
ausculting the lungs since once the ear has diagnosing pathology and has been shown
accustomed itself to louder sounds quieter to be more sensitive than a stethoscope.
sounds can be more difficult to hear. Five anatomic locations are interrogated.
Because of the narrow chest wall of the cat, Pleural and pericardial effusion can easily
lung sounds can be referred easily across be diagnosed. Lack of a glide sign indicates
both hemithoraces making it difficult to pick a pneumothorax and the presence of
up unilateral abnormalities in this species. hyperechoic lines (“lung rockets”) is
consistent with pulmonary disease
Gastric distention secondary to aerophagia including contusions, pulmonary edema,
can lead to significant respiratory pneumonia, and neoplasia.
compromise or even cardiovascular
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RESPIRATORY SUPPORT recumbent. If a mask is used the rubber

fitting should be removed. Many animals
Respiratory support of the critically ill or
will tolerate having their heads or even
injured patient can be divided into oxygen
most of their bodies placed inside a plastic
support and ventilatory support. The end
bag. The oxygen tubing is placed through a
goal of respiratory support is to ensure
small hole in the front of the bag and the
adequate oxygen reaches the blood and
back of the bag is left open to allow gas to
carbon dioxide is removed from the blood.
escape. This is particularly useful in the
Oxygen should be considered a first line
obtunded patient because high
drug and should be provided to any patient
concentrations of oxygen can be provided
that presents with an increased respiratory
(75-95%) while allowing other procedures
rate or effort or evidence of cyanosis.
to be performed (blood drawing, placement
of catheters, x-rays etc.) An oxygen hood
can be made by covering the ventral 75% of
OXYGEN an Elizabethan collar with plastic wrap. The
Oxygen can be provided in a variety of Elizabethan collar should be 1 size larger
forms. An oxygen source, baggie, plastic than would normally be used for that size of
wrap, Elizabethan collar, and red rubber patient. The oxygen tubing is placed along
tubes are all that are necessary to provide the inside of the collar and taped in place
oxygen to almost any patient. It is ventrally. Oxygen concentrations of up to
recommended that a direct oxygen source 80% generally can be achieved. Flow rates
be available; however, if an anesthetic of approximately 1 L usually provide an
machine is used then a “Y”- shaped adapter adequate FiO2. Flow rates should be
should be used to bypass the anesthetic adjusted based on patient comfort, clinical
circuit. A “Y” connector is placed in the status, pulse oximetry, and blood gases.
tubing before it enters the circle. A piece of Oxygen hoods generally are not tolerated
tubing connects the “Y” to the circle and the by the panting dog as the hood rapidly
second arm of the “Y” is connected to the becomes overheated and over-humidified.
oxygen tubing to the patient. A hemostat or Nasal oxygen is the most effective way to
C clamp is used to clamp off the oxygen to provide oxygen to the patient. For small
the patient or to the circle system patients 3.5 to 5 Fr tubes are used. For
depending on what is required. Nasal and medium-sized dogs 5-8 Fr tubes are used
tracheal oxygen should always should be and for larger dogs 8 to 10 Fr tubes are
humidified, although nasal oxygen may be placed. Cats will usually tolerate 5-8 Fr
able to be delivered for up to 24 hours not tubes. The nasal catheter is typically
humidified. Hood, mask and flow-by oxygen measured from the tip of the nose to the
should not be humidified. lateral canthus of the eye so that the tip will
Oxygen is most easily provided by using be in the nasopharynx (nasopharyngeal
oxygen tubing that is connected directly to catheter). Clinically animals tolerate the
the oxygen source. The end of the tube is oxygen better if the tip is at this location as
placed in front of the patient’s nose or opposed to being in the nostril. A narrow
mouth. The flow rate is 1-10 L/min, bore red rubber or other pediatric feeding
depending on the size of the patient, but it tube is placed in the ventral nasal meatus
may need to be decreased based on patient and sutured or stapled to the patient’s nose
tolerance. A mask also can be used but is and on the side of the face or on the bridge
often much less well tolerated and may of the nose between the eyes. At flow rates
cause increased stress unless the patient is of 100 ml/kg/min the FiO2 will be a
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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minimum of 0.4 and may reach as high as readily available. Response to therapy
0.65. Nasal oxygen should be avoided in the usually can be gauged by monitoring
patient with severe nasal or pharyngeal respiratory rate and effort, presence of
disease and in the patient with severe cyanosis, pulse oximetry readings, and
thrombocytopenia. Sneezing will elevate blood gases.
intracranial pressure and nasal tubes should
be avoided if this is a concern.
TRACHEOSTOMY
Oxygen cages also can be used to provide
oxygen to patients but have several A tracheostomy is indicated in the patient
drawbacks and should be used only if other with an upper airway obstructive disorder
forms of providing supplemental oxygen are that cannot be relieved, when airway
contraindicated. The biggest problem is the control is indicated but an endotracheal
inability to evaluate the patient except tube is not possible or not desirable, in
through observation. Each time the door to patients with severe bronchopneumonia,
the cage is opened the oxygen level drops and in the patient who requires prolonged
substantially. This can lead to significant ventilatory support. If the thought occurs to
patient anxiety and respiratory you that a tracheostomy is indicated then
compromise. The oxygen flow rates one probably should be placed! Other
required to operate the units effectively indications include situations when an
makes this a costly alternative. On occasion, endotracheal tube cannot be inserted in a
due to the stressed nature of cats with patient with an obstructed or near
respiratory problems an oxygen care is obstructed airway, when the obstruction is
essential. It would be ideal in these rostral to where the proximal portion of the
circumstances to use a small volume ‘cage’ tracheotomy tube ends, when it is
such as a pediatric incubator. necessary to assess and treat the
bronchoalveolar (pulmonary) tree such as
delivery of medications and aspiration of
Gastric Decompression exudate, and when it is necessary to
decrease the dead space and airway
Patients with significant gastric distention
resistance, in order to decrease the work of
that appears to be causing significant
breathing.
respiratory compromise or hemodynamic
instability may require immediate gastric There are no absolute contraindications but
decompression. This can be accomplished there are several relative contraindications.
either by transabdominal trocarization or If the tracheostomy is the only breathing
orogastric intubation. Immediate route for the patient then the patient must
decompression of a severely distended be monitored around the clock since
stomach can lead to cardiovascular collapse coughing mucus into the tube will cause a
and ideally should be avoided until fluid complete airway obstruction and
resuscitation has been initiated. suffocation. Appropriate humidification and
suction equipment as well as replacement
tubes must be pleasant. A tracheostomy
VENTILATORY SUPPORT may not be ideal when the patient has a
coagulopathy, when suction equipment
If the patient does not respond to does not exist, and in situations when an
supplemental oxygen rapid sequence endotracheal tube may suffice.
induction, intubation, and ventilation
should be considered. Suction should be
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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A tracheotomy can be performed most between the tube and the tracheotomy
easily on an anesthetized patient. The incision.
patient is placed in dorsal recumbency and
Choosing an inappropriately-sized
a towel or IV fluid bag is placed under the
endotracheal tube can lead to a significant
neck which pushes the trachea ventrally. An
problems for a patient if they are breathing
incision (approximately 5-8 cm or 2-3 inches
spontaneously. One study showed an
long) is made on the ventral cervical midline
increase in the work of breathing of 34%
about midway between the cricoid cartilage
and increase in airway resistance of 25% if
and the thoracic inlet. The “strap” muscles
the diameter of the endotracheal tube was
(sternohyoideus) are separated using blunt
decreased by only 1 mm. When picking an
or sharp dissection and the trachea is
appropriately-sized tube estimation by
exposed. The trachea is elevated into the
digital palpation of the trachea was shown
incision using thumb and fingers. An incision
to be the most accurate method.
is made between 2 tracheal rings at the
level of rings 3 to 6 extending about 40% of Sterile saline (2-10 ml depending on the size
the circumference of the trachea and a tube of the patient) should be instilled or the
is placed in the incision. Traction sutures are patient should be nebulized (preferred) q2-
then placed through the 1 ring cranial and 1 4 hours to help lubricate respiratory
ring caudal to the tracheotomy and tied secretions. The tube should be suctioned
with the knot approximately 8-10 cm or 3-4 q6-8 hours after instilling saline and
inches from the trachea. These sutures are hyperoxygenating, and should be
used for opening the trachea when the tube aseptically changed q6-12 hours or as
needs to be exchanged. A tube needed. When suctioning larger patients
approximately 1-1.5 sizes smaller than what the operator should inhale a normal breath
would be used for orotracheal intubation is and hold the breath. When the operator
placed. comfortably feels the need to breathe
suction should be discontinued. For small
patients the breath should be exhaled then
Commercial tracheostomy tubes can be held. When the operator comfortably feels
used or a clear endotracheal tube can be the need to breathe the suction should be
modified. To modify an endotracheal tube discontinued. Oxygen can be provided via
the plastic connector is removed from the the tracheostomy by placing a sterile red
end of the tube. Two cuts are then made in rubber catheter through the tracheostomy
the tube 180 degrees apart. The cuts are tube. Care should be taken to ensure the
made long enough so that the tube that oxygen tube is not too large and does not
remains intact is the right length for the obstruct exhalation. When the tube is no
patient (i.e., reaches from the tracheotomy longer needed the tracheotomy incision is
to the thoracic inlet region). Do not cut the left to heal by second intention. It should
cuff inflating mechanism. The 2 wings that not be bandaged until the tracheotomy
are created can be cut short if needed. The incision is healed to avoid developing
tube connector is placed back into the tube. subcutaneous emphysema.
Two holes are created the end of each wing
and umbilical tape or IV tubing is placed
through the holes and tied around the back THORACENTESIS
of the neck of the patient. The tube is not
secured in any other form to the patient. Pleural space disease (pneumothorax,
Two or 3 sterile 4x4 squares are placed hemothorax, pyothorax, chylothorax) often
can be diagnosed based on the presence of
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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a rapid shallow respiratory pattern, loss of In the case of a pneumothorax a 3-way

airway sounds, or hollow sounds on stopcock can be placed in the tube and the
percussion of the thorax. Any patient who is tube can be aspirated on an intermittent
suspected of having pleural space disease basis; however, this is only advised if it is
should have a thoracentesis performed anticipated that the patient will only
prior to taking radiographs. The stress of the accumulate small volumes of air. Ideally
radiographic procedure in a patient with continuous underwater suction should be
severe pleural space disease may lead to used on chest tubes until it is established
respiratory arrest. Thoracentesis is that the air leak is resolving.
performed between the 7th and 9th
intercostal spaces. The thoracentesis is
performed in whatever position the patient Analgesia must be provided to every patient
is the most comfortable (sternal, sitting, with a chest tube. This can be effectively
lateral recumbency). Thoracentesis should provided using local or regional blocks a
always be performed bilaterally unless the mixture of lidocaine and bupivacaine.
patient is known to have unilateral disease. Intercostal nerve blocks for 1-2 rib spaces
The area is clipped and prepped and if the either side of the tube can be performed or
patient is painful local anesthesia should be intrapleural analgesia can be provided by
instilled in the skin and down to the pleura. administering the local anesthetics via the
The needle is introduced slowly until the chest tube into the pleural space. Local
pleura is penetrated at which point the anesthetics should always be either
needle is angled parallel to the chest wall warmed to body temperature or mixed (1:9)
with the bevel pointed medially. This will with sodium bicarbonate to decrease the
prevent injury to the lung as the pleural sting. Parenteral narcotics should be
space is evacuated. If negative suction is not provided if local anesthetics are not
achieved a chest tube will need to be providing sufficient analgesia.
placed.

CONTINUOUS POSITIVE PRESSURE

CHEST TUBES AIRWAY SUPPORT
Chest tubes can be placed under sedation Continuous positive airway pressure helps
and local anesthesia or under general to decrease the work of breathing and
anesthetic. In most dogs chest tubes can be improve gas exchange. It is defined as
placed under sedation and local anesthetic. maintaining the pressure above
General anesthesia is required in most cats. atmospheric pressure throughout the
If general anesthesia is required the patient respiratory cycle. This can be used as a
should be intubated and ventilated. The size bridge in patients that do not fully respond
of the chest tube should be the to oxygen support but positive pressure
approximate diameter of the mainstem ventilation is not an option or if it is felt that
bronchus in a patient with a pneumothorax some assisted ventilation may help avoid
since this is conceivably the largest hole that the need to positive pressure ventilation. A
could exist. It also helps prevent having the modified form of CPAP can be fairly easily
tube clog with viscous fluids or blood clots. provided to most awake dogs. A fairly tight
Smaller diameter tubes may be chosen for fitting mask attached to an anesthetic
patients with a chylothorax or pyothorax. circuit is placed on the patient. The pop-off
valve is tightened down and the oxygen
flow rate is increased until the pressure on
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

the circuit registers at 5 cm H2O. The patient flow rates through a nebulizer. The
breathes this oxygen under high pressure. nebulized fluid can be delivered via face
mask, into a baggie placed over the
patient’s head, or into an enclosed chamber
NEBULIZATION if the patient will not tolerate the flow
directed at the face. Saline (0.9%) is an
Nebulization therapy should be used for excellent mucolytic if nebulization is being
treating patients with pneumonia and used to loosen secretions. Bronchodilators
bronchoconstrictive disease (i.e., feline such as albuterol and terbutaline as well as
allergic bronchitis). It is provided using a corticosteroids such as fluticasone can be
commercial unit or oxygen delivered at high given by nebulization to asthmatics.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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How To Make The Right Decisions In The

First 10 Minutes

INTRODUCTION: The hospital must be maintained in a state of readiness in order to be able to

prevent catastrophic consequences from occurring when the severely ill or injured patients are
presented to or being treated in hospital. This state of readiness includes not only the physical
equipment but also the mental readiness of the doctors, nurses and receptionists. In-hospital
training and drill sessions are recommended to practice assessment and resuscitation team skills.
Everyone must be trained to deal with typical emergency situations and equipment must be
available and ready to be used at a moment’s notice. Drill sessions facilitate the practice of
psychomotor skills and working as a team, providing for effective and efficient treatment of
critical patients. Lack of preparation may make the difference between life and death.

Trauma protocols for general assessment, management, and treatment for specific catastrophic
injuries are recommended. These protocols should be printed and reviewed at staff meetings.
They may also be posted in key areas in the hospital or the "ready" area where they can be
referred to easily. They act as guidelines and mental reminders for the staff and clinician
in-charge - increasing team efficiency and helping to prevent assessment and management
mistakes. Each trauma protocol may be organized in a numerical or alphabetical list of steps to
follow, or in an algorithm. Protocols should be reviewed and revised as required periodically to
insure they remain current, easily understood, and effective in the setting they are used.

GOALS the difference between life and death.

Oxygen, fluids ready to be administered,
The fundamental goals of patient care
and a crash cart containing all the supplies
should be to avoid hypoxia and hypercarbia,
needed to deal with a life-threatening
to ensure the patient has a normal
emergency should be present in the ready
hemodynamic status (normal heart rate,
area. It is recommended that a multi-
blood pressure, blood volume, urine
drawer tool cart be purchased for use as a
output), and to keep the patient as pain free
crash cart. The crash cart should be mobile
and comfortable as possible. Enteral
(on wheels or transportable) in order to be
nutrition should be provided as early as
able to take the equipment and supplies to
possible to help maintain gastrointestinal
the patient, no matter where the
function and integrity of the gut mucosal
emergency takes place. The cart should be
barrier.
reserved for emergency use only and
material should not be removed unless a
code is being run or emergency
resuscitation is being performed. Supplies
CRASH CART that may be used routinely such as
laryngoscopes, catheters or certain drugs
A ready area is essential for performing such as furosemide should be stocked in a
effective CPR and resuscitating critically ill general use area as well as in the crash cart.
or injured animals since seconds may mean Emergency resuscitation can be
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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unsuccessful simply because someone The first two drawers of the crash cart
“borrowed” something for another patient should contain airway equipment and drugs
and forgot to return it. respectively. The airway and drug drawer
are lined with foam and sections are cut out
of the foam to hold the supplies. This serves
An oxygen source must be available and an to keep the drawer organized and also
AMBU bag should be kept connected to the indicates when something is missing from
oxygen source. An AMBU bag can be the cart. The airway drawer should contain
connected using piped-in oxygen or an a laryngoscope with a small and large Miller
anesthetic machine. If an anesthetic blade and a variety of sizes of endotracheal
machine is being used a “Y” connector tubes. Each tube should have gauze or IV
should be inserted between the oxygen tubing attached to it so once the patient is
outflow and the anesthetic circuit. One arm intubated the tube can be secured
of the “Y” is connected to the AMBU bag. A immediately in place. Each tube should also
bag of fluids should be connected to a have a syringe attached to it primed to
macrodrip set and placed in a pressure inflate the cuff once the patient is
infusor bag (“slam bag”). intubated. Foerster sponge forceps and
Velsellum forceps should be available to
remove foreign material from the mouth
The top of the crash cart should hold an ECG and oropharynx. A #10 scalpel blade and a
machine, ECG gel, a capnograph, a suction pair of sharp Mayo scissors should be
unit, a Doppler blood pressure monitor, present to perform a tracheotomy and open
ultrasound gel, and at least 3 sizes of blood chest CPR if necessary.
pressure cuff. The Doppler unit must be
charged and a probe left attached at all
times. All electronic equipment must be The second drawer should contain
plugged in. Electrocardiogram leads must emergency drugs such as epinephrine,
be attached to the machine. Either a atropine, lidocaine, sodium bicarbonate,
commercial suction unit or a Mityvac (brake dexamethasone sodium phosphate, and
line suction unit) should be present and a furosemide. Other recommended drugs
Yankauer suction tip or some other tip include mannitol, dextrose, dopamine,
capable or aspirating thick exudate, vomitus dobutamine, and calcium gluconate. Both 3
and blood from the pharynx, larynx, and cc and 12 cc syringes with needles attached
trachea should be attached to the suction should be present alongside the drugs. A
unit. An endotracheal tube can be attached stiff long 3.5 Fr urinary catheter or red
to a suction unit on an emergency basis and rubber tube should be available for instilling
used to suction the oropharynx. drugs via the endotracheal tube.

An emergency drug chart should be posted The third drawer should contain different
on the cart and ideally on the wall in the sizes hypodermic needles and intravenous
ready area so that it can be determined catheters. A large syringe with an extension
immediately how much medication the set and 3-way stopcock connected should
patient needs. be present for performing rapid
thoracentesis. Tape for securing catheters
should be tabbed ready for easy use.
Remaining drawers should contain surgical
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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gloves, gauze squares, intravenous fluids, In-house determinations of hematocrit,

chest tubes, and surgical instruments and total serum solids, platelet numbers, white
supplies that might be needed for blood cell count and differential cell counts
resuscitation. A basic surgical pack should should be standard requirement. An ability
also be present for performing emergency to determine blood glucose, activated
surgical procedures. This should include a coagulation time or PT and PTT, creatinine,
scalpel handle, curved Mayo and serum electrolytes, blood pH and blood
Metzenbaum scissors, curved mosquito and gases can be life saving. A good microscope
Kelly hemostats, tissue forceps and a must be present for evaluation of blood
Balfour retractor. Sterile red rubber tubes, smears, urine sediments, and body cavity
gauze and towels can also be very useful. aspirates.

Intravenous fluids should include a TRIAGE

combination of crystalloids and colloids. A
Triage is defined as the sorting or
buffered crystalloid such as Normasol-R or
classification of patients according to the
Plasmalyte-A and 0.9% saline in one litre
priority of need for treatment. It was
bags should be available. In addition D5W or
designed to help avoid unnecessary death
0.9% saline 250 ml bags should be available
because of inappropriate attention. It starts
for mixing up constant rate infusions. A
on the phone when an owner calls into the
synthetic colloid should be available as well
hospital or when an owner walks in the
as biologic colloids such as packed red blood
front door with their pet. The members of
cells and fresh frozen plasma. If blood
the team that have first contact with the pet
products are not available then a walking
need to be trained in how to triage - how to
donor program where blood can be
take a quick accurate history and to
collected on an emergency basis is vital.
recognize abnormalities.
The ready area requires good lighting,
Certain problems or complaints always
similar to that required in the operating
warrant immediate attention and
room. Dual lights that can be directed at
immediate evaluation. These include airway
divergent angles are especially important
or breathing abnormalities, bleeding, a
for the care of the seriously injured patient.
history of trauma, non-productive retching,
These patients frequently require
profuse vomiting or diarrhea, urethral
emergency surgical procedures that
obstruction (“straining to defecate”),
demand this availability of good
seizures, loss of consciousness or collapse,
illumination, e.g., venous cutdown and
heat prostration, open wounds, shock,
slash tracheostomy. A focusing
anemia or pale mucous membranes, burns,
high-intensity cool beam light (very useful
dystocia, prolapsed organs, abdominal
for close/exacting or deep cavity work) and
distention, and extreme restlessness.
a wider beam reflecting dish light for
general full-body illumination are
recommended. A headlamp is very effective
for directing light into the appropriate PRIMARY SURVEY
location; inexpensive headlamps are Once the patient has been triaged to the
available through camping and hardware ready area a primary survey is completed
stores. within 30 to 60 seconds. The goal of this
survey is to determine the presence of
emergent conditions that require
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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immediate treatment. The following steps rate are easily determined in all but the very
are recommended. smallest animals, unless they are obese or
very cold. Assessment of heart tones,
1. Visually assess the patient from a
mucus membrane colour and capillary refill
distance, noting LOC, unusual body or limb
time, already completed earlier can be
posture, the presence of blood or other
repeated, as well as any other part of the
materials on or around the patient, and any
primary survey thus far if there are any
other gross abnormalities. Note breathing
questions.
effort and pattern and any airway sounds
generated. 6. The primary survey ends with very rapid
observation and palpation of the
2. Approach the patient from the rostral
abdominal, flank, and pelvic regions, as well
direction, noting the level of awareness and
as the spinal column, and limbs, noting
its reactions to this movement. Ask
anything abnormal.
questions concerning the patient's
temperament. Take appropriate safety Any major abnormalities are immediately
precautions in "questionable" animals, treated. Unconscious patients should be
(muzzling, head covering, physical intubated and ventilated if necessary. Drugs
restraint). should be given immediately to seizing
animals. This may include dextrose or
3. Assess airway and breathing status by
antiepileptic drugs. Dextrose can be given
closely observing colour of the oral mucus
intraosseously in very small patients if
membranes (capillary refill time is also
immediate vascular access cannot be
assessed at this time), listening for tracheal
obtained. Drugs such as diazepam can be
breath sounds (first without, then with the
given intranasally while an attempt is being
aid of a stethoscope), palpating the neck
made to gain vascular access. If the patient
noting tracheal position and
is showing any evidence of an increased
tracheal/peritracheal integrity. Injuries to
respiratory rate or effort then flow-by
the skin, subcutaneous emphysema, and
oxygen should be provided. Transtracheal
blood in the nose or mouth are assessed for
oxygen may be indicated in cases of upper
bilaterally.
airway obstructive diseases. A thoracentesis
may be required immediately if the patient
is cyanotic and has a restrictive breathing
4. Continue to assess the patient's breathing pattern. Fluids are infused intravenously if
status by observing, palpating and then there is evidence of hemodynamic collapse.
listening to the thorax (first without then This may require a vascular cutdown.
with the aid of a stethoscope). Lung sounds Temporary sterile dressings are placed over
should be auscultated bilaterally (heart bleeding wounds or herniated organs.
tones are also assessed following lung Direct pressure will typically control most
sounds). Changes involving the skin over external hemorrhage. Analgesics should be
thorax and cranial abdomen such as given to painful patients. Sedatives may be
erythema, bruising or subcutaneous required in combative patients.
emphysema, should be assessed by
visualization and palpation.
COMPLETE HISTORY AND PHYSICAL
EXAMINATION (SECONDARY SURVEY)
5. Cardiovascular assessment is completed
by palpating pulses during auscultation of After the emergency patient has undergone
the heart. Pulse strength, vessel tone and successful resuscitation of the catastrophic
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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life-threatening injuries or is deemed the presence of any abdominal component

"stable" following the primary survey, a to the breathing pattern should be noted.
thorough history and physical examination The chest should be ausculted for the
is performed. The history and initial survey presence of breath sounds, areas of
should always be performed in the same dullness, crackles or wheezes in at least 4
manner every time to ensure consistency quadrants (upper and lower right and left
and that no important details are missed. sides). Chest percussion in at least 4
Vital signs including temperature, heart rate quadrants will help detect areas of dullness
and rhythm, pulse rate and strength, and suggesting pulmonary contusions, hollow
respiratory rate and effort are recorded sounds indicating a pneumothorax, or a
during the secondary survey. fluid line indicating a hemothorax.

In English, the mnemonic AMPLE is one of

several mnemonics that can be used for this
Blood pressure can be recorded directly or
purpose.
indirectly. Direct BP measurement is the
A :Does the pet have any allergies? most accurate but requires placement of an
arterial catheter which is not practical in the
M :Is the pet on any medications?
emergency setting. Indirect BP
P :Does the pet have any past history of any measurements can be recorded using a
problem? Doppler ultrasonic flow detector or an
oscillometric device. Doppler flow detectors
L :When was the pet last normal? Last meal? are preferred over oscillometric devices
Last urination? Last defecation? since they also allow the clinician to assess
E :What were the events leading up to the flow to the periphery of the limb to which
problem? the ultrasonic flow probe is attached. Often
irregular heartbeats such as premature
ventricular contractions can be detected by
In the severely traumatized patient it should the trained ear. Mean BP should be
be assumed that fractures are present until maintained above 65 mm Hg to ensure
proven otherwise and the patient may need renal perfusion; however, hypertension in
to be restrained to prevent further injury. the hemorrhaging patient may worsen the
The most effective method of restraint is to hemorrhage and should be avoided.
tape the animal to a board with duct tape. Mean arterial pressure (MAP) can be
Backboards made from Plexiglas are useful calculated only if both systolic and diastolic
because not only are they sturdy, but the BP are measured. Mean BP is calculated
animal can be visualized on all sides, and using the following formula:
radiographs can be taken without having to
remove the animal from the board. MAP = diastolic BP + (systolic BP - diastolic
BP)/ 3
The five vital signs are temperature, heart
rate, respiratory rate, blood pressure and Diastolic BP can be consistently measured
pain. Each should be assessed. Heart using a Doppler flow detector in many
rhythm and pulse rate and strength should patients. Digital palpation of femoral or
also be assessed at this time. peripheral arteries may not provide an
adequate assessment of BP. The ability to
The breathing pattern should be closely detect pulses depends on the degree of
observed and evidence of increased effort vasoconstriction, pulse pressure (difference
noted. Symmetry of chest movement and
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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between systolic and diastolic BP), and skill may be bleeding and additional pressure
of the clinician. could cause them to rupture. Focal areas of
pain should be identified. The caudal
Jugular veins should be clipped and checked
abdomen should be carefully palpated for
for filling when held off at the thoracic inlet.
the presence of a urinary bladder. Cranial
Flat jugular veins that cannot be raised
nerves should be assessed and a
indicate severe hypovolemia. The presence
fundoscopic exam performed. The ear
of jugular distention in trauma patients in
canals should be evaluated with an
shock is most likely an indicator of increased
otoscope for the presence of fluid (blood,
intrathoracic pressure or venous
cerebrospinal fluid). Fractures may worsen
obstruction. In the previously healthy
with movement and if the animal is
animal this may indicate a pneumothorax or
recumbent only spinal reflexes and the
pericardial tamponade. If the animal has
presence of limb sensation should be
underlying heart disease jugular distention
assessed until radiographs have been taken.
can be associated with right heart failure.
The entire body should be palpated gently
for fractures, swelling, and wounds. After
clipping any wounds a sterile dressing
Toe web temperature should be taken and should be applied. Wounds should be
compared with the rectal temperature. A covered with sterile saline and a sterile
difference of greater than 3.5C is strongly water soluble lubricant prior to being
suggestive of poor peripheral perfusion. clipped. This prevents further
Mucous membrane color and capillary refill contamination and tissue desiccation, and
time should be recorded. may help avoid healing complications.
The abdomen should be auscultated for Fractures of the distal limbs (below the
bowel sounds and percussed for areas of elbow and stifle) should be stabilized
dullness that would suggest fluid in the following assessment of the injury.
abdomen or tympany suggesting a torsed Newspaper splints are placed easily and
hollow viscus. The abdomen should be rapidly and are very effective as temporary
palpated thoroughly but gently as organs splints. Radiographs can be taken through
the newspaper.
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Gizmos And Gadgets

CRASH CART fluids with additives. Blood transfusion sets

and filters ideally should be available.
A crash cart can be made from a
handyman’s cart with multiple drawers in it
(available from any hardware store) or
AMBU Bag
fishing tool box. Each drawer should be
labeled. Foam padding can be used to line AMBU bags are resuscitator bags with one-
each drawer and holes can be cut out of the way valves. A section of corrugated tubing
foam to hold tube and bottles in place. The or a rebreathing bag is attached to the end
first drawer should contain airway materials of the AMBU bag to act as a reservoir for
- endotracheal tubes, a long polypropylene oxygen to be stored in while the AMBU bag
3.5 or 5 Fr catheter for instilling drugs is squeezed, delivering positive pressure
intratracheally during CPR, forceps for ventilation to the patient. When using an
removal of foreign material and a scalpel or AMBU bag, conventional or high frequency
Mayo scissors for surgical airways. ventilation can be delivered easily without
Mechanic’s helpers available from any concern for the pop-off valve and worrying
automotive store make very useful grabbers about matching flow rates to the rates
for oral, airway and esophageal foreign needed during resuscitation. Because the
bodies. Each endotracheal tube should have hands of the ventilator are closer to the
a partially inflated syringe attached to the patient he/she can "feel" the pressure
cuff and gauze attached to the tube for developing in the lungs much better than if
securing the airway once it is in place. The using a rebreathing bag on an anesthetic
second drawer should contain emergency machine. Also pure oxygen, not oxygen that
drugs and syringes (1 cc and 12 cc) is scented or containing any anesthetic
preloaded with 18ga needles. The third gases can be delivered via an endotracheal
drawer should contain hypodermic needles, tube or mask if assist ventilation is being
peripheral catheters of various sizes, attempted. In the former case this is
butterfly catheters, and larger 13 cm 14g important because even a small amount of
and 16g catheters for pericardiocentesis anesthetic can have disastrous negative
and diagnostic peritoneal lavage. Syringes, consequences in an animal that is arrested.
tape, number 15 scalpel blades for making In the latter case it is important in the
side holes in catheters and a 35 to 60 cc conscious patient that frequently objects to
syringe with an extension set and 3-way the anesthetic.
stopcock connected should be present. All
equipment should be compartmentalized in
order to visualize the retrieve the “Y” CONNECTOR
appropriate equipment rapidly. Instead of
compartmentalization certain supplies can Oxygen is given by tubing connected to the
be placed in labeled zip lock bags. The anesthesia unit by a "Y" connection. The
fourth drawer should contain fluids and oxygen hosing from the source to the
administration set, extension sets, t-ports anesthetic machines is removed at the
and male catheter plugs. Buretrols are insertion to the anesthetic machine. A “Y”
useful for making up smaller volumes of connector is inserted at the tubing. If a “Y”
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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connector is not available then a “T” FOERSTER SPONGE FORCEPS

connector from the plumbing section of a
These 10" slightly curved sponge forceps
hardware store is used. One end of the “Y”
should be always available for the retrieval
is connected back into the anesthetic
of oral, pharyngeal and upper airway
machine via a piece of suction or oxygen
foreign bodies. A gauze sponge can be
hosing. The other arm of the “Y” is
placed in the jaws and the oropharynx can
connected to suction or oxygen hosing and
be swabbed effectively to help clear an
coiled up for use in emergency situations as
airway obstruction of mucus, blood or
oxygen tubing. The “Y” has 2 clamps on it-
vomitus without having to insert fingers
one going to the anesthetic machine and
into the mouth of the animal. They can also
one going to the oxygen tubing. If oxygen is
be helpful when used across the hilus of the
required the clamp is closed going to the
lung or spleen when these are badly
anesthetic leading to the anesthetic circle to
traumatized and hemorrhaging badly.
prevent oxygen going anywhere than to the
oxygen hood, mask, nasal cannula or AMBU
bag. The tubing and connectors are all
available through medical supply VELSELLUM FORCEPS
companies but can also be purchased in These straight forceps have jaws with 2
home hardware stores. A commercially sharp prongs on each side. They are very
available mare uterine flush system can also useful for grabbing smooth objects such as
be used in place of “Y” or “T” connectors. rubber balls that become lodged in the
oropharynx.

OXYGEN HOOD (COLLAR)

These can be made from Elizabethan collars BRAKE LINE SUCTION UNIT
and plastic food wrap or it can be This is a hand-held suction unit used to clear
commercially purchased. Homemade air from brake lines. It is a very effective
collars should have the top ¼ of the collar device for suctioning airways and will
open to the air. The oxygen tube is placed generate pressures of up to 760 mm Hg. A
into the collar from the neck side and taped fluid trap can be placed between the
in place to the inside of the collar and to the suction tubing and the suction tip to avoid
outside of the collar to prevent accidental having fluid accumulate in the suction unit.
dislodgement. A roll of 1” or 2” tape taped It can be purchased from hardware and
to the outside of the underside of the collar automotive stores.
will create a pendulum effect and help
prevent the collar from rotating. Oxygen
flow rates vary from 1-10l/min depending CLEAR ENDOTRACHEAL TUBE
on the size of the patient. The oxygen
should not be humidified to prevent Endotracheal Tube - The clear low pressure,
moisture build-up. The patient must be high volume cuffed tube is the preferred to
monitored closely for signs of overheating – opaque tubes. This is because of the ability
especially if the patient is panting. to monitor the inside of these tubes for a
vapour trail or the lack of it, blood, vomitus,
etc. The cuff is much safer than those in
many other types since it is lower pressure
than the red tubes. The cuff inflating
mechanism has a one-way valve on it,
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

making it easier to inflate. Red tubes tend to won’t be used further, or the bag can be
become more brittle with continued use emptied, a new drip set is attached and the
and may create more trauma to the tracheal entire unit is sterilized as a closed collection
mucosa. system.

Tracheotomy Tube - The connector is Irrigation Fluids - Intravenous fluid bags are
removed from the end of the tube. Two sterile inside the outer wrap. If the outer
incisions 180 degrees apart are made in the wrap is properly opened the bag can be
tube, peeling it down like a banana. Care is placed on the surgical table and used by the
taken to keep the cuff inflation mechanism surgeon as sterile lavage fluids.
intact. The incisions are made so that the
intact section of the endotracheal tube is
the right length for the patient (i.e. from the Dressings - Fluid bags can be emptied and
tracheotomy incision to the thoracic inlet). opened to be used as sterile waterproof
The plastic connector is reattached to the dressings for open abdominal drainage. This
tube and the split pieces are connected to is ideal if there is tension due to abdominal
gauze or sections of umbilical tape. packing, bowel edema, bowel distention, or
any other situation when closure may
create abdominal compartment syndrome
Chest Tube - This can be made out of a clear (excessive intraabdominal pressure). The
disposable endotracheal tube and the use bag can be sutured in place to provide a
of a bone rongeur to make side holes. The complete seal. If only a temporary, non-
cuff inflation tubing needs to be tied off. waterproof closure is indicated it can be
The chest tubes can be sterilized by secured to the wound edges using safety
ethylene oxide or glutaraldehyde. pins.

Fluid bags make strong waterproof

coverings to protect foot bandages from
Mouth Gag – Sections of 3-4 mm
getting wet.
endotracheal tube can be used to make
mouth gags.

Autotransfusion Sets – Empty fluid bags can

be sterilized with a blood administration set
COPPER WIRE
and kept ready for use as autotransfusion
Copper wire that is sanded on the tip makes sets. The blood is collected into syringes or
a malleable stylet for endotracheal tubes. sterile suction bottles and then placed into
The size of the cooper wire can be adjusted the fluid bag and delivered to the patient.
based on the size of the endotracheal tube.

Enteral Feeding Bags – Empty fluid bags can

FLUID BAGS be filled with liquid enteral feeding formulas
and dripped through a regular fluid
Closed Collection Systems - Partially or administration set. The bag should be
completely empty fluid bags should be kept washed out with very hot water every 24
sterile and saved for use as urine collection hours to prevent residue build-up and avoid
bags for closed systems. The drip set can be bacterial contamination.
left attached to the bag and tied off so it
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Mouth Gag – The end of the syringe case is

cut off and both ends are padded with
FLUID ADMINISTRATION SET DRIP
gauze or tape. The case can then be inserted
CHAMBER
between the upper and lower canines as a
Tracheostomy - The drip chamber is cut in mouth gag.
half. The spiked end can be inserted in an
emergency into the trachea as a
transtracheal cannula. The open end will fit Tail Protector – Sutured tail wounds tend to
exactly onto an AMBU bag so that the rebleed when the dog knocks its tail. The
patient can be ventilated. Since the spike is plastic case is placed over the lightly padded
made of hard plastic that can damage the bandage on the tip of the tail. When the tail
trachea, this device should not be used wags the sutures are protected and repeat
except in a dire emergency. As packaged hemorrhage is minimized.
these drip sets are sterile. A feeding tube
can be placed into the trachea via the drip
chamber and the chamber can then be Mask – The end of a large syringe case is cut
removed. This provides transtracheal access off and a hole is made in the tip of the case.
for delivery of oxygen. This can be attached to oxygen or to a gas
anesthetic circuit for birds, pocket pets and
other small patients.
Tracheal Prosthesis – The drip chamber is
cut into thin sections and sutured in place as
a tracheal prosthesis for surgical repair of SYRINGES
tracheal collapse.
Mouth Gag – The ends of the syringes are
cut off and both ends are padded with
gauze or tape. The syringe tubing can then
FLUID ADMINISTRATION SET LINE
be inserted between the upper and lower
Used fluid lines can be recycled and used as canines as a mouth gag.
ties for endotracheal and tracheostomy
tubes. The line is cut into sections of a
suitable length and kept in a bag beside the Tubing Connector – The plunger of a 1 cc
anesthetic machine. The line should be syringe is withdrawn and discarded. The
stretched prior to use which will help the base of the barrel is cut off. The tip will fit all
knot stability. narrow gauge tubes and the barrel end will
fit almost all suction hosing and oxygen
hosing.
SYRINGE CASE

Oropharyngeal Airway - A syringe case with

Suction Drain – The plunger of the syringe is
the end cut off makes an effective
withdrawn approximately two-thirds of the
oropharyngeal airway. This can be used in
length of the barrel and an 18 ga needle is
times of emergency when there is
placed across the base of the barrel to stop
significant oral trauma but the larynx and
the plunger from depressing. The tip of the
trachea are functional.
needle is cut off to prevent injury. The
needle is withdrawn and the plunger is
depressed fully. The syringe is then
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attached to the suction drain and the

plunger is withdrawn. The needle is
Nasal Tubes – Feeding tubes can be placed
reinserted creating steady negative
with the tip in the nasopharynx or in the
pressure.
trachea to deliver oxygen into the
respective sites. They can be placed into the
esophagus or stomach and used as
SLAM BAGS
nasoesophageal or nasogastric tubes for
Fluid Infusor - Fluids often need to be given decompression and feeding.
rapidly to patients in hypovolemic shock.
This requires that the fluids be delivered
under pressure. A pressure infusor bag is an Intravenous Catheters - They make effective
effective way of delivering pressurized long central lines in dogs in which the
fluids. The fluid bag is inserted into the commercial lines are too short. A 14 ga or
pressure infusor bag and the pressure then 16 ga over the needle 2 inch catheter is
can be inflated up to 300 mm Hg. inserted into the vein. A 5 Fr or 3.5 Fr
feeding tube, respectively, is inserted
through the catheter to the desired length.
Pressure Cuff – The bag can be placed A few drops of 50% dextrose placed on the
proximal to or over the site of a large outside of the feeding tube will help the
bleeding wound (with or without padding). tube slide easier through the catheter. The
The bag can be inflated to a sufficient catheter is withdrawn from the vein and the
pressure to control active hemorrhage. In feeding tube is sutured in place and a sterile
small animals this can be used as an dressing is placed.
abdominal counterpressure wrap (see
below).
Vascular Loops - When using as a vascular
loop the tube is passed around the vessel or
BLOOD PRESSURE CUFF vascular pedicle and the loop is tightened by
sliding hemostats down the tubing and
Hemorrhage Control - A Doppler blood tightening on the vessel. This is a modified
pressure cuff can be placed proximal to a Rumel tourniquet.
bleeding wound and inflated to 20-40 mm
Hg above systolic pressure. This will control
arterial hemorrhage to the region. This is
BUBBLE WRAP
especially useful for distal limb hemorrhage.
Adult human thigh cuffs can be used as Splints - Bubble wrap makes effective
abdominal counterpressure wraps in small lightweight splints for distal limb fractures.
patients (see below). Radiographs can be taken through bubble
wrap.

FEEDING TUBES
Blanket - It also can be heated in a
Three and a half, 5 and 8 French feeding
microwave in a bowl of water to create a
tubes can serve multiple purposes -
warm “blanket”. This can be particularly
especially if they are made of minimally
useful in the operating room.
reactive material such as medical grade
silicone.
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Oxygen Tent - When placed over the front carbon dioxide measurement (ETCO2). It is
of a cage it creates an effective “oxygen waterproof and has been designed to
tent”. withstand being dropped. Capnography
provides a continuous noninvasive
assessment of ventilation and the ETCO2
TOWELS provides an estimation of the PaCO2. The
ETCO2 provides information about
Abdominal Counterpressure - Towels can be pulmonary blood flow in the face of severe
wrapped around the pelvic limbs and hypotension. During anesthesia if the ETCO2
abdomen of a patient and anchored with drops below 18 mm Hg the arrest is
duct tape to serve as external imminent. During CPR if the ETCO2 rises to
counterpressure wraps. When doing this a 15 mm Hg or higher return of spontaneous
towel first should be placed as padding circulation is very likely.
between the pelvic limbs. A second towel is
placed around the pelvic limbs wrapping
from the toes to the hips in a barber pole
RADICAL 7®
fashion. The wrap is continued then around
the abdomen to the level of the diaphragm The Radical 7 (Masimo, Irvine, CA) is a
if needed. It is anchored in place with duct portable pulse oximeter that continuously
tape. Care should be taken not to wrap the calculates a plethysomographic variability
towels too tightly. Two fingers should easily index or pleth variability index (PVI). The PVI
be able to be placed under the abdominal is an assessment of changes in the
counterpressure wrap once it is in place. amplitude of the pulse oximetry waveforms
during different phases of respiration.
Patients do need to be mechanically
SURGICAL PAPER DRAPE ventilated to maintain consistency in
changes in intrathoracic pressure. In the
Surgical drape material makes an effective face of hypotension the PVI will indicate
water repellant outer layer for bandages. It whether a patient is likely to be fluid
can be sutured in place or tied in place using responsive or not.
umbilical tape to provide a water repellant
outer layer for open abdominal drainage
bandages. It can be safety-pinned or taped
KITTY KOLLAR®
in place to cover larger wounds.
The Kitty Kollar® (Orange, CA) is a collar
designed to replace a standard bandage for
EMMA® an esophagostomy tube. It is made of a soft
padded washable fabric. The tube exits the
The EMMA (Masimo, Irvine, CA) is a collar through a buttonhole and a Velcro
portable battery run capnograph. Within as hook and loop fastener secures the tube to
short a period of time as 15 seconds the the collar. The collar is secured around the
device will provide a respiratory rate and patient’s neck with a Velcro tab.
continuous capnogram and an end-tidal
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Acute Pancreatitis

INTRODUCTION: Acute pancreatitis is one of the most difficult diseases a clinician can manage.
The systemic inflammatory response syndrome can be severe in these animals. Major organ
failure – refractory hypotension, liver failure, gastrointestinal failure, ARDS (acute respiratory
distress syndrome), and DIC (disseminated intravascular coagulation) may develop. Only through
aggressive medical management and sometimes surgical management can the clinician hope to
minimize morbidity and mortality. Commonly used diagnostic tests do not necessarily correlate
with severity of disease or prognosis, which means that the clinician should treat all pancreatitis
patients as having potentially life-threatening disease. The ultimate diagnosis of pancreatitis is
a histopathologic one which is rarely achieved. Aggressive fluid therapy, analgesia and
nutritional support form the cornerstone of therapy. If patients have necrotic, abscessed or
neoplastic pancreatic tissue present, the inflammatory process may not subside until the affected
tissue is debrided. Surgery is rarely indicated but may be important in the management of some
patients.

PATHOPHYSIOLOGY death can occur from acute disseminated

intravascular coagulation and shock as the
Multiple causes of pancreatitis have been
circulating proteolysis and cytokines
identified but in most dogs and cats it is
activate the complement, coagulation, and
considered to be idiopathic. Regardless of
fibrinolytic cascades.
the cause the pathophysiology is similar and
ultimately is a result of activation of the Grossly pancreatitis progresses from that of
pancreatic enzymes within the pancreas edema and mild saponification and a few
leading to autodigestion as well as digestion one millimeter sized abscesses to that of
of the peripancreatic tissues and severe edema, numerous areas of
subsequent activation of the inflammatory saponification and many small abscesses.
process. If the inflammatory cascades Then it progresses to hemorrhagic
persist unabated the systemic inflammatory pancreatitis, localized peritonitis and
response syndrome (SIRS) can result. edema of the surrounding tissues and
advances to necrosis, larger abscesses, and
The systemic uptake of all of the products
the formation of very firm sections of
that are liberated during the inflammatory
cellulitis and pancreatitis (a phlegmon). In
process can then lead to systemic
some cases bacteria are thought to
inflammation and multisystem
translocate from the duodenal lumen and
involvement. The protective plasma
generalized peritonitis, bacterial
protease inhibitors such as 2-
abscessation, secondary biliary blockage
macroglobulin and 1-protease inhibitor
and necrosis of the ventral aspect of the
are consumed as the necrotizing process
duodenum may occur. In the most severe
continues. Alpha macroglobulins change
cases the entire pancreas becomes
the configuration of the proteases when
involved. In some cases necrosis of fat that
they bind to them which allows
normally accumulates in the
macrophages to clear the enzymes. As the
retroperitoneal space and falciform
plasma protease inhibitors are depleted
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ligament may be present. Gastric and cats. Species specific pancreatic lipase
duodenal ileus are common. immunoreactivity (fPLI and cPLI) are
sensitive (85-90%) for pancreatitis but some
DIAGNOSIS
feel they are not very specific. Both SNAP
Animals with acute pancreatitis are usually and Spec tests have been validated. Spec
presented because of depression, anorexia, tests are quantitative and repeat tests may
vomiting, and in some cases, diarrhea. In allow for trending of the disease process.
severe cases shock and collapse may be Liver enzymes and bilirubin may be
present. In other cases the signs are very elevated. If the inflammatory process has
vague to almost nonexistent. Cats with mild progressed then albumin levels may be
pancreatitis are often presented with a decreased due to third-spacing. Blood gas
vague history of being inappetent. Some abnormalities will reflect the degree of
animals with severe pancreatitis will exhibit perfusion abnormalities as well as any
signs of cranial abdominal pain and even a possible secondary pulmonary involvement
"praying" position. Pain may or may not be (aspiration pneumonia, ARDS). Electrolyte
evident. Patients in shock may not show any abnormalities typically reflect a
signs of pain until perfusion is restored with combination of dehydration and losses
fluid therapy. Occasionally the only clinical through vomiting and diarrhea.
signs the patient exhibits are from systemic Hypocalcemia may result from calcium soap
complications. Physical examination should formation, intracellular shifts due to
include careful auscultation, palpation and alterations in membrane function, or
visual inspection of the animal. Lack of altered levels of thyrocalcitonin and
gastrointestinal sounds is consistent with parathyroid hormone. Ideally ionized
ileus, which may be localized or generalized. hypocalcemia should be assessed rather
The right and left cranial abdominal than total calcium. Coagulation profiles (PT,
quadrants should be individually evaluated PTT, platelet counts or estimates) are
using palpation underneath the rib cage. indicated in sick pancreatitis patients in
Large dogs may need to have their front feet order.
placed on a stool or chair to shift abdominal
Radiographs often reveal increased density,
contents caudally. The umbilicus should be
diminished contrast, and granularity in the
closely inspected since masses involving the
right cranial quadrant of the abdomen,
umbilicus have been associated with
displacement of the stomach, widening of
pancreatic neoplasia. A rectal examination
the "angle" between the antrum and the
should be performed to evaluate for
descending duodenum, and displacement
evidence of diarrhea as well as the presence
of the descending duodenum to the right
of blood. Vomitus should also be evaluated
with gas patterns in the duodenum. The
for blood.
subjective loss of visceral detail in the
Although a leukocytosis with a left shift is cranial abdomen is probably the most
commonly observed in more serious cases common radiographic sign observed. In
there may be no changes in the white cell cats the loss of detail associated with
number or types in milder cases. Red blood pancreatitis is more commonly seen on the
cell morphology should be closely lateral view immediately caudal to the
examined, especially in cats, for signs of stomach and extreme lateral displacement
oxidant-induced damage (suggesting of the duodenum does not occur.
depleted glutathione levels). Assays of
Ultrasonic interrogation of the cranial
pancreatic enzymes (amylase, lipase) do not
abdomen will be helpful but is operator
provide any useful information in dogs and
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dependent. The appearance of mixed least at 1/2 ml/kg/hr in cats, 1 ml/kg/hour

echogenicity or a mass effect within the in dogs), central venous pressure (3-7 cm
pancreas as well as cystic areas, abscesses H20), and normal heart rate and arterial
(complex cystic regions), edema, and free blood pressure should be maintained.
intraabdominal fluid are occasionally
Pain kills. Analgesics should be provided
observed. Changes in the duodenum
immediately to patients in pain in adequate
consistent with pancreatitis include a fluid
doses and at frequent enough time intervals
and gas-filled descending duodenum, a
to control the pain. Methadone and
thick-walled duodenum and atony. Caution
hydromorphone are effective intermediate
should be exercised in ruling out
acting pure mu agonists. Butorphanol may
pancreatitis on the basis of a normal
be indicated in very critical patients (0.05-
ultrasound exam.
0.2 mg/kg) and may be effective in cats, but
MEDICAL MANAGEMENT it should be kept in mind that butorphanol
may only last 20 to 60 minutes and is not
Supplemental oxygen should be provided to
very effective if pain is moderate to severe.
all patients showing signs of shock, typically
A constant rate infusion of butorphanol may
using nasopharyngeal catheters. Aggressive
be helpful in more painful cats. Patients
fluid support is indicated. This requires a
with severe pancreatitis may require
continuous rate intravenous infusion of a
continuous rate infusions of fentanyl. For
crystalloid and often colloids. Use a
those with intractable pain peritoneal
replacement formula to rehydrate the
lavage with lidocaine and bupivacaine is
animal and replace fluids and electrolytes
often very effective. Nonsteroidal
lost secondary to vomiting, diarrhea, and
antiinflammatory drugs (NSAIDs) should be
third spacing and plan to rehydrate over 6
avoided.
to 8 hours. Colloids should be used
immediately in more critical patients Antiemetics are usually indicated,
(hypotensive, evidence of hemorrhagic maropitant being the most effective drug in
vomiting or diarrhea, systemically ill most patients. Serotonin antagonists such
patient, hypoproteinemic, evidence of as ondansetron hydrochloride or dolasetron
developing coagulopathy) to improve can also be used. Metoclopramide may help
microcirculatory blood flow and help in the improve gastrointestinal motility and
prevention of endothelial, interstitial and clinically seems to be more effective given
intracellular edema. as a constant rate infusion (2 mg/kg/d) than
when given as intermittent injections.
Albumin levels should be maintained above
Nasogastric (NG) tubes should be placed for
2 mg/dL using plasma. Not only is plasma an
gastric decompression in patients that have
important contributor to oncotic pressure
significant gastric distention with fluid or
but albumin is important also as a free
frequent large volume vomiting.
radical scavenger. Plasma provides a source
of macroglobulin, which binds the Nutritional support ideally should begin
activated and liberated proteases. In the within 12 hours of admission. Partial
author’s opinion fresh frozen plasma should parenteral formulas can be given by
be used during resuscitation if there is any peripheral catheter. ProcalAmine (B. Braun
concern that a coagulopathy is present or is Medical), which is a hyperosmolar solution
developing. containing 3% amino acids, 3% glycerol and
maintenance concentrations of
To ensure adequate fluids are being
electrolytes, is an excellent partial
administered adequate urine output (at
parenteral nutritional support product. It is
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given at a rate of 0.5 mL/kg/hr as a constant suctioned via the NG tube. Blood tests are
rate infusion. Maintenance fluids to which indicated at least every 24 hours including
3% amino acids and 3-5% dextrose are packed cell volume, total solids, albumin,
added can be used instead of commercially glucose, creatinine, electrolytes, blood gas,
prepared solutions. and blood smear evaluation. Additional
tests (complete blood counts, other blood
Enteral feeding is always preferred over
chemistries, radiographs, fluid analysis,
parenteral. Jejunal feeding is the ideal route
etc.) may be indicated based on the status
since feeding in this location does not
of the patient. All parameters should be
stimulate pancreatic enzyme secretion and
kept in as normal a range as possible. More
is generally well tolerated. Patients that
critical patients or those with clinically
have surgery have an advantage since a
relevant abnormalities will require more
jejunostomy or gastrojejunostomy tube can
frequent monitoring.
be placed. Evidence also suggests that
gastric feeding may be possible in some INDICATIONS FOR SURGERY
patients. It is recommended that an NG tube
A decision to perform surgery is made based
be placed and used for gastric
on history, physical examination findings,
decompression as well as microenteral
laboratory parameters, and diagnostic
feeding. This trickle feeding (0.1 – 0.25
imaging; however, many of these findings
mL/kg/hr) of an electrolyte solution
are nonspecific, especially in cats. One study
containing an isotonic mixture of
showed that there was no definitive means
electrolytes and 3 to 5% glucose is well
of determining acute necrotizing
tolerated. This will help prevent gastric
pancreatitis from chronic nonsuppurative
stress ulceration, help prevent the down
pancreatitis. The presence of septic
regulation of the gastrointestinal tract that
peritonitis based on paracentesis or
occurs when the patient is not eating, and
diagnostic peritoneal lavage, or a mass
help improve the transition to full enteral
lesion found on ultrasound consistent with
feeding. This microenteral nutrition is only
an abscess is an absolute indication for
continued if hourly aspirations of the NG
surgery. Other indications are more
tube reveal no accumulation of this fluid in
subjective.
the stomach and/or no vomiting of the
material is detected. Surgical exploration should be considered in
patients with a waxing and waning history
Close monitoring is essential in patients
of recurrent pancreatitis in order to procure
with severe pancreatitis. Monitoring should
an exact diagnosis as well as determine if
include regular (q 1 to 4 hr) measurement
resolution of the disease is possible.
and documentation of level of
Patients who have been diagnosed with
consciousness, temperature, heart rate and
pancreatitis that is not responding to
rhythm, pulse rate and strength, respiratory
medical management should be explored –
rate and effort, blood pressure, central
again to diagnose the underlying cause,
venous pressure (if a jugular catheter is in
debride or resect necrotic, infected or
place), pain/analgesia, gastrointestinal
neoplastic tissue, and place an enteral
sounds, amount and characteristics of
feeding tube.
vomitus and diarrhea, and volumes of fluid
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Toxicologic Emergencies

INTRODUCTION: Toxicological emergencies are a common part of veterinary practice. Both dogs
and cats have an amazing ability to ingest all sorts of foreign substances. Some of these
substances can cause life-threatening problems while some just cause minor problems. In many
situations the amount of the toxin ingested will dictate how serious the problem is. Often
veterinarians work on assumptions since it is not uncommon that the actual identity of the toxin
is never known. Thorough history taking and physical examinations are key in order to avoid
missing a diagnosis of a toxin that requires a specific antidote. Aggressive supportive care is
indicated for all those patients who ingested an unknown toxin to avoid morbidity and mortality.

HISTORY AND CLINICAL SIGNS: control centers - both local human centers
and any veterinary centres that are
History from an owner is essential in the
available. The National Animal Poison
accurate diagnosis and treatment of most
Control Center at the University of Illinois
toxicities since clinical signs can be
has a vast bank of information and is staffed
extremely variable. If the toxin is suspected
24 hours a day by veterinarians. Blood,
or identified it is essential to get accurate
urine and gavage samples may be required
and detailed information on the chemical or
for assay to identify suspected toxins and
chemicals involved in order that a poison
samples of whole blood, serum, urine, and
control center can be contacted for
gastric contents or vomitus should be taken
information on expected effects, treatment
on admission whenever possible. If the
and prognosis. The type of toxin, the
owner has had the animal vomit at home
amount ingested, the time since ingestion,
instructions should be given to have them
the clinical signs the patient is showing, and
save the contents in a plastic bag and bring
the previous medical history of the patient
it in with the animal.
are all key. In the case of unknown exposure
the owner should be questioned closely as
to the type of chemicals, and especially
TREATMENT OVERVIEW
medications that are available in the house
that the pet might have access to. Although Treatment will in many cases be
owners will not uncommonly try to indicate symptomatic unless a specific antidote is
the ‘neighbour has poisoned their pet’ this known. Fluid diuresis may be indicated.
is uncommon in the author’s experience. It Seizure activity, ventilation and
is much more likely that the animal ingested oxygenation, blood pressure and perfusion,
a natural or man-made toxin in the house or cardiac rhythms and rates, renal function
on the owner’s property. and coagulation are just some of the
parameters that should be assessed and
maintained as normal as possible.
DIAGNOSIS:

The identification of a specific toxin often

requires a high index of suspicion. The
clinician should work closely with poison
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INDUCING VOMITING less than 15%. In small animal veterinary

medicine, it is rare that gastric lavage would
Vomiting should be induced as soon as
be completed within this period. In
possible in the patient ingesting a suspected
addition, administration of activated
or an unknown toxin, unless vomiting is
charcoal without lavage has shown very
known to be specifically contraindicated
similar outcomes in people with many
(strong acids or alkalis, petroleum
different types of toxin ingestion.
distillates, etc.). Apomorphine should be
used intravenously for induction of
vomiting. Hydrogen peroxide and salt can
Activated charcoal should be administered
be given by the owner at home and are
via a gavage or nasogastric tube if it is
generally very effective in inducing
indicated. Ideally a cathartic should be
vomiting. The dose of hydrogen peroxide is
administered with the charcoal to hasten
1 to 2 teaspoons of 3% hydrogen peroxide
removal of the toxin. Many activated
per 10 kg body weight. This can be repeated
charcoal compounds are manufactured
3 times at 5 minute intervals. Salt should be
with cathartic (sorbitol magnesium sulfate)
avoided whenever possible but can be given
already present. The charcoal may need to
at a dose of 1/8 teaspoon per 10 kg. The
be repeated over an extended period
sooner the toxin is out of the system the less
(sometimes 3 days) since some toxins
likely toxic effects will be seen... even
undergo enterohepatic cycling. The decision
making the animal vomit in the car on the
to do this should be on a case-by-case basis.
way to the clinic is a good idea.
Activated charcoal often seems to stimulate
vomiting which should be kept in mind
when a decision is being made to administer
Dexmedetomidine or xylazine can be used
the compound.
to induce vomiting in cats; however, in the
author’s experience neither work very well
Both drugs can have serious cardiovascular
SKIN CONTAMINATION
side effects and the patient should be
carefully assessed prior to administration of Skin contaminants should be rinsed
the drug and monitored for undesirable side thoroughly. Because these compounds also
effects. may be toxic to humans gloves should be
worn. Sedation may be required with cats
and aggressive animals. Make sure if
GASTRIC LAVAGE AND ACTIVATED sedatives are used that there is no
CHARCOAL interaction between the sedative and the
toxin that might preclude its use. In many
Gastric lavage is widely used in small
cases large volumes of warm water will
animals poisoned by ingestion of toxins.
suffice. In some situations washing with a
Experts are beginning to question the value
mild dish soap or pet shampoo may be
of gastric lavage and it is currently not
indicated. Make certain all soaps are rinsed
recommended in human medicine in most
from the fur and the animal should be
situations since studies have failed to
actively dried to prevent hypothermia and
confirm its value. Even when gastric lavage
avoid having the animal lick any residual
can be performed within minutes of
chemicals from the skin during grooming.
ingestion, recovery of the toxin is limited. If
the procedure is not completed within an
hour of ingestion, recovery of many toxins is
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AIRWAY AND BREATHING coagulopathies should received fresh whole

blood (if also anemic) or fresh frozen
On presentation the patient should be
plasma. Patients that are hypoalbuminemic
checked for the presence of a patent airway
may require a combination of synthetic
and adequate ventilation. If the patient has
colloid and albumin replacement depending
an obstructed airway an emergency
on the serum albumin concentration. Blood
tracheotomy may be required. Patients who
pressure and perfusion status should be
do not have a gag reflex should be
returned to normal. Some toxins may cause
intubated. Patients who are not ventilating
hypotension by depressing cardiac function
adequately should have positive pressure
or by causing excessive vasodilation. In this
ventilation instituted immediately. Patients
case positive inotropic drugs, blockers,
with evidence of anemia, cyanosis,
antiarrhythmics, or vasopressors may be
increased respiratory effort, or shock
indicated depending on the toxin. Patients
should have supplemental oxygen provided
that are dehydrated should have their fluid
immediately.
deficit calculated and administered over an
8-12 hour period.

If the patient has signs consistent with

pulmonary edema then furosemide should
Certain toxins can cause hypertension.
be administered intravenously in addition
Systolic blood pressure greater than 200
to supplemental oxygen. If the patient will
mm Hg can lead to significant patient
not tolerate an intravenous injection the
morbidity. The underlying cause should be
drug should be given intramuscularly into
identified if possible in order to treat with
the epaxial muscles. If the patient is
the appropriate drug. Nitroprusside at 0.5-
extremely stressed mild sedation with an
10 mcg/kg/min constant rate infusion will
opioid or acepromazine (if the patient is
lower blood pressure in many patients and
hemodynamically stable) may be indicated.
can be titrated to effect. Acepromazine will
cause hypotension through vasodilation but
can be difficult to titrate. If hypertension is
If the patient has evidence of associated with tachycardia then a
bronchospasm then supplemental oxygen blocker (propranolol at 0.02-0.06 mg/kg
should be provided and bronchodilators IV over 5 minutes) should be given.
should be administered. Aminophylline and Hydralazine, angiotensin-converting
2 agonists can be given parenterally; enzyme inhibitors and calcium channel
however, in the author’s experience blockers may also be helpful in controlling
nebulized 2 agonists tend to be superior hypertension depending on the underlying
to parenterally administered agents. cause. Unfortunately many of these
Aminophylline can cause anxiety and medications are in an oral form only which
tachycardia whereas side effects of 2 may limit their usefulness in the acute
agonists are rare. stages.

CIRCULATION Severe bradycardia (heart rates less than

Patients that are hypotensive may require 50-60 beats per minute) with concurrent
crystalloids and colloids for resuscitation. heart blocks, or bradycardia associated with
Animals that are significantly anemic should hypotension should be treated with
receive red cells. Patients with atropine or glycopyrrolate. Bradycardia
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associated with normal to high blood ventilation should be instituted if the animal
pressure should not be treated with is not ventilating adequately. The patient
anticholinergic drugs. should be placed in a 30 degree body tilt to
help minimize the risk for aspiration.
Pressure on the jugular veins should be
A urinary catheter should be placed and avoided. Patients should be rotated every 2-
urine output monitored if the animal was 4 hours to prevent atelectasis and reduce
exposed to a nephrotoxin. Alkalinizing the the risk for pneumonia. Pressure points
urine by systemic administration of sodium should be padded to minimize the risk of
bicarbonate may aid in excretion of certain pressure sores developing. The eyes should
toxins. The urine pH will need to be be kept lubricated with ocular ointments
monitored in these patients to ensure the and the tongue may need to be kept
goal is being achieved. moistened. Chlorhexidine rinses may help
minimize the colonization of the mouth
with potentially pathogenic bacteria.
SEIZURE MANAGEMENT

Seizures should be controlled using Mannitol may be useful in helping treat

intravenous or intranasal diazepam. If this is cerebral edema.
unsuccessful intravenous phenobarbital
should be given. Both diazepam constant
rate infusions and phenobarbital constant
A nasogastric tube may be indicated for
rate infusions can be given to help maintain
helping with gastric decompression if
control of seizures. The two drugs are
regurgitation or vomiting and aspiration.
synergistic when given together.
The tube also can be used to provide enteral
Phenobarbital loading may be required to
nutrition. Sneezing can raise intracranial
achieve therapeutic phenobarbital levels. If
pressure. This is not an issue for comatose
the animal has never received
patients but if sneezing is not desirable in
phenobarbital before this generally can be
more aware patients then placement of a
achieved by giving 16 mg/kg divided into 4
nasal tube may not be appropriate.
doses given every 20 minutes. (A dose of 3
mg/kg will raise the blood level by
approximately 5 mcg/ml.) If the patient
MANAGEMENT OF TREMORS
becomes excessively sedate or loses a gag
reflex the clinician may prefer not to give Tremors are best controlled by use of
further doses of phenobarbital until the intravenous methocarbamol, diazepam or
patient is more alert. Muscle activity during midazolam. Constant rate infusions may be
recovery from pentobarbital can be easily required to control the tremors. Dosing
confused with seizure activity. should be adjusted to ensure the patient
Levetiracetam is often used instead of does not become anesthetized. If general
phenobarbital due to the high cost of the anesthesia is necessary to control the motor
latter drug. movement the patient should be intubated
to help protect the airway.

MANAGEMENT OF STUPOR AND COMA

Patients who do not have a gag reflex

should be intubated and positive pressure
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MANAGEMENT OF TEMPERATURE the cold oxygen in the circuit and ideally an

ABNORMALITIES air warmer should be placed in the circuit.
Spontaneous ventricular fibrillation can
Hyperthermia may result from excessive
occur if the temperature drops to 28C.
seizure activity, muscle rigidity, malignant
hyperthermia, or a hypothalamic disorder.
The patient should be actively cooled if the
ANTICOAGULANT RODENTICIDE
temperature is above 104F. While the
patient is being cooled appropriate Mechanism of Toxicity: Interferes with
measures to secure the airway, provide production of vitamin K dependent clotting
oxygen, fluids and control seizures or factors (II, VII, IX, X) leading to active
muscle activity should be taken. Cooling can hemorrhage.
be done by running the fluids through an ice
bath, and placing icepacks around the head
and over superficial major vessels such as History and Clinical Signs: Signs relate to
the femoral and brachial arteries. Spraying hemorrhage which can be external or
the patient with water and then placing a internally into any body cavity, tissue space,
fan on the patient will cause evaporative or organ. Clinical signs generally take a
heat loss. Application of topical alcohol minimum of 48 hours to develop and more
should be avoided since it can be absorbed serious signs usually indicate exposure 4-5
systemically leading potentially to alcohol days prior to presentation. Hemorrhage
intoxication. Cooling should be stopped around the larynx can cause an acute upper
once the patient’s temperature reaches airway obstruction. Life-threatening
103F. If the patient’s temperature is in an hemorrhage can occur into the lungs and
extreme danger zone (greater than 105F) mediastinal tissues.
active core cooling may be indicated. This
can be done by administering cold water
enemas and cold water gastric lavage. Specific Diagnostic Tests: Prothrombin time,
These patients frequently develop the activate partial thromboplastin time,
systemic inflammatory response syndrome activated clotting time, PIVKA (proteins
with all of its accompanying complications induced by vitamin K absence or
(hypotension, vasculitis with secondary antagonism) test. Prothrombin time will
albumin loss and third-spacing of fluids, prolong first and return to normal first.
coagulopathy, and multiple organ failure).

Treatment: Animals who have ingested the

Hypothermia can be caused by certain toxin should have vomiting induced.
toxins that depress the patient’s level of
consciousness or reset the hypothalamus.
Certain medications used to treat toxicities
Animals with clinical signs should have
that depress the metabolic rate (opioids,
supportive care provided (see above).
anesthetic agents, etc.) can also lead to
Vitamin K1 should be given subcutaneously
hypothermia. Any patient that has a
at a loading dose of 5 mg/kg followed by 5
depressed level of consciousness should be
mg/kg divided every 12 hours for 2-3 weeks
kept warm with warm intravenous fluids,
for first generation coumarins and 4-6
blankets, warm water circulating blankets,
weeks for second and third generation
etc. Patients that require long term
coumarins. Once the patient is able to take
ventilation can be cooled significantly from
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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oral medications the vitamin K1 can be include muscle fasciculations,

given orally. hyperthermia, and possible seizures.

If the owner is uncertain whether or not the Diagnostic Tests: Stomach contents, urine,
pet actually ingested the toxin or ingested plasma or tissue can be analyzed for
sufficient to induce hemorrhage the metaldehyde.
prothrombin time can be monitored on a
Treatment: Emergency treatment to secure
daily basis for 3 days. If at 72 hours there is
an airway, establish intravenous access and
no evidence of a prolonged prothrombin
control seizures may be required. Gastric
time treatment is not necessary.
lavage should be performed followed by
administration of a single dose of activated
charcoal. Patients should be placed on a
PYRETHRIN
constant rate infusion of methocarbamol or
Source: Insecticides especially flea products diazepam to control the muscle tremors.

Mechanism of Toxicity: Neurotoxin

(prolongs sodium conductance and
GARBAGE
antagonizes GABA)
Mechanism of Toxicity: Bacteria can release
History and Clinical Signs: Pets have usually
endotoxins and exotoxins. Molds can cause
been exposed to topical or premise spray
gastrointestinal irritation, hepatotoxicity or
products. Clinical signs include depression,
neurotoxicity.
muscle fasciculations, salivation, vomiting,
bronchospasm and ataxia. History and Clinical Signs: Signs usually
include vomiting and/or diarrhea.
Treatment: Skin decontamination should be
Endotoxemia can lead to the systemic
performed if this was the route of exposure.
inflammatory response syndrome (SIRS)
Vomiting can be induced if the patient
and multiple organ failure. Certain toxins
ingested the toxin within the previous 1-2
such as botulism can cause muscle tremors,
hours and the animal is neurologically
ascending flaccid paralysis and coma.
stable and able to protect its airway against
possible aspiration and the product did not Diagnostic Tests: Because garbage
contain petroleum distillates. Atropine can intoxication can mimic many other disease
be used to control salivation as long as the processes a full diagnostic workup is
patient is not tachycardic. Most patients indicated.
recover within 24-48 hours with supportive
Treatment: There is no antidote.
care.
Appropriate supportive and symptomatic
care should be provided. This may need to
be very aggressive care if there is evidence
METALDEHYDE
of endotoxemia. Supportive care may be
Source: Slug or snail bait indicated for several weeks if flaccid
paralysis develops. Broad spectrum
Mechanism of Toxicity: Unknown antibiotics such as penicillin, ampicillin
History and Clinical Signs: Signs usually and/or metronidazole are indicated in all
appear within 15 minutes to 3 hours of cases of suspected garbage intoxication.
ingestion. Early signs include anxiety,
salivation, panting, ataxia and possibly
mydriasis and nystagmus. Later signs
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CHOCOLATE cause central nervous system depression

and gastrointestinal irritation. It also
Mechanism of Toxicity: Theobromine is a
inhibits the cytochrome P450 system which
phosphodiesterase inhibitor that causes an
leads to increased production of oxygen
increase in cyclic AMP and a subsequent
radicals. The accumulation of acids can lead
increase in catecholamines. Unsweetened
to a severe metabolic acidosis. The acid
baking chocolate and cocoa contain very
metabolites also interfere with oxidative
high levels of theobromine. Dark chocolate
phosphorylation glucose metabolism and
also contains very high levels. Milk
protein synthesis and are toxic to renal
chocolate contains approximately one-
epithelium. Calcium oxalate crystal
tenth the amount found in unsweetened
deposition occurs in all organs including the
chocolate.
brain. The minimum lethal dose is 1.5 mL/kg
History and Clinical Signs: Vomiting and in cats and 6.6 mL/kg in dogs. Many
diarrhea may be present that are not direct solutions containing ethylene glycol also
causes of the theobromine but are related contain other toxins.
to the dietary indiscretion. Pancreatitis may
History and Clinical Signs: An environmental
be seen depending on the type of chocolate
toxin, exposure typically occurs secondary
that was eaten. Clinical signs include cardiac
to the animal drinking fluid that has leaked
abnormalities (tachycardia, arrhythmias),
from vehicles and drinking from toilets that
central nervous system excitement
have been treated to prevent freezing. Early
(hyperactivity, tremors, seizures), panting,
signs, which can be seen within 30 minutes
and urinary incontinence.
of exposure and may last 12 hours may
Treatment: Appropriate symptomatic and include nausea, vomiting, central nervous
supportive care should be provided. system depression and signs of “being
Activated charcoal should be administered. drunk”. Polyuria and polydipsia may be seen
Electrocardiographic monitoring is secondary to the osmotic diuresis. Signs
indicated in severe intoxications and consistent with renal failure typically
arrhythmias should be treated develop within 12-24 hours in cats and
appropriately. within 36-72 hours in dogs.

ETHYLENE GLYCOL Diagnostic Tests: Serum ethylene glycol

levels can be measured or estimated using
Source: Antifreeze, windshield de-icing a colourimetric test. The colourimetric test
fluid, solvent in many chemical solutions is not sensitive enough for cats although if
the test is positive the cat definitely
ingested a toxic dose.
Mechanism of Toxicity: Ethylene glycol is
oxidized to glycoaldehyde by alcohol
dehydrogenase. Glycoaldehyde is oxidized Treatment: Vomiting should be induced
to glycolic acid and then to glycoxylic acid. within 30 minutes; after that time it is not
Glycoxylic acid is metabolized primarily to likely to be effective due to the raid
oxalic acid, which combines with calcium to absorption rate. Activate charcoal is not
form calcium oxalate crystals. Other end effective. Treatment includes treatment
products include glycine, hippuric acid, and monitoring as for any renal failure
formic acid, oxalomalic acid and benzoic patient. A central line and a urinary catheter
acid. Ethylene glycol is an alcohol that can are advised in order to be able to monitor
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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central venous pressure and urine output

respectively. Primary treatment involves
History and Clinical Signs: Dogs will present
administration of an antidote, either
with signs consistent with liver failure. Cats
ethanol, which acts as a competitive
will present with signs consistent with
substrate for alcohol dehydrogenase, or 4-
methemoglobinemia (cyanosis, respiratory
methylpyrazole, which is an alcohol
distress, brown mucous membranes, brown
dehydrogenase inhibitor. Ethanol has many
blood) as well as facial edema. Cats are
side effects; therefore; 4-methylpyrazole is
extremely susceptible to the drug since they
preferred. The prognosis is excellent if dogs
cannot efficiently metabolize it.
are treated with 4-methylpyrazole within 5
hours and cats within 3 hours. Dialysis is
always advised but is probably unnecessary
if 4-methylpyrazole is being administered Treatment: Appropriate supportive care
early. Dialysis is continued until the should be provided. Gastric
ethylene glycol test is negative which decontamination and activated charcoal
usually requires 24-32 hours of continuous administration are warranted. N-
dialysis. acetylcysteine is given at 240 mg/kg loading
dose followed by 140 mg/kg every 4 hours
for 3 days in dogs or 70 mg/kg every 6 hours
for 3 days in cats. This can be given orally or
ETHANOL
intravenously. Vitamin C at 30 mg/kg orally
Administer 0.6 g/kg 7% ethanol or subcutaneously or 20 mg/kg
intravenously or 0.6 g/kg 20% ethanol orally intravenously may help convert the
as a loading dose. Then begin 100 mg/kg/hr methemoglobin to oxyhemoglobin.
constant rate infusion of 7% ethanol. If Because cimetidine interferes with the
intravenous therapy is not an option metabolism of the acetaminophen its
ethanol can be administered via a administration may be warranted.
nasogastric tube; however, vomiting can be
a problem when given by this route.
Supplement fluids with multiple B vitamins. STRYCHNINE
Treatment should be continued until the
ethylene glycol test is negative (minimum Source: Pesticide
36 hours). Mechanism of Toxicity: Strychnine
antagonizes glycine which is an inhibitory
neurotransmitter. Most signs relate to
ACETAMINOPHEN inhibition of glycine released by Renshaw
cells which are neurons that mediate the
Source: Prescription and over-the-counter
activity of antagonistic muscle groups.
drugs
Inhibition of these neurons leads to
Mechanism of Toxicity: Acetaminophen is uncontrolled muscle contraction. Persistent
metabolized to non toxic and toxic muscle activity can lead to muscle injury,
metabolites. Glucuronidation and sulfation hyperthermia and rhabdomyolysis.
as well as combination of toxic metabolites
with glutathione are key to minimizing the
toxic effects of acetaminophen. The toxic History and Clinical Signs: Early signs
metabolites cause direct cellular death and included anxiety and restlessness. Tonic
methemoglobinemia. muscle contractions of the extensor muscle
groups become evident. A risus sardonicus
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is evident from facial muscle contraction. lavage with a protected airway is preferred
Muscle contractions are worsened by if clinical signs are evident. Muscle
external stimuli. Tetanic contractions of the relaxation can be achieved using
respiratory muscles can lead to apnea. methocarbamol. Diazepam may be
effective. More severe muscle contractions
Diagnostic Tests: Vomitus, stomach
may need to be controlled with
contents, serum, or urine can be analyzed.
pentobarbital. Positive pressure ventilation
Treatment: Appropriate symptomatic and may be required in serious cases. The
supportive care should be provided. patient should be kept sedated in a
Activated charcoal is indicated. Because of darkened, quiet room to avoid exacerbation
the mechanism of action of the toxin gastric of muscle activity.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Índice
BONIE CAMPBELL
Bonnie Grambow Campbell, DVM, PhD, Diplomate ACVS
College of Veterinary Medicine
Washington State University, Pullman, WA, USA

1.3.1. Clinical Applications Of The Amazing Omentum......................................................... 72

1.3.2. Reconstructive Surgery: Skin Grafts ............................................................................ 75
1.3.3. Reconstructive Surgery: Subdermal Plexus Flaps ....................................................... 80
1.3.4. Axial Pattern Flaps ....................................................................................................... 86
1.3.5. Bites, Bullets, & Branches............................................................................................ 91
1.3.6. Maximize Healing With Proper Wound Management ................................................ 95
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Clinical Applications Of The Amazing

Omentum

INTRODUCTION: The omentum is extremely versatile in form and function. Omentalization of

damaged tissues can be readily performed in the abdomen; in addition, the omentum can be
lengthened and passed into the thorax or tunneled subcutaneously to reach just about anywhere
on the body! Potent fluid-absorbing, infection-fighting, and wound healing properties make the
omentum an asset in a wide variety of conditions.

The omentum consists of a mesothelial Inflammation activates omental

membrane (2 cell layers thick) covering a components in a number of ways.
connective tissue framework that contains Lymphoreticular bodies are glomerular-like
scattered fibroblasts, fibrocytes, pericytes, capillary structures in the omentum
and fat cells. Its rich vascular supply interconnected by lymphatic vessels. When
originates from the gastroepiploic and exposed to inflammatory mediators,
splenic arteries and drains into the portal fenestrations open in the vasculature of the
system. The omentum also has an extensive lymphoreticular bodies, allowing entry of
lymphatic system that drains into cranial fluid and particulate matter from the
abdominal lymph nodes. The mesothelial peritoneal cavity and stimulating the
cells have a glycoprotein-polysaccharide resident white blood cells into action. The
coating that allows the omentum to easily extensive network of omental lymphatics
slide over other abdominal organs. The provides a very large absorptive surface and
superficial or ventral leaf of the greater effective peritoneal lymphatic drainage.
omentum attaches to the greater curvature Macrophages in the lymphoreticular bodies
of the stomach and spleen. This leaf extends migrate to the surface of the omentum and
caudally and then folds dorsally on itself to project microvilli into the peritoneal cavity,
become the deep or dorsal leaf, which phagocytosing particulate matter and
attaches to the left lobe of the pancreas and transferring antigens to omental
dorsal body wall. The omental bursa is the lymphocytes for antibody production.
potential space between the two leaves of
the greater omentum. During an abdominal
explore, a hole can be manually torn in an Omentum adheres to inflamed or ischemic
avascular area of the superficial leaf to tissues via activated fibrinogen. This
allow assessment of the left lobe of the adhesion seals off the diseased area from
pancreas and cranial abdominal lymph surrounding tissue, and ensures direct
nodes and vasculature. The lesser access of omental healing factors to the
omentum, a single sheet extending inflamed region. The omentum aids in
between the lesser curvature of the hemostasis by speeding the activation of
stomach and the liver, is much smaller and prothrombin and by applying pressure via
more anchored than the greater omentum. its adhesion. Angiogenic factors released by
the omentum stimulate new vessels to
cross from the omentum into the inflamed
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tissue within 6 hours of omental reaches beyond the distal extremities and
attachment, and omental neurotropic the muzzle.
factors appear to stimulate reinnervation
and may modulate pain.
A common use of omentum in veterinary
medicine is placement of the omentum over
Omentalization is the process by which the sutured surgical sites in hollow organs such
omentum is placed in a specific site by the as the intestine or bladder. The omentum
surgeon. The omentum should always be adheres to the incision site, which benefits
kept moist and handled gently, with care from the omentum’s hemostatic and
taken to preserve its blood supply. The angiogenic effects. The omentum also
moldable nature of the omentum allows it prevents leakage of luminal contents
to be placed in or around a variety of organs through small gaps in the incision and
or defects, although care should be taken to prevents peritonitis by dealing with local
avoid 360 degree wrapping of a luminal bacterial contamination. Overlay of
organ out of concern for stricture. While the omentum can also prevent adhesions from
omentum readily adheres to sites of forming between the surgical site and other
inflammation, it may also be sutured into organs or the body wall. While the
place with 3-0 or 4-0 absorbable suture. omentum will likely adhere to surgical sites
When passing the omentum out of the with no help from the surgeon, deliberate
abdomen, the hole made in the diaphragm omentalization ensures immediate and
or abdominal wall should be large enough complete contact between the omentum
to prevent compromise to omental vessels and operated area.
and yet small enough to prevent herniation
of abdominal contents. For protection
during subcutaneous tunneling to distant When placed in an abscess, the omentum’s
sites, the omentum can be temporarily extensive vascular and lymphatic networks
placed in the lumen of a large, moistened absorb fluids (often precluding the need for
Penrose drain. drain placement) and actively fight
infection. The abscess should first be
debrided to the degree possible and
When needed, the omentum can be lavaged, and then omentalized, putting
unfolded and extended to twice its normal omentum in contact with the inner surface
length. One lengthening technique involves of the abscess. This technique has led to
dissecting the deep leaf of the omentum resolution of abscesses in the liver,
away from the left lobe of the pancreas to prostate, uterine stump, and pancreas of
create an omental pedicle flap based on the dogs and cats without the need for
left gastroepiploic artery. If still more length synthetic drains. Similarly, omentalization
is needed, an inverted L-shaped incision is has been used to resolve intra-abdominal
made in the extended omentum, with the cysts in a variety of locations (liver, prostate,
base of the L parallel to the greater sublumbar lymph nodes, perinephric); the
curvature of the left side of the stomach, cyst is first deroofed and debulked to the
and the arm of the L dividing the omentum degree possible, and then omentalized.
in half for two-thirds of its extended length.
The left side of the omentum is then rotated
caudally. When fully extended in this Omental use is not limited to the abdominal
manner, the canine omentum typically cavity. The omentum can be brought into
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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the thorax by passing it through a small hole was spread out and sutured to the
made in the diaphragm. Indications might periphery of the wound. Thoracic wall
include the need to provide additional defects in dogs repaired with mesh or
continuous drainage for chylothorax, or to porcine submucosal bioscaffold have been
deliver the healing and sealing powers of reinforced with omentum tunneled
the omentum to organs like the esophagus, subcutaneously to the affected site. The
which is normally a poor healer. Chronic omentum has also been exteriorized to
axillary wounds in cats resolved after serve as the vascular bed for a full thickness
omentalization +/- a thoracodorsal axial meshed skin graft on the back of a dog. Free
pattern flap; the unfolded omentum was pieces of non-vascularized omentum placed
passed through a small hole in the around experimental nonunion fractures in
abdominal wall and tunneled dogs significantly enhanced fracture
subcutaneously to reach the axilla, where it healing.
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Reconstructive Surgery: Skin Grafts

INTRODUCTION: Skin grafts are pieces of skin that are totally removed from a donor site and
placed in a recipient site. In veterinary medicine, skin grafts are routinely autografts, i.e. the
donor and recipient are the same individual. Partial thickness grafts contain complete
epidermis and a portion of dermis, while full thickness grafts contain the complete epidermis
and complete dermis. Full thickness grafts are most commonly used in dogs and cats because
they provide a more cosmetic repair and because these species have elastic skin that makes it
relatively easy to close the donor site. Full thickness grafts contain adnexal structures and can
ultimately result in robust, furred skin at the grafted site.

INDICATIONS FOR SKIN GRAFTS interstitium of the graft. Because the newly-
placed graft has no draining blood or lymph
Closure options for wounds include
vessels, the graft becomes edematous.
undermining, walking sutures, releasing
Absorption of heme products and lack of
incisions, subdermal plexus flaps, and axial
circulation cause the graft to turn blue-
pattern flaps. Skin grafts are indicated these
tinged.
options will not work or when second
intention healing would take too long, result
in a fragile epithelial cover subject to
Inosculation, which begins on 1 or 2 days
recurrent injury, or lead to scarring that
after grafting, is the process by which pre-
might compromise movement or function.
existing blood vessels in the granulation bed
anastomose with pre-existing vessels in the
skin graft. It establishes sluggish blood flow
HEALING OF THE GRAFT
to and from the graft. The graft becomes
As soon as the graft is removed from the less edematous and redder in color as these
donor site, degeneration of the graft tissue vascular connections are established over
begins. Revascularization of the graft must the first week.
occur within 7 to 10 days in order for the
graft to ‘take’ (i.e. to be established as a
viable piece of skin in the recipient site). Neovascularization begins on day 2 to 4
after grafting. New blood vessels and
lymphatics grow from the wound into the
Starting immediately after grafting and graft, providing a much more substantial
continuing for several days, the graft blood supply and allowing the graft to
survives via plasmatic imbibition, in which return to normal color during the second
fibrinogen-free serum moves from the week after grafting.
wound into the open ends of pre-existing
blood vessels in the graft via capillary
action. The fluid then moves into the
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Contact between the graft and wound bed donor site is one with redundant skin that
is initially maintained by a fragile meshwork can be closed after the graft is harvested
of fibrin, which helps support the vessels and in an area that is accessible when the
involved in inosculation. With time, patient is positioned for surgery on the
fibroblasts and endothelial cells migrate wound. Skin on the lateral thorax or lateral
into the fibrin and produce granulation abdominal wall is commonly used as graft.
tissue that solidifies the connection If multiple donor sites are available, chose
between wound bed and graft. The graft the one which best matches the recipient
also becomes stabilized by ingrowth of new site in color and length of fur.
vessels and by granulation tissue growing
up into the graft’s mesh holes. Sutures,
bandages, and negative pressure wound MESHED SHEET GRAFTS (FIG. 1)
therapy provide additional stability.
A meshed sheet skin graft is cut to match
the size and shape of the wound to be
grafted. Make a template of the wound
PREPARATION OF THE WOUND BED AND
using sterile paper (e.g. from surgery
DONOR SITE
gloves). Place the paper on the wound, let it
A graft relies on the wound for its survival, soak up blood, then cut out the wound
so the wound bed must be healthy. Good shaped from the paper. Lay the cut-out on
graft beds include healthy granulation the donor site, orienting it so the correct
tissue, healthy muscle, healthy periosteum, side of the paper is up (if you accidentally
and healthy peritenon. A freshly-made turn the paper over, your graft will be
wound that is capable of developing shaped like a mirror image of the wound!)
granulation tissue can support a skin graft and so the fur will grow in the desired
as well. Skin grafts have also been direction when the graft is moved to the
successfully used over an omentalized recipient site. Trace the cut-out on the
wound. Contamination, infection, exudate, donor skin with a sterile marker.
poorly vascular tissue (e.g. tendon,
ligament, bone without periosteum),
exposed joint, and/or chronic granulation
tissue are all contraindications for grafting.
Crania
↑

Gentle scraping of the granulation surface

with an angled scalpel blade can remove
surface biofilm and perhaps help plasmatic
imbibition. To decrease the risk of a
hematoma forming between the graft and
Figure 1. Meshed skin graft sutured to the
graft bed (which would block inosculation),
caudal portion of a wound on the dorsum
it may be better to do the scraping a day or
of a dog. (Dog is in ventral recumbency).
two before grafting Trim the skin edges of
The graft was taken from the lateral torso
the wound to provide a fresh edge that will
(donor site not in photo). A sliding
heal to the edge of the graft.
advancement flap was used to close the
cranial part of the wound.

Clip and prep the donor and recipient sites

as for any surgical procedure. The ideal
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Incise the donor skin along the tracing and from the graft to the wound bed, which
excise the skin graft immediately deep to interfere with graft/wound contact and can
the dermis. Leave as much subcutaneous induce hematoma which separates the graft
tissue in the patient as possible because it and wound further. The mesh holes
will interfere with plasmatic imbibition and preclude the need for a drain under the
inosculation. Cover the donor site with graft.
moist gauze until you are ready to close it.

PUNCH GRAFTS (FIG. 2)

Place the skin graft dermis-side up onto a
Punch grafts are small (2 -6 mm diameter)
sterilized wooden block, thick cardboard,
plugs of skin that are planted in the wound
cork board, or huck towel. Pin the graft in
bed. Multiple rows of punch grafts are
place with hypodermic needles. Scrape off
typically placed. Unlike sheet grafts, which
any subcutaneous tissue remaining on the
require a donor site that is approximately
dermis with a scalpel blade held at an acute
the size of the wound, punch grafts can be
angle. When all of the subcutaneous tissue
harvested from multiple smaller areas of
is removed, the exposed dermis will look
available skin. Indications for punch grafts
white and ‘pebbly’ due to the pattern of hair
include a wound in a high motion area (e.g.
follicles. Keep the dermal surface moist with
overlying a joint), a wound with a highly
sterile saline as you work.
contoured surface, or when there is not an
adequately sized donor site. Because punch
grafts are set down into the granulation
Next, mesh the graft with a scalpel while the
tissue, their contact with the wound bed is
graft is pinned to the block. Cut staggered
less likely to be disrupted by movement
rows of 0.5 – 2 cm long holes that are 0.5 –
than a meshed sheet graft lying on the
2 cm apart. Benefits of meshing include: (1)
surface of the wound.
allowing fluid to drain instead of
accumulating deep to the graft, where it
would interfere with inosculation and
revascularization and be a media for
bacteria, (2) making the graft more flexible
so that it maintains contact with the wound
bed in a contoured defect, and (3)
expanding the graft so that it covers a wider
surface area. The longer the mesh holes, the
more the graft will increase in width and
decrease in height - take this into account
when planning the overall size of the graft.

Place the meshed skin graft in the wound Figure 2. Multiple punch grafts implanted
bed and attach it to the wound edges with in the granulation bed of a wound on the
staples or simple interrupted or cruciate cranial surface of the elbow in a dog. A
non-absorbable monofilament sutures. splint will be added to the bandage to
Make sure the graft is in good contact with prevent joint motion during healing.
the wound bed, not taut so that it is pulled Punch grafts are easily harvested with a
out of the wound bed. Avoid tacking sutures dermal biopsy punch. Angle the punch
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parallel to the hair follicles to can increase any movement between the graft and the
the number of follicles per punch graft. graft bed, which can readily shear off the
Punch grafts can also be collected by tenting fragile new vascular connections that are
the skin with forceps or a suture needle and key to survival of the graft. Because even a
cutting off the elevated skin with a scalpel gentle bandage change can disrupt healing,
blade. As for sheet grafts, any subcutaneous the bandage is not changed for the first 2 to
tissue still attached to the punch graft must 3 days unless absolutely necessary (e.g.
be removed; hold the punch graft on its side bandage is badly soiled or there is marked
against the sterile board with a pair of strike-through). The potential for
thumb forceps and cut off the subcutis with movement between graft and graft bed is
a scalpel blade. Make small stab incisions further minimized by cage confinement of
into the granulation bed of the wound, and the patient in the hospital, sedating a
insert the subcutis-free punch graft; no patient that is too active, placing a splint or
sutures are used. It is helpful to plant the bi-valved cast for grafted wounds on or near
grafts on the bottom of the wound first, and joints, and an Elizabethan collar.
then move upward; this prevents bleeding
from the top row of grafts from running
down on the second row as you are working A petrolatum-impregnated dressing on the
on it. Compared to mesh sheet grafts, the graft is a good choice because it is non-
cosmetic result for punch grafts is not as adherent and keeps granulation tissue
good. Hair growth tends to be sparse and moist (thus speeding healing) without
patchy with punch grafts, and since it is macerating the skin. The grafted skin
difficult to maintain orientation of punch typically returns to normal appearance in 3
grafts as they are planted, hair is likely to to 4 weeks. Because of altered sensation
grow in multiple directions. There also that can occur as the graft is reinnervated,
tends to be more areas of thin epithelial it is advisable to keep the site bandaged for
scar with punch grafts once healing is ~ 4 weeks to prevent licking. (Splints can be
complete. removed after 2 weeks if there are no
associated orthopedic injuries).

The punch graft technique can also be used

to harvest grafts from healthy digital paw Negative pressure wound therapy is a good
pads for wounds in the main metacarpal or way to pull the graft down against the
metatarsal foot pad. Sutures are typically wound bed and eliminate motion. It also
needed to secure paw pads grafts in place. results in faster healing of the graft with less
The grafted pad should be protected from necrosis.
weight bearing with an extended splint or
bi-valve cast.
The early blue, edematous appearance of
the graft can be disconcerting, but it is
POSTOPERATIVE MANAGEMENT OF SKIN normal. The viability of the graft is hard to
GRAFTS assess for the first 7 to 10 days. It is not
uncommon for some regions of the graft to
Bandages and activity restriction are
fail and turn into a black, leathery eschar. In
absolutely required for skin grafts. The
the absence of signs of infection, the eschar
bandage helps maintain moisture in the
can be left in place as a biological bandage.
granulation tissue exposed in the mesh
Often, granulation tissue develops deep to
holes, absorbs drainage, and guards against
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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the eschar, and the area can be re-grafted if CLIENT COMMUNICATION ON GRAFTING
it is not small enough to heal by second
As always, good client communication is
intention. With partial thickness failure of
important. Graft success is not guaranteed,
the graft, the epidermis and superficial
and the possibilities of partial or total graft
dermis die, but the deeper dermis is
failure and subsequent need for a second
revascularized and survives. In this case,
surgery should be discussed. The critical
new epithelium will grow from adnexae in
importance of minimizing the patient’s
the grafted dermis, but hair growth may be
activity as the graft becomes revascularized
spotty.
should be conveyed. Clients should be
prepared for the size and location of the
donor site wound. They should also be
If the graft develops a superficial infection,
advised of the expected cosmetic
it can be cleaned with 0.05% chlorhexidine
appearance of the graft site once it heals
solution and treated with topical antibiotics
(e.g. spotty hair for punch grafts,
with good chance of survival. When an
anticipated changes in hair color or
infection develops deep to the graft,
direction of hair growth).
bacterial enzymes dissolve the fibrin that
helps hold the graft to the wound and
stimulate exudate that blocks inosculation.
In summary, appropriate wound selection,
Treatment of deep infection includes lavage
proper graft preparation and placement,
and systemic antibiotics, but if the infection
and diligent protection of the graft
is not responding, the graft needs to be
postoperatively will maximize grafting
removed.
success.
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Reconstructive Surgery: Subdermal Plexus

Flaps

GENERAL PRINCIPLES: Preservation of blood supply is

crucial for success in reconstructive surgery. In dogs
and cats, direct cutaneous arteries emerge from deep
tissues, turn parallel to the skin, and run in the
cutaneous muscle, sending innumerable branches
(the subdermal plexus) to the overlying dermis and
epidermis (Fig. 1). To preserve blood supply when
undermining the edges of a wound or raising a flap,
dissect immediately deep to (dashed line) the
cutaneous muscle. This preserves the blood supply to the elevated skin. Do not be fooled by the
layer of subcutaneous tissue that may be between the cutaneous muscle and the dermis;
undermining in this superficial fat cuts off the skin’s blood supply. If there is no cutaneous muscle
(e.g. limbs), undermine deep to all of the

Fig 1.Blood supply to the skin. subcutaneous tissue, just superficial to the muscle fascia, to
preserve blood supply.

The viability of subdermal plexus flaps (SPF)

depends on the many small vessels of the
SINGLE PEDICLE SLIDING ADVANCEMENT
subdermal plexus; thus, a relatively wide
FLAP AND H-PLASTY
base of attachment is needed to provide
adequate blood supply. In order to preserve A single pedicle sliding advancement flap
blood supply, keep the length (longer side) (Fig. 2) is rectangular and used when the
to width (shorter side) ratio of a subdermal long axis of available skin is aligned with the
plexus flap less than or equal to 2:1. Suture long axis of the wound. The flap width (W)
the flap to the wound first, then close the is made to equal the width of the wound.
donor site (if undermining of the donor site The flap length (L) is no more than twice its
edges is needed to decrease tension, width. When the flap is advanced into the
undermine deep to the cutaneous muscle). wound, tissue bunches up and create dog
ears at the corners of the flap’s base.
Avoid putting tacking or walking sutures on
Burrow’s triangles can be cut to remove this
the underside of a flap, as there is a risk of
excess tissue and allow a smooth closure.
comprising its blood supply. Walking
The triangles must be made in the skin
sutures can be used more safely on the edge
outside of the flap; if they are made within
of the flap, where it is being sutured to the
the base of the flap itself, the blood supply
wound edge. If there is a lot of dead space
to the flap will be compromised. An H-plasty
deep to a flap, a drain (preferably a closed
(Fig. 3) is created with two single pedicle
active suction drain) may be placed.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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advancement flaps coming from opposite into account when assessing the amount of
directions. For the H-plasty, each flap covers wound coverage the flap will achieve.
a portion of the wound, but the division
does not have to be 50:50.
V-to-Y PLASTY

With a V-to-Y plasty, an isthmus of skin is

created between the wound and a V-
shaped-incision, undermined, and
advanced to cover the wound. Step 1: make
a V-incision (dashed line) that spans the
wound, with the open side of the V facing
the wound. The V-incision is placed far
enough away from the wound that (1) the
isthmus of skin between the wound and the
V-incision is large enough to fill in the
wound (A=A, B=B, C=C) and (2) the width of
Fig 2. Single pedicle Fig. 3. H- each attachment of the isthmus is large
sliding advancement plasty. enough to support at least half the length of
flap. the isthmus, as per the 2:1 rule. Step 2:
TRANSPOSITIONAL FLAP Undermine the isthmus of skin (staying
deep to the cutaneous muscle). Step 3:
Move the isthmus of skin into the wound.
The original V will expand into a chevron.
Step 4: Suture the isthmus to the original
wound. Step 5: Undermine the chevron and
close it by suturing in from each corner.
Step 6: The result is a Y-shaped incision
where the V was originally made.

Step 1
Fig. 4. Transpositional flap.

A transpositional flap is used when the

available skin is oriented up to 90 degrees
from the long axis of the wound (Fig. 4). The
width of the flap is made to match the width
of the wound, and the length to width ratio
of the flap is no more than 2:1. Once
elevated, the transpositional flap is pivoted
on its base and into the wound; the flap will
cross over intact skin as it is rotated. The
closer the transpositional flap is to 90
degrees relative to the wound, the more the
flap will effectively shorten when it is
rotated. This shortening should be taken
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Steps 2 & 3 The Z has 3 parts: the central limb and two
arms. The 3 parts are equal in length and the
arms are at ~60○ to the central limb. Fig. 5
shows a wound being closed with two
opposing Z-plasties made adjacent to a
wound. The Zs are oriented to meet two
criteria: (1) central arm is parallel to the
direction you want the skin to move and (2)
one arm is tangent to the defect (Fig. 5A).
After incising the Z’s the position of the
resulting triangles are switched (A with B, C
Steps 4 & 5
with D), filling the defect with triangles A
and D (Fig 5B).

Step 6

Fig. 5. Two Z-plasties used to close a

circular defect. (A) The block arrows
indicated the direction the skin needs
to move. Two Zs are drawn in red on
either side of the defect, with their
central arms parallel to the direction
the skin needs to move. The Zs are
positioned so that one arm is tangent
Z-PLASTY to the defect (this arm will not need to
be incised as it has already been ‘cut’
A Z-plasty moves skin in the direction of the by the wound). Two triangles are
central axis of the Z by breaking up a line of formed within each Z (A and B, C and
tension. It is particularly useful for wounds D) (B) After incising the Zs, the triangles
on the limb or perineum where there is skin were undermined and their positions
proximal or distal to the wound that could switched (A with B, C with D) to fill in
be used to close the defect if only the the defect.
tension that would be generated by pulling
that skin into the wound was alleviated.
While it may not look like much, the Z-plasty
A Z-plasty can also be made at a distance
can be very useful in tight spots!
from the wound, creating an isthmus of skin
that can be moved into the wound. Just as
with the V-to-Y plasty, each isthmus
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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attachment must be wide enough to supply moved into wounds on the body wall or
blood to at least half the isthmus length, as proximal limbs. Each skin fold has two sides
per the 2:1 rule. The central limb of the Z is (lateral and medial); you can slide these two
placed along the line of tension that is sides relative to each other. Each side has
palpable as you attempt to pull the desired two points of attachment (to the body wall
skin into the wound (Fig. 6). and to the adjacent limb). Cut two or three
of the four attachments (often, one
A B
attachment lies along the wound and thus is
already ‘cut’), gently separate the lateral
and medial sides, unfold the flap, spread
onto the wound, and suture in place. The
absence of skin folds does not cause any
changes in ambulation. By altering the point
C D of attachment that is preserved, these flap
can be rotated into wounds on the lateral or
ventral torso or lateral or medial proximal
limbs.

Fig. 6. A Z-plasty was used to break-up a

line of tension distant from the wound.
(A) A left perineal wound was created by
the resection of a soft tissue sarcoma in a
dog. (Dog is in right lateral recumbency,
dorsal is to the right in all photos). There
was too much tension to close the wound
directly. (A) A Z-incision was made on the
caudal left thigh, with the central arm
over the line of tension that kept the skin
from the limb from being moved into the
wound. This created triangles X and Y,
which were undermined. (B, C) By
switching the positions of X and Y, the
tension distal to the wound was broken
up and the limb skin could be moved into
the wound. (D) The wound was closed
first and the Z-plasty site was closed
second.

SKIN FOLD FLAP

Skin fold flaps use the redundant piece of

skin between the torso and forelimb
(axillary skin fold) or torso and hindlimb
(flank or inguinal skin fold) (Fig. 8). When
unfolded, the skin fold provides a large,
mobile piece of expendable skin that can be
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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undermine the flap as you go; you may not

need to incise the whole flap to get the
wound covered. The length (height) to
width (base) ratio of the flap should be <
2:1.

Fig. 9. Rotational flap

INTRA- AND POST-OPERATIVE

CONSIDERATIONS FOR SUBDERMAL
PLEXUS FLAPS & AXIAL PATTERN FLAPS

Reconstructive surgery patients should be

clipped and draped extra-wide because the
undermining, stretching, and rotation of
skin during flap movement may mobilize
Figure 8. Skin fold flaps. (A) Four drawings more skin than initially anticipated, and
show how an axillary skin fold flap can be because the original surgical plan may need
used to cover a wound on the lateral thorax to be changed intraoperatively. Make sure
by preserving its attachment to the medial excess skin is free to be pulled into the
body wall, and how an inguinal skin fold flap wound and not trapped under the patient
can be used to cover a wound on the lateral when positioned on the operating table. A
hindlimb by preserving its attachment to the sterile skin marker and sterile ruler are used
medial limb. (B) For this left lateral thigh to draw lines before cutting; as in carpentry,
wound, the inguinal skin fold flap was cut you want to “measure twice, cut once”.
along the lateral and medial attachments to After being elevated, skin flaps will shrink in
the body wall (purple ink) and left attached size, but they can be expanded back to their
on the medial side of the limb. The original dimensions when sutured to the
attachment to the lateral side of the limb is wound.
along the wound, and thus was already
‘cut’. X and Y mark the dorsal and ventral
sides of the flap before rotating. Penetrating towel clamps can be used to
hold skin flaps in place, try different
ROTATIONAL FLAP orientations of the flap in the wound to see
A rotational flap can be helpful for which works best, and stretch skin intraop.
triangular wounds (Fig. 9). The base of the Take into account the patient’s normal
flap is in line with the base of the wound, standing position and the forces that occur
and the arc, which is an extension of the during walking to determine the optimal
shortest side (x) of the defect, is 4x long. flap position. Be sure to keep the wound
Start incising on the wound side and bed and the underside of the flap moist
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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during the procedure. If you are having

trouble closing a wound, try releasing a few
Bandages are not needed for all skin flaps,
towel clamps or a restrained limb.
and in some cases may be contraindicated.
Sometimes this is all you need to allow
Advantages of bandages include keeping
tissue to close without tension.
the incision and drain sites clean, keeping
the pet from chewing/licking, and
decreasing dead space (thus preventing
Pain can be significant with reconstructive
seroma formation). The main disadvantage
surgery, so intra- and post-operative
of bandages on skin flaps is the risk of
analgesia is a must. An epidural can be very
compromising blood supply, which can be
helpful. Postoperatively, a continuous rate
very serious. When put on too tight, a
IV infusion of fentanyl or an
bandage can lead to flap failure due to
opiod/ketamine/lidocaine combination
interference with capillary perfusion,
may be needed. At minimum, systemic
venous and lymphatic drainage, or the
analgesics (e.g. opiods) are given for the
direct cutaneous artery. Even when a
first 24 to 48 hours. Non-steroidal anti-
bandage is placed with the proper level of
inflammatory drugs (NSAIDs) may be added
pressure, movement by the animal may
to the opiods in patients without renal,
cause intermittent vascular compression.
hepatic, or gastrointestinal disease.
Thus, ‘less is more’ for skin flap bandages.
Bupivicaine can be injected into a wound
Commonly, a stockinette shirt is all that is
diffusion catheter every 6 hours for topical
needed to protect the surgery site.
analgesia. Oral analgesics are given for 1-2
weeks.

Before surgery, clients should be prepped

about the importance of seriously
Skin flaps may initially look bruised due to
restricting the patient’s activity, monitoring
the decreased blood supply. The most
the surgery site, and keeping follow-up
vulnerable site is the point furthest away
appointments. If client compliance is a
from the flap’s attachment to the body (and
concern, suggest hospitalization of the pet
thus its blood supply). Flap failure flap is
for one or two weeks postoperatively, as
indicated by progressive transition of the
this is the critical healing period for flaps.
affected skin to black. As long as there is no
Clients should also be made aware of the
sign of infection under the dying part of a
potential for a portion of a flap to fail, which
flap, it can be left in place as a biological
might necessitate a second surgery. Finally,
bandage. If there is any concern for
they should told of expected cosmetic
infection underneath, the necrotic portion
changes: large amounts of hair will be
is removed and the open wound is managed
clipped and use of flaps may lead to changes
with moist wound healing techniques until
in color pattern, direction of hair growth,
it heals on its own or is ready for revision
and length of hair in a given location.
surgery.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Axial Pattern Flaps

GENERAL PRINCIPLES: vein as the flap is elevated and the base of

the flap is reached. The deep side of the flap
Unlike subdermal plexus flaps [See
should be kept moist with sterile saline.
proceedings on Subdermal Plexus Flaps by
Once elevated, the APF is ready to be
Dr. Campbell], which can be made just
rotated into the wound.
about anywhere on the skin, axial pattern
flaps (APF) are located where a specific A)
direct cutaneous artery will enter their
base. The advantage of this placement is a
robust blood supply; as a result, an APF can
be much longer than a SPF and can be used
in wounds that lack a healthy granulation
bed and/or that have exposed bone or
tendon. The shape and size of the APF is
prescribed by that artery’s angiosome (i.e. B)
the area of tissue that will survive if that
artery is its only source of blood). Most
surgery textbooks provide the ‘recipe’ of
where to cut to create each APF. The
instructions for commonly used APFs are
shown in Table 1. When measuring whether
an APF will cover a given wound, take into C)
account the fact that the more the APF is
rotated to reach the wound, the more it will
shorten in length.

After incising the proscribed borders of an

APF, the APF is elevated starting at its most
distal location and working back to its base
(which contains the entry of the direct
cutaneous artery). If the APF is in a region Fig. 1. Caudal auricular axial pattern flap and
where there is a cutaneous muscle, the flap bridging incision for a wound on the caudal
intermandibular region. (Dog is in dorsal
is elevated by dissecting deep to the
recumbency with cranial to the right). (A) A
cutaneous muscle, so that this muscle (and
caudal auricular APF has been elevated from its
the subdermal plexus it contains) is kept donor site. There is intact skin (*) between the
with the skin. If there is no cutaneous flap base and the wound. (B) A bridging incision
muscle, dissection is done between the (*) is made in the intact skin to create a path for
subcutaneous tissue and underlying muscle the flap. (C) The flap has been sutured to the
fascia (so that the subcutaneous tissue is wound (#) and bridging incision (*). The donor
kept with the skin). Extreme care is taken to site (^) has been closed. A Jackson Pratt drain
not damage the direct cutaneous artery and exits dorsal to the donor site.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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If there is a section of intact, unwounded APF, freeing the flap from all skin
skin between the base of the APF and the attachments and leaving the direct
wound, a bridging incision is made (Fig. 1). cutaneous artery & vein as the only
Because the entire underside of the APF connection between the flap and the body.
needs to be in contact with subcutaneous or Care is taken not to kink off the vessels as
deeper tissue (i.e. not skin) when it is laid in the island APF is rotated into place.
place, a section of the intervening intact
skin is excised to create a non-skinned path
from the base of the APF to the wound. The If the recipe for the borders of the APF has
region of intact skin that is removed is called been followed, the donor site should be
a “bridging incision”. able to be closed routinely after some
undermining of the edges.
In order to avoid damage to the blood
supply, tacking sutures should not be used
to secure the flap in the wound bed.
Instead, a closed active suction drain (e.g.
Jackson Pratt drain) is used to eliminate CAUDAL SUPERFICIAL EPIGASTRIC FLAP
dead space deep to the flap, preventing
seroma and sucking the flap down against The axial pattern flap based on the caudal
the wound bed to allow the two to heal superficial epigastric (CSE) artery is the APF
together. The drain should be placed before most commonly used in veterinary
the flap is sutured to the wound edges. The medicine. This flap can be used to cover
drain should not be exited through the any wounds on the body wall, perineum, and
part of the APF (Fig. 2C).

After placing the drain and rotating the APF

into the wound, the APF is shifted until the
best, tension-free fit is found. Penetrating
Figure 2. Caudal superficial epigastric flap.
towel clamps can be used to temporarily
clamp the APF to the wound edges to assess hindlimbs.
different positions. Once the best fit is
The CSE artery) emerges from the deeper
found, the clamps can be replaced by single
tissues in the inguinal area (Fig. 2). The
sutures to hold the APF spread out in the
‘recipe’ for making a CSE flap starts with an
desired location. The edges of the APF are
incision along the ventral midline from the
then sutured to the edges of the wound in a
level of the CSE artery to a level midway
2 or 3 layer closure (cutaneous muscle,
between the first two mammary glands. A
subcutaneous tissue, skin), using
parallel incision is made lateral to the
absorbable suture in the deeper tissues and
nipples, such that the distance of the lateral
non-absorbable suture or staples in the
incision from the nipples equals the
skin.
distance from the nipples to the ventral
midline. The cranial aspects of these two
incisions are connected between mammary
Sometimes, an APF cannot be rotated all the
glands 1 and 2, and the flap is elevated back
way to the wound because it is too
to the CSE artery. Because there is no
restrained by the uncut skin at its base.
cutaneous muscle in this area, the flap is
When this occurs, an island flap can be
elevated deep to all of the subcutaneous
created by cutting the skin at the base of the
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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tissue (and the mammary glands contained birth, the mammary glands will be
therein), immediately superficial to the functional, but they will be located at the
external rectus fascia of the body wall. This site to which the flap was relocated.
means that all subcutaneous tissue and the
mammary glands stay with the skin (Fig. 6).
If the patient is an intact female and gives

Other common axial pattern flaps include the thoracodorsal APF, omocervical APF, and caudal
auricular APF (Table 1).

Table 1. Common axial pattern flaps.

Borders
Caudal superficial epigastric Medial Runs craniocaudal along the ventral abdominal midline.
The flap is based where the
caudal superficial epigastric artery Measure the distance from the ventral midline to nipple,
emerges from the inguinal canal. Lateral move that distance lateral to the nipple, and draw the lateral
border parallel to the medial border.
Use for wounds on the abdomen, Connect the lateral and medial borders between the cranial
Cranial
perineum, hindlimbs. two mammary glands.

Cranial Runs dorsoventral along the scapular spine.

Thoracodorsal axial pattern flap
Based where the thoracodorsal a. Measure the distance from the scapular spine to the caudal
emerges in the depression just edge of the scapula, move that distance caudal to the
Caudal
caudal to the scapula at the level scapula, and draw the caudal border parallel to cranial
of the acromion. border.
Connect the cranial and caudal borders along the dorsal
Use for wounds on the torso midline (this flap can also be extended to the opposite
Dorsal
(cranial half), forelimbs. shoulder or into an L-shape along the dorsal portion of the
opposite body wall).

Caudal Runs dorsoventral along the scapular spine.

Omocervical axial pattern flap
Measure the distance from the scapular spine to the cranial
Based where the omocervical a.
edge of the scapula, move that distance cranial to the
emerges in the depression just Cranial
scapula, and draw the cranial border parallel to caudal
cranial to the scapula at the level
border.
of the acromion.
Connect the cranial and caudal borders along the dorsal
midline (this flap can also be extended to the opposite
Use for wounds on the neck, Dorsal
shoulder or into an L-shape along the dorsal portion of the
thorax, forelimbs.
opposite body wall).

Caudal auricular axial pattern Two parallel craniocaudal lines that outline the central third
flap of the lateral side of the neck; the distance between the
Dorsal
Based where the caudal auricular dorsal border and the depression between the atlas and
and
a. emerges in the depression vertical ear canal equals the distance between the ventral
ventral
between the wing of the atlas and border and the depression between the atlas and vertical
the vertical ear canal. ear canal.
Connect the dorsal and ventral borders at the level of the
Use for wounds on the head, Caudal
spine of the scapula.
neck.
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INTRA- AND POST-OPERATIVE inflammatory drugs (NSAIDs) may be

CONSIDERATIONS FOR AXIAL PATTERN added to the opiods in patients without
FLAPS & SUBDERMAL PLEXUS FLAPS renal, hepatic, or gastrointestinal disease.
Bupivicaine can be injected into a wound
Reconstructive surgery patients should be
diffusion catheter every 6 hours for topical
clipped and draped extra-wide because the
analgesia. Oral analgesics are given for 1-2
undermining, stretching, and rotation of
weeks.
skin during flap movement may mobilize
more skin than initially anticipated, and
because the original surgical plan may
Skin flaps may initially look bruised due to
need to be changed intraoperatively. Make
the decreased blood supply. The most
sure excess skin is free to be pulled into the
vulnerable site is the point furthest away
wound and not trapped under the patient
from the flap’s attachment to the body
when positioned on the operating table. A
(and thus its blood supply). Flap failure flap
sterile skin marker and sterile ruler are
is indicated by progressive transition of the
used to draw lines before cutting; as in
affected skin to black. As long as there is no
carpentry, you want to “measure twice, cut
sign of infection under the dying part of a
once”. After being elevated, skin flaps will
flap, it can be left in place as a biological
shrink in size, but they can be expanded
bandage. If there is any concern for
back to their original dimensions when
infection underneath, the necrotic portion
sutured to the wound.
is removed and the open wound is
Penetrating towel clamps can be used to managed with moist wound healing
hold skin flaps in place, try different techniques until it heals on its own or is
orientations of the flap in the wound to see ready for revision surgery.
which works best, and stretch skin intraop.
Take into account the patient’s normal
standing position and the forces that occur Bandages are not needed for all skin flaps,
during walking to determine the optimal and in some cases may be contraindicated.
flap position. Be sure to keep the wound Advantages of bandages include keeping
bed and the underside of the flap moist the incision and drain sites clean, keeping
during the procedure. If you are having the pet from chewing/licking, and
trouble closing a wound, try releasing a decreasing dead space (thus preventing
few towel clamps or a restrained limb. seroma formation). The main disadvantage
Sometimes this is all you need to allow of bandages on skin flaps is the risk of
tissue to close without tension. compromising blood supply, which can be
very serious. When put on too tight, a
bandage can lead to flap failure due to
Pain can be significant with reconstructive interference with capillary perfusion,
surgery, so intra- and post-operative venous and lymphatic drainage, or the
analgesia is a must. An epidural can be very direct cutaneous artery. Even when a
helpful. Postoperatively, a continuous rate bandage is placed with the proper level of
IV infusion of fentanyl or an pressure, movement by the animal may
opiod/ketamine/lidocaine combination cause intermittent vascular compression.
may be needed. At minimum, systemic Thus, ‘less is more’ for skin flap bandages.
analgesics (e.g. opiods) are given for the Commonly, a stockinette shirt is all that is
first 24 to 48 hours. Non-steroidal anti- needed to protect the surgery site.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Clients should also be made aware of the

potential for a portion of a flap to fail,
Before surgery, clients should be prepped
which might necessitate a second surgery.
about the importance of seriously
Finally, they should told of expected
restricting the patient’s activity, monitoring
cosmetic changes: large amounts of hair
the surgery site, and keeping follow-up
will be clipped and use of flaps may lead to
appointments. If client compliance is a
changes in color pattern, direction of hair
concern, suggest hospitalization of the pet
growth, and length of hair in a given
for one or two weeks postoperatively, as
location.
this is the critical healing period for flaps.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Bites, Bullets, & Branches

INTRODUCTION: Penetrating wounds are deceiving! They create an “iceberg effect”, where the
skin is relatively unharmed except for a few puncture wounds despite severe damage to
underlying tissues and blood supply. The patient may appear fine for a few days and then be
suddenly overwhelmed by necrosis and infection. Pro-active patient assessment and surgical
debridement are important to prevent progression to systemic inflammatory response syndrome
(SIRS) and sepsis.

Cover penetrating wounds to the chest immediately and other wounds as time allows. Even if
the patient does not have respiratory signs at that moment, movement of the patient may shift
wounded tissues in such a way as to result in pneumothorax. The seal on the chest can be
improved by placing sterile ointment on the wound before adding the dressing and keeping
pressure on the site with a gloved hand or bandage. Further wound care is undertaken once
airway, breathing, and circulatory issues are addressed.

FORCES & TISSUE DAMAGE less dense tissues, which explains why
cortical bone hit by a bullet may shatter into
A dog bite can exert a force of 450 psi (3.1
multiple pieces (each of which becomes a
N/mm2) or more. Incisors and canine teeth
new projectile) while the same bullet with
puncture skin, shear through deeper
the same KE may pass cleanly through a
tissues, and inoculate bacteria and foreign
lung lobe with little parenchymal damage.
material. When the victim is picked up and
Waves of cavitation energy move ahead and
shaken, the skin, which is elastic, moves
perpendicular to the bullet, pushing aside
with the teeth while the more anchored
tissue and creating a larger temporary
underlying muscles and vessels are
cavity that follows the path of least
shredded and torn. Crushing by premolars
resistance, separating tissue planes and
and molars further compounds deep tissue
tearing fixed tissues. The outward
injury.
movement of tissue also creates a vacuum
A bullet’s damage depends on its kinetic which draws contaminants into the wound.
energy (KE = mass x velocity2)/2) and the As the compressed tissues rebound back,
tissue density. The permanent cavity is the they recoil off each other, creating more
tract created as the bullet cuts through damage. Because of cavitation, a missile can
tissue. Dense tissues absorb more KE than fracture bones, tear vessels, rupture bowel,
and contuse organs without ever directly
contacting these tissues.
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DIAGNOSTICS local inflammatory, immunologic,

coagulation, and fibrinolytic cascades. With
A thorough exam, including shaving fur, is
insufficient treatment, these cascades may
important to find all sites of penetrating
expand into systemic inflammatory
injury. Teeth typically leave paired marks,
response syndrome (SIRS; a severe
and multiple bite sites are common. Bullets
inflammatory response in which local
or penetrating foreign material may create
regulatory
entry and exit holes or just an entry hole.
control is
Entry and exit holes may not line up because
lost) and
the penetrating object was deviated by
sepsis. The
dense tissue, fragmentation, or shaking.
body can
Because of the iceberg effect, it is important be ramping
to assess for deep or internal injuries. Probe up to SIRS
wounds with a sterile instrument; it is even when surface wounds appear mild.
common to find that multiple bite wounds Surgical exploration is the only way to
are all connected beneath the skin due to definitively assess the extent of trauma and
disruption of subcutaneous tissue. It can be thorough debridement of devitalized tissue
difficult to assess the true depth of a is the only effective way to prevent or treat
penetrating wound tract with a probe SIRS or sepsis.
because the path may not be straight.
After a wide surgical prep, incise entry and
Internal injury may also be revealed via
exit wounds and assess the underlying
thoracocentesis, abdominocentesis, or
tissue. If the damage does not go beyond
imaging. However, because it takes time for
the skin, lavage and manage as an open
tissues to necrose or infection to develop,
wound. If the damage continues, follow the
the absence of abnormalities on these tests
path to its deepest extent; it is common to
does not rule out internal injury. Endoscopy
find increasing amounts of tissue damage as
of the esophagus and trachea should be
you go deeper. Be prepared to enter the
considered when there are deep wounds to
chest or abdomen. Excise clearly necrotic
the neck.
tissue; leaving it perpetuates the
Imaging is also useful in identifying retained inflammatory response, blocks granulation,
foreign material. The number of intact and increases the risk of infection. If the
bullets in the body and the number of bullet viability of tissue is uncertain, err on the
holes in the skin should add up to an even side of taking it out unless it is essential for
number (i.e. a bullet that exits the body = 2 function or superficial enough to be
holes + 0 bullets on imaging; a retained debrided during a later bandage change.
bullet = 1 hole + 1 bullet on imaging). Lavage extensively. Leave wounds open and
manage with moist wound healing
techniques +/- serial debridement and
TREATMENT lavage until such time as all tissue is healthy
and all contaminants are gone. (See
Regardless of the type of penetrating injury, author’s proceedings “Maximize Healing
the untreated patient may seem fine for a with Proper Wound Management”). Drains
few days, with just one or more small skin may be indicated if there is a lot of dead
wounds. During that time, however, space or some uncertainty about the tissue
necrotic tissue, hematomas, compromised health at the time of closure.
vasculature, dead space, inoculated
bacteria, and foreign material stimulate
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Damage from single, non-tumbling, non- bleeding from holes in major vessels
deforming bullets that only pass through previously plugged by the foreign body,
skin and muscle before exiting the body additional tissue damage caused by barb-
may be limited to the permanent cavity like projections, and/or leaving behind
since skin and muscle are elastic and able to fragments of foreign material (e.g. pieces of
handle a lot of the energy associated with bark off of a stick). Prep the object as you
cavitation. A similar effect may be created would for a hanging leg prep, cleaning it
by penetration with a sharp, smooth, clean with surgical scrub and/or wrapping it with
foreign body. Such wounds can often be sterile material prior to surgery.
managed with more conservative
debridement and lavage focused on the
entry and exit sites. One technique for surgical removal of a FB
is to slit the tract open to its end and lift out
Because of the high risk of injury to the
the FB. However, fragments of foreign
gastrointestinal tract (which can be life-
matter or other contaminants embedded in
threatening and may not produce clinical
or around the tract can be missed. The
signs for several days), exploratory
preferred approach is to make an elliptical
celiotomy should be performed if there is
incision around the tract opening and
penetrating trauma to the abdomen. The
dissect out the entire tract with a margin of
absence of pathologic findings on imaging
normal tissue around it; this technique is
or abdominocentesis does not rule out
more likely to remove all foreign material.
serious intestinal damage and thus cannot
preclude the need to explore the abdomen.

ARE ANTIBIOTICS INDICATED IN

PENETRATING WOUNDS?
REMOVAL OF FOREIGN MATERIAL
All penetrating wounds are contaminated
Tissue reaction varies with the chemical
with bacteria and debris from the site of
composition of foreign material. Oils and
penetration (skin, mucosa) and from the
resins from wood can cause intense
penetrating object. (High temperature in
inflammation while some plastics slowly
the gun barrel does not sterilize bullets).
release irritating products. Steel shot, which
Cultures taken at the time of injury are
is 99% iron, causes a local inflammatory
typically not helpful because the bacteria
reaction in dogs that generally subsides
that grow at that time do not correlate with
after 2 to 8 weeks. Lead bullets embedded
bacteria that are cultured if the wound later
in soft tissues are typically walled off by
becomes infected.
fibrous tissue and do not pose a poisoning
risk. Lead in the GI tract or in contact with
CSF does cause lead toxicity, and lead in a
joint causes severe synovitis, so bullets The risk of infection increases with the
should be removed from these areas. amount of tissue damage and vascular
compromise. Debridement and lavage are
A penetrating foreign body (FB) that is still the keys to minimizing the chance that
partially exposed outside of the body should contamination will turn into infection;
be left in place until it can be removed antibiotics do not replace the need for local
surgically, unless it is clear that the risks of wound care! While prophylactic antibiotics
leaving it in are more life-threatening than may be given during the actual
the risks of pulling it out without surgery. debridement, ongoing antibiotics are not
Risks of non-surgical removal include indicated in immunocompetent patients
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with simple wounds that have been Nocardia are strong indicators that foreign
effectively debrided. A course of material is present.
prophylactic antibiotics should be
considered in patients with extensive tissue
damage and/or SIRS, or in those that are OTHER CONSIDERATIONS
immunocompromised. Avoid
fluoroquinolones and aminoglycosides as Thorough documentation of wounds and
single agents since they do not affect proper storage of foreign material (e.g.
anaerobes, which are common in bullets) retrieved from the body is
devitalized tissues. particularly important when legal action
may be taken. Necropsy by a board certified
pathologist should be considered when a
patient dies from such an injury.
Foreign material lowers the concentration
of bacteria required for infection. Patients
often improve while on antibiotics, but signs
return when antibiotics are stopped, and Refer to local guidelines for proper
resolution of infection requires removal of management of bite wounds in animal not
the foreign material. Actinomyces and vaccinated for rabies. Cats can be tested for
FeLV and FIV 60 days after being bitten by
another cat.
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Maximize Healing With Proper Wound

Management

INTRODUCTION: Like the white blood cell, our initial goals for wound management are to rid the
wound of contamination and necrotic tissue and provide an environment that promotes
granulation. These objectives are best achieved by combining knowledge of the body’s own
wound healing processes with accurate assessment of tissue viability, proper lavage, surgical
and/or autolytic debridement, and moist wound management.

WOUND HEALING BASICS LAVAGE

There are three overlapping phases of Properly done, lavage removes foreign
wound healing, each of which sets the stage matter, decreases bacterial counts,
for the phase that follows. The rehydrates tissues, and speeds healing.
inflammatory/debridement phase typically Improperly done, lavage can damage tissue,
occurs during the first 3 to 5 days after delay healing, and increase the risk of
wounding. White blood cells move into the infection. Important components of lavage
wound and perform selective, autolytic are pressure, volume, and fluid
debridement of bacteria, foreign material, composition.
and necrotic tissue. This debridement is
A B
selective because only cells and matrix that
are damaged are removed; healthy tissue is
spared. Think of the white blood cells as tiny
premier surgeons, cutting away only
unhealthy tissues with microscopic
accuracy! During the repair phase over the
next ~2 to 4 weeks, fibroblasts and
endothelial cells moving in from the
periphery of the wound fill in the defect
with granulation tissue. Epithelial cells from
the skin edges migrate across the
granulation tissue and build new skin as
they move toward the center of the wound.
Fig. 1. (A) An emergency pressure
Skin coverage is also achieved via sleeve on a one liter bag of fluids
contraction, in which pre-existing skin is is pumped up to 300 mm Hg,
pulled over the granulation tissue by as read on the gauge (B).
myofibroblasts in the center of the
It takes more pressure to remove
granulation bed. The remodeling phase
microscopic particles and bacteria than it
continues for months to years after the
does to remove gross debris. Thus, just
wound appears healed. Collagen fibers are
because a wound looks clean grossly does
realigned and cross-linked along lines of
not mean it is clean on a microscopic scale.
force add to tissue strength.
The lavage pressure which maximizes
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removal of debris and bacteria while combination of debridement methods is

minimizing tissue damage is 7 – 8 psi (48 – typically employed in wound care, and a
55 kN/m2). This pressure can be accurately given wound may require debridement
achieved via a needle (16 to 22 g) on an multiple times.
intravenous drip set attached to a bag of
fluids pressurized to 300 mm Hg with an
emergency pressure sleeve. Sedation and SURGICAL DEBRIDEMENT
analgesia are likely needed when lavage is
done with appropriate pressure. While not as precise as debridement by
white blood cells, surgical debridement is
Bulb syringes, squirt bottles, and syringes selective within the surgeon’s ability to
without needles do not provide enough distinguish between viable and nonviable
pressure, and a 35 cc syringe with a 16 to 22 tissue. Attachment, color, and texture
g needle generates too high a pressure appear to be most reliable means of
(mean = 15-18 psi (103 – 124 kN/m2)). assessing tissue viability by eye. Tissues that
are unattached have clearly lost their blood
As the volume of lavage is increased,
supply; they should be removed if still lying
contaminants in the wound are decreased,
on the wound. For flaps of tissue that are
as long as appropriate pressure is used. Tap
partially attached, the portion of a flap that
water is okay for removing surface dirt from
exceeds a length to width ratio of 2:1 has a
the wound to start, but it should be
poor chance of surviving. The color of
followed by lavage with a sterile solution,
necrotic tissue ranges from black to brown
such as normal saline. Antiseptics can be
to yellow to grey to white as the moisture
added for additional antimicrobial effect;
content increases. Desiccated necrotic
the proper dilutions are 0.05%
tissue becomes firm and leathery and
chlorhexidine solution (e.g. 25 ml of 2%
persists as a dark-colored eschar, while
chlorhexidine + 975 ml of diluent) or 0.1%
moist necrotic tissue (“slough”) is slimy,
povidone-iodine solution (e.g. 10 ml of 10%
light-colored, and stringy (like mozzarella
P-I + 990 ml diluent). Higher concentrations
cheese on a pizza). Slough impairs healing
may delay healing, while lower
and should be removed. It should be
concentrations may not be antimicrobial.
distinguished from a layer of fibrin, which is
Diluting to a certain color by eye rather than
also light-colored and moist but more
measuring is not accurate. Use the solution,
gelatinous (as in grilled cheese). Fibrin is left
not the scrub, formulation of these
in place as it does not impair healing (and
antiseptics; the detergent in scrub is
attempts to remove it may). Inflammatory
harmful to subdermal tissues.
exudate (pus) is wound fluid containing
leukocytes (especially degenerating
neutrophils) and dead tissue. Recognize
DEBRIDEMENT:
that slough, fibrin, or pus do not mean that
Debridement is the process of removing the wound is infected.
damaged tissue and foreign material from a
Tissues that are cold or that do not bleed
wound. It promotes healing by eliminating
when cut may be non-viable, but these
physical barriers to granulation and
changes may also be due to hypovolemia
epithelialization, removing a media for
and/or hypothermia, common conditions in
bacteria, decreasing exudate production,
a trauma patient. Thus, do not make a
releasing inflammatory mediators that
decision about tissue viability based on
promote healing, and improving the
temperature or lack of bleeding until
clinician’s ability to assess the wound. A
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hypovolemia and hypothermia have been severe because the tissue can be readily
treated. When a tissue is cut to check for removed at that time. An example would be
bleeding, bright red flowing blood is a good damaged skin on a distal limb, a location
sign of viability; dark, oozing blood indicates where there is limited skin available and
congestion and poor perfusion. which can be easily assessed at the next
bandage change.
When warranted by the patient’s condition,
assess sensation prior to giving analgesics or The wound should not be surgically closed if
sedatives. Differentials for a lack of contamination or non-viable tissue remains
sensation include tissue death, drug effects, or if the closure will be under tension. Treat
or nerve damage. Nerve damage can take open wounds with moist wound healing
weeks to months to resolve, and even if techniques (see below).
permanent, the tissue can still be valuable
to the patient. Thus, do not use lack of
sensation alone to decide whether or not to MECHANICAL DEBRIDEMENT – WET-TO-
debride a piece of tissue. DRY NOT RECOMMENDED
Surgical debridement techniques range For a wet-to-dry bandage, saline-soaked
from the conservative resection of clearly gauze are placed on the wound and
devitalized (and thus insensate) surface bandaged in place. The gauze sticks to the
tissue in an awake patient in a treatment wound as moisture is wicked into the outer
area to aggressive resection of deeper bandage layers. When the gauze is
devitalized tissue in an anesthetized patient removed, the adhered tissue is ripped off
in the operating room. Regardless of the with it. Unfortunately, this results in non-
approach, the wound should be prepared as selective debridement; i.e. healthy cells and
for any surgical procedure, with proper new tissue involved in healing are removed
clipping and cleaning of the peri-wound along with necrotic tissue, and healing is
area and the use of sterile instruments, significantly interrupted. Additional
gloves, and aseptic technique. Before disadvantages of the wet-to-dry technique
shaving, place a sterile lubricant (e.g. K-Y include loss of cells that migrate into the
jelly) in the wound so that hair clippings do open-weave gauze, ability of bacteria to
not stick to the wound bed. penetrate the gauze, aerosolization of
bacteria as the dried dressing is removed,
Tissues that are clearly not viable must be
pain when worn and when removed, and
removed, as their presence only delays
gauze fibers that stay in the wound and
healing and increases the risk of infection.
stimulate prolonged inflammation. Wet-to-
When the viability of a given piece of tissue
dry bandages are no longer standard of care
is unclear, use the following guidelines: (1)
in human or veterinary medicine, and have
“When in doubt, cut it out” if there is only
been replaced by moist wound healing
one opportunity to access that tissue, there
practices.
is plenty of residual tissue so it won’t be
missed, and/or consequences of later
necrosis would be severe. Examples include
damaged tissue deep in a wound or inside MOIST WOUND HEALING
the abdomen or thorax. (2) “When in doubt, Wound fluid contains oxygen, water, and a
if it’s superficial or skin, leave it in” if there physiological ratio of proteases, protease
will be multiple opportunities to assess the inhibitors, growth factors, and cytokines
tissue, the tissue is needed for later closure, appropriate to the current stage of wound
and consequences of later necrosis are not healing. Moist wound healing (MWH)
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supports the body’s own amazing healing dry out the wound, while using a low
mechanisms by keeping wound fluid in absorptive dressing on a wound with high
contact with the cells involved in healing; exudate will overhydrate (macerate) the
these cells need wound fluid to function wound; neither is desirable. See Table 1 for
fully. Thus, during the inflammatory/ guidelines on dressing selection.
debridement phase, MWH supports
Cut the chosen MRD to fit the shape of the
selective, autolytic debridement by white
wound so that moisture stays in the wound
blood cells 24 hours a day under the
and off of the skin. Cover the MRD with a
bandage. During the repair phase, MWH
standard soft-padded bandage (e.g. cast
supports the cells involved in granulation,
padding, roll gauze or Kling, and Vetwrap).
epithelialization, and contraction.
Compared to wet-to-dry or dry dressings, During early healing when exudate
MWH techniques accelerate healing, production is highest, a properly absorptive
increase patient comfort, decrease costs MRD is usually changed every 2 to 3 days. As
(due to longer intervals between bandage granulation tissue forms and exudate level
changes, faster healing, and less need for subsides, a less absorptive dressing is used,
sedation), prevent aerosolization of and bandage changes may be 4 to 7 days.
bacteria, do not leave inflammatory (Change sooner if strike-through or soiling
components in the wound, and decrease occurs).
the risk of wound infection.
Many MRDs combine with wound fluid to
MWH can be achieved with moisture form a gel. It is normal for this gel to have a
retentive dressings (MRDs). Four common slight odor and yellow color (“gel & smell”),
MRDs (listed from most to least absorptive) which may be misinterpreted as infection.
are: calcium alginate, polyurethane foam, However, diagnosis of infection should be
hydrocolloid, and hydrogel. Choose the based on examination of the patient (e.g.
dressing that is best able to absorb the redness, swelling, pain, fever), not the
amount of expected exudate while still dressing. If infection is present, MWH
keeping a layer of wound fluid in contact should still be used to support immune cell
with the wound. Using a highly absorptive function.
dressing on a wound with low exudate will
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Table 1. Characteristics of Common Moisture Retentive Dressings

MRD Exudate Level Properties Indications Contraindications

Made from seaweed. Especially good for autolytic If insufficient exudate,

Calcium High Felt-like material that debridement of contaminated, will not gel and can
Alginate (Absorbs 20- turns to gel as absorbs moderate to highly exudative dehydrate wound.
30 times its wound fluid. wounds.
weight). Good stimulator of granulation
tissue.
Hemostatic.

Good for autolytic debridement, Insufficient exudate.

Polyurethane Moderate to Soft foam; does not gel. stimulates granulation and
Foam high epithelialization. Foam is too soft to
Versatile –pre-moisten foam with provide protection to
saline for use on lower exudate boney prominences.
wounds.
Place dry foam on macerated skin to
wick out moisture.
Sheet, paste, or Good for autolytic debridement, Caution in late repair
Hydrocolloid Low to powdered forms all turn granulation, and epithelialization in phase (adhesive edge
moderate into a gel as absorbs low to moderately exudative may slow contraction).
wound fluid. wounds. Caution if infection,
Sheets typically have Hydrocolloid sheet with (occlusive backing
occlusive backing & impermeable backing can be used to creates hypoxic
adhesive perimeter to add occlusive cover over other environment - may
attach to peri-wound skin. dressings. favor anaerobes).
Hydrogel Low 90-95% water, comes as Dry wounds requiring autolytic May inhibit
gel or as sheet that gels in debridement, granulation, or contraction on trunk
wound. epithelialization. Adds moisture wounds.
If lacks occlusive cover, back to dry wounds.
can add occlusive film on May enhance contraction on limb
top to keep hydrogel’s wounds.
moisture in wound.
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Índice
MATT WINTER
Matthew D. Winter, DVM, DACVR
Vice President VetCT North America
Clinical Associate Professor, Diagnostic Imaging
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
University of Florida Gainesville, FL

1.4.1. Radiographic Evaluation Of The Coughing Dog......................................................... 101

1.4.2. Diagnostic Imaging Of The Spine ............................................................................... 105
1.4.3. The Limping Dog: Imaging Of The Lame Patient ....................................................... 109
1.4.4. Radiographic Evaluation Of The Heart ...................................................................... 113
1.4.5. Radiographic Evaluation Of The Vomiting Patient .................................................... 117
1.4.6. Sonographic Evaluation Of The Vomiting Patient ..................................................... 121
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Radiographic Evaluation Of The Coughing

Dog

INTRODUCTION: Interpretation of thoracic radiographs can feel intimidating, especially without

a systematic approach. The purpose of this brief session is to aid the practitioner in developing
an organized approach to the review of thoracic radiographs and specifically to review
pulmonary patterns.

OBJECTIVES 3. the mediastinum (all of it, including

the heart);
1) Review the 4 part interpretation
paradigm 4. the lungs (pulmonary parenchyma
and pulmonary vessels).
2) Describe the radiographic features
of: These regions can be evaluated separately
as long as it is understood that most
a. the unstructured interstitial pattern
diseases are multicompartmental, and
b. the alveolar pattern synthesis of all abnormalities key to
developing a succinct, prioritized list of
c. the bronchial pattern differential diagnoses. We will focus on the
d. the structured interstitial pattern pulmonary parenchyma for the purpose of
this short communication.
3) Review the differentiating features of
pulmonary edema vs. pneumonia ORGANIZING YOUR INFORMATION

4) Review the normal and abnormal In terms of organizing your information,

appearance of the trachea follow a 4 part process to work through the
information you gather from the
INTERPRETATION PARADIGM radiographic image.
In an effort to provide structure to 1. Describe your findings. Remember
radiographic interpretation of the thorax, a to use your Roentgen signs
4 part interpretation paradigm can be (Location, Number, Size, Shape,
helpful. Margin, Opacity)
The thorax can be deconstructed into: 2. Generate a conclusion based on
1. the extrathoracic structures your findings.
(including the osseous structures, 3. Generate a succinct, prioritized list
body wall, and diaphragm as well as of differentials
the portions of the abdomen and
cervical region in the collimation); 4. Create a list of next steps

2. the pleural space;

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EVALUATING THE PULMONARY lobes. From this, we can conclude that if the
PARENCHYMA lung is larger than normal, there is too much
“stuff” inside the lung (blood, pus, water,
The easiest way to evaluate the pulmonary
cells); if the lung is smaller than normal,
parenchyma is based on peak inspiratory
there is not enough air inside the lung
films. There are two questions you must ask
(atelectasis).
as you evaluate the pulmonary
parenchyma. Now we are equipped to approach the
pulmonary patterns. We are going to work
1. Is there an increase or decrease in
through the patterns from the easiest to
pulmonary opacity?
identify to the most difficult.
2. What is the location of the change in
opacity?
PULMONARY PATTERNS
3. Is there a change in the position of the
mediastinum? Alveolar Pattern

4. How severe are the changes you’ve The alveolar pattern is the easiest to find.
identified? The components of an alveolar pattern
include: uniform increased soft tissue
If the lung(s) are generally radiolucent, we
opacity; border effacement with the
need to consider where this change is
pulmonary vessels and outer serosal wall of
located. The most common reason for
the airways; the presence of air
diffuse decreases in opacity is hypovolemia
bronchograms; a lobar sign; and border
from any cause, followed by pulmonary
effacement with the heart or diaphragm.
thrombo-embolism (focal or diffuse).
Causes of focal radiolucencies would Bronchial Pattern
include: pulmonary bullae, blebs, cavitated
The next pattern is the bronchial pattern. In
lesions (granulomas or tumors),
general, bronchial patterns are generalized
pneumatocoeles and pulmonary thrombo-
and you are looking for thickened small
embolism involving a specific lung lobe.
airways that will create “rings and lines” in
If the lungs are too radiopaque (white), we the periphery of the lung. The central
must consider the distribution/location of airways will always be prominent and in
this change. Describe the anatomic location older dogs can mineralize. This can be quite
of the abnormality, noting which lung lobes striking in appearance but is an incidental
are involved and if there is partial lobar finding in an older patient. Try to evaluate
involvement. Is the change peripheral, mid- for the presence of small airways in the
zone or hilar? peripheral aspect of the lungs or the thin
section of the lungs.

Next, is there a contralateral or ipsilateral

mediastinal shift noted on the VD/DV image Vascular Pattern
(assuming the VD/DV image is straight and
Next is the vascular pattern. There are
the sternum is superimposed over the
three options for increased opacity.
thoracic vertebrae)? In other words, is the
Increase in size of the pulmonary arteries
mediastinal shift toward or away from the
(heartworm disease), increase in size of the
abnormality that you have identified? It is
pulmonary veins (left heart failure) or
important to understand that this change is
increase in size of both pulmonary arteries
an indirect measure of the size of the lung
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and veins (over circulation from left to right “Cranioventrally distributed alveolar
congenital cardiac shunts, arteriovenous pattern.”
fistulas, heart failure in cats, or volume
All of the radiographic features described
overload in renal failure patients).
support an alveolar pattern.

Interstitial Pattern
Our differential diagnoses would sound
If none of the above fits, you are left with something like this:
the “dreaded” interstitial pattern. The
“Based on the anatomic location,
interstitial pattern can be classified as either
bronchopneumonia or aspiration
a structured (miliary or nodular) or
pneumonia are the top differentials.”
unstructured (diffuse increase in
background lung opacity with decreased If we are imaging a patient with clinical signs
vessel border definition). of fever, labored breathing or a history of
vomiting and/or regurgitation, this
Lastly, assign some degree of severity to the
radiographic diagnosis and differential list
pulmonary pattern (mild, moderate and
fits our other information (Table 1).
severe). If you are arguing over a mild
unstructured interstitial pulmonary pattern, Now we can use this information to confirm
forget it. You are not going to do anything next steps:
about it anyway. Ultimately, the interstitial
and alveolar patterns form a continuum, Treat empirically.
with the alveolar pattern being the most Trans-tracheal wash.
severe form of increased lung opacity.
Therefore, it is probably redundant to say The caveats for lung patterns are:
“severe alveolar pattern”. a) The pulmonary pattern will not
So a radiographic description may sound correlate to a pathognomonic
something like this: histological diagnoses. Interpret in
the context of other findings.
“In the ventral aspect of the right cranial
and middle lung lobes, there is an increased b) Pulmonary patterns are often
soft tissue opacity, with obscured vascular mixed for a given disease. Decide
margins and the presence of air what pattern is dominant, even if
bronchograms. A lobar sign is also noted.” more than one is present.

c) The pulmonary pattern may

represent a disease in transition
Our conclusion may be something like this: (interstitial to alveolar or vice
versa).
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Table 1: Pulmonary Patterns

Pattern Name Radiographic Features Comments Disease examples (no
way all inclusive)
Alveolar Lobar sign; Uniform soft Location is important for Aspiration pneumonia;
tissue opacity; Air formulating a differential Bronchopneumonia;
bronchograms; Will not list; Is the easiest cardiogenic and non-
see pulmonary vessels pulmonary pattern to cardiogenic pulmonary
or airways; Border recognize. edema; neoplasia;
effacement of heart or hemorrhage; smoke
diaphragm. inhalation; etc.

Bronchial Rings and lines are Usually generalized; be Chronic bronchitis;

noted within the sure to evaluate in the pulmonary eosinophilic
pulmonary parenchyma; peripheral lung fields pneumonopathy;
look in the periphery and and in the thin areas of heartworm disease;
away from the lung. allergic lung disease;
pulmonary hilum. feline asthma

Vascular Increased in size of the Added lung opacity is Pulmonary arteries –

pulmonary arteries, secondary to heartworm disease or
veins or both (left to right enlargement of the cor pulmonale;
shunting lesions). pulmonary vessels. Pulmonary veins – left
heart failure; Both – left
to right PDA, VSD, ASD
or over circulation
secondary to volume
overload.

Structured Interstitial Multiple “millet seeds” or Usually needs to be at Lymphoma,

(nodules or miliary small miliary nodules least 5 mm in size to be disseminated neoplasia
pattern) noted throughout the seen as a distinct (carcinoma) and fungal
lung fields; variably nodule; Fake-outs disease. Parasitic,
sized pulmonary include nipples, end-on eosinophilic or
nodules. vessels and pulmonary pyogranulomatous
osteomas. pneumonias. Nodules
can be cavitated.

Unstructured Interstitial Increased opacity to the Typically generalized Exposure, exposure,

lung fields with and never mild! expiration, expiration,
decreased visualization lymphoma, fibrosis,
of the pulmonary fungal infection, edema,
vessels, aorta and hemorrhage, infectious
caudal vena cava. etiologies (viral,
bacterial), eosinophilic
pneumonopathy.

CONCLUSION Dennis R, Kirberger RM, Wrigley RH

and Barr FJ. Handbook of Small Animal
Interpreting lung patterns is less
Radiological Differential Diagnosis, WB
complicated than it seems. Changes in
Saunders, 2001.
opacity should be identified and
localized. The utility of interstitial vs. O’Brien RT. Thoracic Radiology for the
alveolar patterns is to establish severity Small Animal Practitioner, Teton
and response to therapy. Cats never NewMedia, 2001.
follow the rules.
SUGGESTED
READING/REFERENCES Schwarz T and Johnson V. BSAVA
Manual of Canine and Feline Thoracic
Thrall, DE. Veterinary Diagnostic Imaging. BSAVA, 2008.
Radiology, 5 or 6th Edition.
th
WB
Saunders: 2008.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Diagnostic Imaging Of The Spine

INTRODUCTION: Diagnostic imaging of the spine can be challenging, and multiple modalities
are employed. The choice of modality is dependent upon the clinical question to be answered
and availability. For many, radiographs serve as a very accurate and efficient screening test for
many diseases of the vertebral column. Osseous lesions, including traumatic fractures,
subluxations, or aggressive lesions associated with infectious or neoplastic processes can be
detected using radiography.

Evaluation of the soft tissues of the spine, orthogonal projections are acquired (at
including the spinal cord, intervertebral minimum); that the x-ray beam is
discs, and direct visualization of soft tissue collimated to the area of the spine; and that
stabilizing structures require additional technical factors are appropriately selected.
imaging techniques. Myelography, or the For CT, appropriate positioning is also
injection of non-ionic iodinated contrast critical. The scan must be planned with a
media into the subarachnoid space, can small field of view, on a straight spine, and
allow for indirect evaluation of the spinal reconstructions should be performed using
cord for changes in position, size, and both a bone sharp and a soft tissue
shape. Computed tomography (CT) is a algorithm. Positioning is no less crucial for
cross-sectional imaging modality that MRI, and effective neurolocalization will
provides contrast resolution compared to assist in directing the examination to the
radiography. This allows for more detailed appropriate anatomy.
assessment of the bones and soft tissue
RADIOGRAPHY
structures of the spine, including the spinal
cord. Evaluation of some spinal cord Radiography is an excellent screening test
pathology is also possible with CT. for many diseases. It is readily available,
Magnetic Resonance Imaging provides even relatively inexpensive, and rapid.
greater contrast resolution of soft tissues Radiographs are obtained by passing x-rays
and bones. The direct imaging of chemical through a patient, and capturing
alterations in anatomy allows visualization transmitted x-rays to form a 2 dimensional
of edema, hemorrhage, and alterations in image of a 3 dimensional object. Images are
the chemical composition and structure of evaluated using Roentgen signs; lesions are
abnormal anatomy. described with respect to their location,
size, shape, number, margin and opacity.
Before beginning any discussion of
interpretation, it is important to address the Systematic radiographic evaluation of the
concept of image quality. It is nearly spine requires evaluation of the osseous
impossible to gain any diagnostic structures as well as the spaces occupied by
information from a poorly performed study the joint spaces and the spinal cord.
in any modality. For radiography, it is Evaluating the dorsal lamina, the pedicles,
important that the patient is properly the vertebral bodies and endplates, the
positioned without rotation; that 2 articular facets, and the spinous processes
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

is part of the osseous evaluation. Additional indirectly. Areas of compression can be

evaluation of the intervertebral disc spaces, identified, as well as regions of spinal cord
the articular facet joints, and the swelling using myelography. The spinal
intervertebral foramina is also required for cord cannot be directly assessed, but this
complete radiographic assessment of the indirect information is useful for diagnosis
spine. of extradural lesions, such as intervertebral
disc protrusion, extrusion, intradural,
Evaluation of osseous structures for the
extramedullary lesions such as
presence of degenerative joint disease
subarachnoid cysts, and intramedullary
includes detection of osteophytes and
lesions such as neoplasia or even
enthesophytes associated with the
fibrocartilaginous embolic myelopathy.
vertebral end plates and articular facets.
Features of aggression should also be Performing myelography requires
noted. Depending on location, these can practice, is invasive, and there are risks.
indicate neoplastic processes (primary This procedure can be done in general
bone, such as osteosarcoma) or infectious practice, but should not be attempted
etiologies (discospondylitis). Finally, in without proper training and experience.
cases of trauma, be sure to note any Risks are lower with lumbar injections. With
potential fractures or subluxations. For injections into the cerebellomedullary
suspected spinal fractures, care must be cistern, there is a risk of pithing the patient.
taken when positioning the patient, and The location of intrathecal injection is often
orthogonal projections are always required. said to be dependent on the suspected
location of the lesion; however, even
Narrowing of disc spaces and sclerosis of
myelography of the entire lumbar, thoracic,
articular surfaces are features of
and cervical spine can be performed via a
degenerative joint disease. Intervertebral
lumbar injection. Collection of
disc disease, or degeneration of the
cerebrospinal fluid should be performed
intervertebral disc, with eventual
prior to injection.
protrusion or extrusion of disc material, is
an extension of these degenerative Lumbar myelography requires placing a
processes. Protrusion of disc material into needle through the interarcuate space
the vertebral canal can cause varying typically at the level of L5-6, and into the
degrees of acute or chronic spinal cord subarachoid space. The bevel of the needle
compression. This can often not be should be directed cranially with lumbar
detected by plain radiography. injection. Often, the spinal cord is
penetrated by the needle; this typically
Lesions within the spinal cord can cause
does not result in additional morbidity,
secondary osseous changes, such as
however there are instances of central canal
thinning of cortical bone, or widening of
filling. CSF flow into the needle and hub
foramina. Evaluation of the surrounding
should be visible, and without blood. Once
soft tissues is also important, and will yield
1-2 ml of CSF have been collected, and
information regarding muscle mass, body
position of the needle in the subarachnoid
condition. Changes in symmetry should be
space confirmed, injection can commence.
noted.
If the needle is in the epidural space,
MYELOGRAPHY contrast will be delivered into the epidural
space, which will result in a non-diagnostic
Introduction of iodinated contrast study. Injection at the cerebellomedullary
media into the subarachnoid space can cistern involves inserting a needle at the
allow for evaluation of the spinal cord
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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junction of the skull and C1, into the dorsal superimposition and distortion that
subarachnoid space. Penetration of the hampers radiographic examination.
medulla/cranial spinal cord can result in the Depending on scanner technology, speeds
death of the patient. The needle should be can be relatively fast. For some cases, heavy
directed caudally. Epidural injection does sedation will allow the patient to remain
not typically occur at this level, as the dura still for the study. If contrast is required,
is adherent to the bony strucxtures of the general anesthesia may increase patient
skull and C1. safety and reduce motion artifact that can
occur during injection.
Complete evaluation of the subarachnoid
space and indirect evaluation of the spinal The cross-sectional nature of the modality
cord requires complete filling of the and superior contrast resolution compared
subarachoid space. The volume of non- to radiography, results in more accurate,
ionic iodinated contrast medium is typically direct assessment of the vertebrae, the
0.3 ml/kg, not to exceed 10 ml, even for epidural space, and the spinal cord while
large dogs. The volume of any tubing eliminating superimposition. Faint
should also be added. mineralization of intervertebral discs can be
detected, making non-contrast CT a
Injection of non-ionic iodinated contrast
relatively accurate test for intervertebral
should be performed slowly, with only mild
disc disease, especially in
pressure. In cases of spinal cord swelling or
chondrodystrophic breeds.
severe compression, injection can be
challenging as the flow of CSF and contrast Assessment of the osseous and soft
can be restricted. Adding too much tissue structures is routine, as outlined for
pressure can also result in an epidural radiography, but more of the anatomy can
injection and a non-diagnostic study. be evaluated. While the spinal cord can be
evaluated directly, pathologic features may
Deviation of the contrast columns is
not result in changes in attenuation, and
indicative of a lesion. Axial deviation
can be missed. For diseases such as
suggests an extradural lesion such as
fibrocartilaginous embolic myelopathy,
intervertebral disc protrusion/extrusion.
lesions will not be evident.
Thinning of the contrast column typically is
also present. Widening of the contrast Myelography can also be coupled with CT
column, with what is often referred to as a (CT Myelography) to increase the
“golf-tee” sign is suggestive of an intradural- sensitivity, specificity and accuracy for
extramedullary lesion, such as a detection of spinal cord disease, including
subarachnoid cyst. Abaxial displacement of intervertebral disc
the contrast column is suggestive of an protrusion/extrusion/sequestration as well
intramedullary lesion, such as a tumor, as diseases such as fibrocartilaginous
inflammatory lesion, or potentially an embolic myelopathy.
infarction.
MAGNETIC RESONANCE IMAGING
COMPUTED TOMOGRAPHY
Magnetic Resonance Imaging or MRI utilizes
Computed Tomography, or CT, also strong magnetic fields to manipulate
uses x-rays to generate an image. The hydrogen atoms, creating an image that is
physics of CT is beyond the scope of this dependent on the magnetic properties of
discussion, but it is important to note that protons and their immediate environments,
CT is a cross-sectional imaging modality that including their chemical bonds. As with CT,
creates “slices” of anatomy, eliminating the
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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the physics of MRI are beyond the scope of most practice imaging test to choose, and
this lecture. much can be learned from a properly
performed radiographic series or CT
MRI is not a screening test for most disease
examination.
processes. Although the technology
continues to advance at an incredible rate, FURTHER READING
MR units are typically not as readily
1. Robertson I, Thrall DE. Imaging Dogs
available due to their expense, the need for
with Suspected Disc Herniation: Pros and
specialized power and room shielding, and
Cons of Myelography, Computed
maintenance. Sequences are getting
Tomography, and Magnetic Resonance. Vet
shorter and new image sequences are being
Radiol Ultrasound. 2011;52:S81–S84.
developed, but most spin-echo sequences
require several minutes to perform. In 2. Hecht S, Thomas WB, Marioni-
addition, the patient must remain still for Henry K, Echandi RL, Matthews AR, Adams
the entire sequence as movement will ruin WH. Myelography Vs. Computed
the acquisition, therefore general Tomography in the Evaluation of Acute
anesthesia is necessary. Thoracolumbar Intervertebral Disk
Extrusion in Chondrodystrophic Dogs. Vet
MRI has contrast resolution that is superior
Radiol Ultrasound. 2009;50(4):353–359.
to radiography and computed tomography.
Pathology creates alterations in the local 3. Cooper JJ, Young BD, Griffin JF,
magnetic field, which has a direct effect on Fosgate GT, Levine JM. Comparison
the signals generated by the protons in that Between Noncontrast Computed
region. Further, MR sequences have been Tomography and Magnetic Resonance
designed to maximize our ability to see Imaging for Detection and Characterization
imaging features that can allow detection of of Thoracolumbar Myelopathy Caused by
hemorrhage, edema, mineralization, Intervertebral Disk Herniation in Dogs. Vet
contrast enhancement, and infarction. MRI Radiol Ultrasound. 2014 Mar 1;55(2):182–9.
has become the standard for the diagnosis
of central nervous system lesions. 4. da Costa RC, Samii VF. Advanced
Imaging of the Spine in Small Animals. Vet
CONCLUSIONS Clin North Am Small Anim Pract. 2010
Sep;40(5):765–90.
Multiple imaging modalities are
available for the evaluation of the spine. 5. Besalti O, Ozak A, Pekcan Z, Tong S,
Choosing the appropriate test will be based Eminaga S, Tacal T. The role of extruded disk
upon clinical signs, availability, and cost. material in thoracolumbar intervertebral
While MRI is superior to radiography and disk disease: a retrospective study in 40
computed tomography for diagnosis of dogs. Can Vet J. 2005;46(9):814.
neurologic diseases, it is not always the
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

The Limping Dog: Imaging Of The Lame

Patient

INTRODUCTION: The interpretation of orthopedic radiographs can be a daunting task.

Investigation of lameness is a common presenting complaint, and radiography is still the primary
screening test for lameness diagnosis in dogs. As with any radiographic assessment, having a
systematic approach to radiographic interpretation is the cornerstone of accurate evaluation.
Differentials primarily revolve around degenerative joint disease from developmental orthopedic
diseases; joint injury, such a cranial cruciate ligament rupture; or aggressive changes associated
with infection or neoplasia.

ROENTGEN SIGNS 1).While it is important to consider diseases

of the immature skeleton when presented
Roentgen signs (location, opacity, size,
with a young dog that had a history of
shape and number) may seem simplistic,
lameness, it is important not to become
but are fundamental in interpreting
limited in the scope of your considerations.
radiography. Of these, the location of a
Cruciate injury/rupture can occur in young
lesion may best serve to narrow your list of
dogs as well as mature dogs. In addition,
differentials. Determining whether the
osteosarcoma is bimodal in its age
geographic center of a lesion is bone, joint
distribution, and may be seen in dogs that
or soft tissue significantly affects the list of
are 2 years of age. Other neoplasms, such
differentials and focuses the diagnostic
as lymphoma and histiocytic sarcoma, may
plan.
also occur in younger patients.
DISEASES OF THE IMMATURE SKELETON4 Osteomyelitis, either fungal or bacterial,
can also occur in young patients, and should
There is a concise list of musculoskeletal not be excluded as a consideration for
diseases that are associated with large lameness in young dogs. Therefore, while it
breed, rapidly growing dogs. These diseases may be tempting to exclude neoplasia or
often have characteristic radiographic other aggressive diseases from your
appearances, and can be easily recognized. differential list in young patients, it is
The first step in this process is isolating the important that you continue to include all
lameness to determine the radiographic differentials prior to radiography.
area of interest. For example, it is
important to determine if the lameness is DEGENERATIVE JOINT DISEASE3
joint related or bone related. Remember, it
Degenerative joint disease (DJD) is a
is NOT acceptable to open up the
common radiographic diagnosis.
collimation and radiograph the entire
Radiographic features of DJD include
thoracic limb. Imaging studies should be
subchondral bone sclerosis, periarticular
targeted to an area of interest to best
new bone formation (osteophytes), and
maximize contrast and spatial resolution.
joint effusion/capsular thickening. Severe
Specific diseases often occur is certain degenerative changes with marked
breeds, or in breeds of certain sizes (Table periarticular new bone proliferation and
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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subchondral bone cysts may mimic the cause of instability. The cause may be
aggressive disease. Be diligent in your evident radiographically, as in a case of
assessment of aggressive radiographic osteochondritis dissecans; or it may not be
features. visible radiographically, as in a case of
cranial cruciate ligament injury or rupture.
DJD can be classified as primary (idiopathic)
Therefore, it is important to understand the
or secondary. Most commonly DJD is a
common pathophysiologic mechanisms of
secondary process, occurring as a result of
instability in specific joints.
joint instability. Once signs of DJD are
noted, the task then becomes to identify

Table 1: Disease processes of the immature skeleton

History and Physical

Disease Signalment Radiographic Findings
Exam Findings

Subchondral bone defect (flattening) affecting

articular cartilage of afflicted joint, often with
sclerotic margins
Secondary DJD
6-9 month old Lameness Locations include:
Osteochondrosis/
Large breeds Joint pain  Caudal head of humerus
Osteochondiritis Dissecans
Rapidly growing +/- Effusion
 Distomedial humeral condyle
 Lateral femoral condyle
 Medial trochlear ridge of the talus
 Lateral trochlear ridge of the talus
Umbrella term that includes:
 Ununited anconeal process
6-12 month old Lameness
 Fragmented medial coronoid process
Elbow Dysplasia Large breeds Joint pain
Rapidly growing +/- Effusion  Osteochondrosis/ Osteochondritis
dissecans
 Incongruity
Pelvic limb Subluxation of coxofemoral joint
Hip Dysplasia 6 months old - Adult
lameness Secondary DJD
Appearance depends on stage of disease.
Early: May be normal or may see lucencies in
subchondral bone of proximal femoral epiphysis
Avascular Necrosis of the 1-2 year old Pelvic limb
and metaphysis
Femoral Head Miniature breeds lameness
Late: Flattening and irregularity with remodeling
of the femoral head and neck
Secondary DJD
Lameness Typically located at distal radial and ulnar physis
Depression Double Physis
2-7 month old Inappetance Periosteal new bone cuff along physis
Hypertrophic Osteodystrophy
Giant Breeds Pyrexia Soft tissue swelling
Hyperkeratosis
Leukocytosis
Solitary or multiple
5-12 months old Lameness Medullary opacities with blurring and
Panosteitis Large breeds Long bone pain accentuation of trabecular bone
Pyrexia Centered on the nutrient foramina of long bones
Smooth, well-defined periosteal new bone
 AGGRESSIVE VERSUS NON-AGGRESSIVE characterization of the features of lysis and
BONE LESIONS3 periosteal new bone formation; however
other features also help in differentiating
The first step in evaluating bone lesions is to
aggressive lesions from non-aggressive
assess for features of aggression. This is one
lesions (Table 1). It is important to
of the most important determinations to be
remember that the presence of one
made early on in the interpretation process
aggressive feature from the list is
as it effectively narrows the differential list.
compatible with an aggressive lesion.
The primary focus of this assessment is the

Table 1: Radiographic Features of Aggressive Bone Lesions

Non-Aggressive Aggressive

Moth-eaten
Lysis Geographic
Permeative
Smooth Irregular
Periosteal Reaction Well-defined Ill-defined
Continuous Interrupted
Narrow Broad
Zone of Transition
Well-defined Ill-defined

Rate of Change Slow Fast

Number of Sites Monostotic Polyostotic

Once a lesion is determined to be patient’s signalment, history and clinical

aggressive, there is a logical decision tree findings. An appropriate list of differentials
that can allow you to arrive at a short, will assist in generating a plan for additional
reasonable list of differentials (Table 2). This tests such as biopsies and thoracic
map can be useful, and one can navigate radiography, or help to institute a therapeutic
down the appropriate path in light of the plan.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Table 2: Tree Diagram of Aggressive Bone Lesion Differentials

Aggressive

Neoplasia Infection

Primary Metastatic Bacterial Fungal

 Osteosarcoma  From primary  Staphylococcu  Histoplasmosis
 Chondrosarcoma bone tumor s  Blastomycosis
 Fibrosarcoma  Carcinoma  Eschericia  Coccidiomycosis
 Hemangiosarcoma  Multiple  Aspergillosis
 Lymphoma myeloma
 Plasmacytoma  Histiocytic
sarcoma

*Not included in this assessment are the immune-mediated arthritides which, as

in the case of rheumatoid arthritis, may appear aggressive and should be added
to your list of differentials for an aggressive lesion centered on a joint.

WHAT DO I DO NEXT? of infection, a urinalysis may also be

performed. In some instances, other
Once an aggressive lesion is identified, it is
screening tests for metastases, including
important to proceed with obtaining a
nuclear scintigraphy and/or whole body CT
cellular diagnosis. This can be attained via
may be indicated.
fine needle aspiration or biopsy techniques.
Fine needle aspirates have been shown to SUMMARY
have reasonable diagnostic accuracy in
While many clinicians find the
cases of osteosarcoma. For other
interpretation of musculoskeletal
neoplasms, biopsies using a jamshidi needle
radiography a challenge, a systematic
may be required.
approach to the information included in an
In cases where fungal disease may be image results in a maximal benefit.
possible, fungal titers may also provide Assessing the aggression of an osseous
additional information on a final diagnosis. lesion is the first step. The best use of
radiography is often not to attain a
Finally, it is important to stage disease. This
definitive diagnosis, but rather to narrow
typically includes radiography or computed
your list of differentials and help plan the
tomography of the thorax, and possibly
next diagnostic test.
ultrasonography of the abdomen. In cases
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Radiographic Evaluation Of The Heart

INTRODUCTION: Radiographic evaluation of the cardiac silhouette can be a daunting task. There
are several semi-objective measures of cardiac size, and a structured method of evaluating the
cardiac shape and contour. These include rules about the number of intercostal spaces a normal
heart should cover in the thorax; the height and width of a normal heart as a percentage of the
total thoracic diameter; the vertebral heart score; and in the case of assessment of the cardiac
shape, the “clock face” analogy.

The diagnosis of heart disease involves further assessment of the cardiopulmonary structures,
including the size and shape of the pulmonary vasculature (arteries and veins), the presence of
pulmonary edema or pleura effusion, and the presence of ascites.

OBJECTIVES:
1. Review and understand the different methods of cardiac size and shape assessment in
the dog
2. Review and understand the utility of the clock face analogy in assessing cardiac shape
3. Understand the utility and the limitations of such tests
4. Discuss the methodology of successful detection and characterization of heart disease
in dogs
KEY POINTS:
1. The vertebral heart scale, and other assessments of cardiac size, are useful tests but
should not be used in isolation
2. The value of radiographic interpretation of cardiovascular disease is in the complete,
summed assessment of all structures rather than in an individual finding
3. Significant breed variation exists, and a range of normal appearances is possible

CARDIAC SILHOUETTE EVALUATION recognize that components of the cardiac

silhouette contain fat (pericardial fat) and
The radiographic evaluation of the cardiac
may influence our assessment of cardiac
silhouette requires the use of all Roentgen
size if we are not careful. Also, there are
signs. It seems strange to think that all
some instances where we may see
Roentgen signs (location, size, shape,
abnormal mineralization of the aortic valve
number, margin and opacity) can apply
or coronary arteries.
here. For example, there is only 1 cardiac
silhouette. But if we consider the number
of chambers that might be involved in
Heart Size
cardiac disease (1, 2, 3 or 4), then number
becomes an important part of our cardiac The vertebral heart score was reported by
assessment, and along with the evaluation Buchanan et al in 1995 as a method for
of the location of enlargement, helps us objectively assessing cardiac silhouette size
determines the distribution of disease in dogs. This score should typically range
(right-sided, left-sided, generalized). In from 8.7 to 10.7 in normal canine patients
addition, while we expect that the heart and 6.9 to 8.1 in feline patients. Since that
should be soft tissue opaque, we need to time, there have been adaptations of this
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

score to cats, and modifications to increase VHS can vary significantly with breed, with
its accuracy in specific breeds, and in some normal dogs of certain breeds having
puppies. This is a useful score, but it should hearts that are much larger than the
be noted that, on lateral projections, this reference range. This further supports the
test has a sensitivity and specificity of 86% idea that complete assessment of thoracic
and 80% respectively, meaning that some radiographs is important in reaching an
animals measured normal that had disease, accurate diagnosis of cardiac disease, and
and some animals measured enlarged, with familiarity with breed variations is of utmost
no disease. In addition, the ranges of the importance.

FIG(1)Example of how the vertebral heart score is measured. Note the placement of the
calipers on both the heart and the vertebrae. On this same image, note the fact that the heart
occupies less then 3 intercostal spaces.

Another valuable tool for evaluation of The “clock face” analogy is a tool used to
cardiac size is assessment of the number of assess changes in cardiac shape that can
intercostal spaces (ICS) that the heart be attributed to enlargements of specific
covers on a lateral projection. In general, chambers or great vessels. In combination
the cardiac silhouette should not cover with assessment of cardiac size, the
more than 3-3.5 ICS on a lateral projection. accuracy of cardiac disease diagnosis will
be increased.
Finally, an increased cardiac height and/or
width can correlate with increased cardiac
size and, potentially, cardiac disease.
Typically, the heart should be ½ to 2/3 of
the height of the thorax on a lateral
projection, and ½ to 2/3 the width of the
cardiac silhouette on the VD projection at
the level of the 5th ICS.

THE CLOCK FACE ANALOGY

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OTHER CARDIOPULMONARY FINDINGS heart failure, fluid overload), pulmonary

overcirculation (left to right shunts, fluid
Pulmonary Vasculature overload), pulmonary undercirculation
The pulmonary vessels are a window into (pulmonic stenosis, dehydration,
the “plumbing” of the cardiovascular cardiovascular shock), or pulmonary
system, and thorough evaluation of the thromboembolism (oligemia).
pulmonary vessels will allow for
determination of congestion (left – sided

FIG(2) Left lateral projection showing the right cranial lobar pulmonary artery (red) and pulmonary
vein (blue). Paired arteries should have similar size and taper as they move out to the periphery
of the lung.

Fluid Accumulation The radiographic evaluation of the cardiac

silhouette in the dog should be done in the
Fluid in the lungs (pulmonary edema), in the
context of all Roentgen signs, including size,
pleural space (pleural effusion) or in the
shape, margination, location, number and
peritoneal space (peritoneal effusion) may
opacity should be used
also indicate an increase in pressures that
relate to cardiac dysfunction. While other FURTHER READING
differentials for the accumulation of fluid
Thrall DE, “Textbook of Veterinary
are possible, when these findings occur in
Diagnostic Radiology”
conjunction with cardiac enlargements, and
in specific regions, they should be included 1. Lamb CR, Tyler M, Boswood A,
in a succinct conclusion and differential list Skelly BJ, Cain M. Assessment of
that involves cardiac dysfunction. the value of the vertebral heart
scale in the radiographic diagnosis
CONCLUSION
of cardiac disease in dogs.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Veterinary Record 2000; 146: 687- ranges for the vertebral heart scale
690. as an aid to the radiographic
diagnosis of cardiac disease in dogs.
2. Lamb CR, Boswood A, Volkman A,
Veterinary Record. 2001; 148: 707-
Connolly DJ. Assessment of survey
711.
radiography as a method for
diagnosis of congenital cardiac 4. Buchanan JW, Bucheler J. Vertebral
disease in dogs. Journal of Small scale system to measure canine
Animal Practice. 2001; 42: 541-45. heart size in radiographs. J Am Vet
Med Assoc. 1995; 206: 194-99
3. Lamb CR, Wikeley H, Boswood A,
Pfeiffer DU. Use of breed-specific
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Radiographic Evaluation Of The Vomiting

Patient

INTRODUCTION: There are many indications for abdominal imaging in the veterinary patient. In
the vomiting patient, abdominal radiography and abdominal ultrasound are commonly
performed, especially in cases of potential gastrointestinal obstruction where surgery may be
indicated. Abdominal radiography is an excellent screening test, readily available, inexpensive
and rapid to perform. However, many radiographic findings can be non-specific, and the
presence of moderate to severe peritoneal and retroperitoneal effusion can decrease the
diagnostic value of abdominal radiography. It can sometimes been difficult to reach a diagnosis
of mechanical obstruction and decide on surgical intervention based on radiography alone.

PERITONEAL AND RETROPERITONEAL serosal detail has a rounded, distended

SEROSAL MARGIN DETAIL abdominal body wall, consider the
possibility of free peritoneal fluid.
Serosal margin detail, or the ability to define
the margins of abdominal organs on the Radiography can be an excellent test for the
radiograph, is dependent on the amount of detection of free peritoneal gas. The
fat in the peritoneal and retroperitonal identification of gas lucencies that cannot
spaces. On initial radiographic evaluation, be reliably localized to the lumen of an
serosal margin detail should be assessed. intestinal segment is highly suggestive of
Specifically, evaluate the ability to visualize free peritoneal gas. Additionally, the ability
the serosal margins of the abdominal to visualize the peritoneal surface of the
organs, and the amount of fat in the diaphragm, or the impression that serosal
abdomen. Each patient should be treated margin detail is increased in some areas can
individually, as there is significant variation further support a conclusion of free
in the amount of peritoneal and peritoneal gas. Barring recent abdominal
retroperitoneal fat, and brown fat in young surgery or full-thickness body wall trauma,
patients does not provide the same degree the primary differential diagnosis for free
of contrast as yellow fat in more mature peritoneal gas is a rupture in the
patients. In patients with moderate gastrointestinal tract. This can be a
peritoneal and retroperitoneal fat, the complication of a chronic foreign body or
margins of abdominal organs should be mural lesion.
easy to delineate. If not, consider the
MECHANICAL OBSTRUCTION
presence of fluid. Free peritoneal fluid
could be blood, pus, water, cellular Radiography has long been the mainstay of
(malignant), urine, chyle or bile. Thin or diagnostic imaging. With the introduction
emaciated patients will have poor serosal and rapid advancement of digital imaging,
margin detail; detecting free peritoneal radiography has become even more
fluid in these patients can be challenging. efficient, and allows a clinician to obtain
Be sure to also consider the contour of the opinions from radiologists, internists and
abdominal body wall in these patients. If an surgeons with a few mouse clicks.
emaciated patient with poor abdominal Fundamentally, image interpretation is
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based on thorough evaluation of Roentgen evaluate the extent and distribution of small
signs: location, size, shape, number and intestinal distention. The presence of focal
opacity. Evaluation of location refers not or segmental ileus is most commonly
only to changes in organ location but also associated with mechanical obstruction.
lesion location and distribution (focal, Diffuse or generalized ileus is most
multifocal, diffuse). Determination of size commonly associated with functional
is, in some cases, subjective, but objective disease.
measurements for some organs have been
The most commonly used tool for
published. Shape, contour and margination
measurement of small intestinal diameter
of an organ or structure are also important
in dogs is the comparison of intestinal
in evaluation of pathology (rounded,
diameter to the height of the mid body of L5
irregular, smooth). While number of organs
on the lateral projection. Normal intestinal
is relatively constant, the number of lesions
diameter should be no greater than 1.6
(one, two, multiple) along with their
times the height of the mid body of L5.
distribution can be used in concert to arrive
Intestinal diameter that is greater than this
at a more narrow list of differentials. Most
suggests the presence of ileus.1 However,
tissues in the abdomen will have soft tissue
this imaging test can be associated with a
opacity. Relative differences in the soft
significant number of false positive
tissue opacity of organs are often related to
diagnoses of mechanical obstruction, and
physical density, or thickness. Fat opacity is
care must be used to interpret this finding
responsible for the contrast available in the
in the context of other radiographic
abdominal cavity. The basis for
features that suggest mechanical
interpretation is recognizing when an organ
obstruction. Additional radiographic
deviates from its expected normal
features that should be assessed include the
appearance. Roentgen signs provide an
presence of sharp, hairpin turns (contour,
organized, systematic method to evaluate
shape); a gravel sign (opacity); and the
an organ for normalcy, and to decide exactly
distinct presence of two, discrete
how it has become abnormal.
populations of bowel – normal diameter
Evaluation of the gastrointestinal tract for and abnormal diameter (distribution). In
evidence of mechanical obstruction has cats, intestinal diameter greater than 12
been extensively studied. The primary mm is considered a sign of pathologic
radiographic finding associated with GI dilation. This measurement is made from
obstruction is small intestinal dilation, serosal to serosa, as determination of the
which manifests as in increase in small serosal margin is difficult due to fluid
intestinal diameter, and is commonly contents.
referred to as ileus. In the context of
Roentgen signs, it is also important to
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FIG.1 Lateral projection of the abdomen of a cat showing the measurements of the bowel
segments. The gas filled segment is mildly larger than the fluid filled sements, but still measures
within normal limits.

FIG.2 Right lateral projection of a dog that is vomiting. Note that there are two distinct populations
of bowel.
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More recently, it has been suggested that cats, the left limb of the pancreas may be
the ratio of largest small intestinal diameter visible in the triangle of fat surrounded by the
to smallest small intestinal diameter should gastric fundus, the spleen and the left
be used to more accurately assess for the kidney.
presence of mechanical obstruction. A ratio In canine pancreatitis, the peritoneal serosal
of 2.4 or less is considered normal, while a margin detail may be reduced focally, in the
ratio of 3.4 or greater is highly suggestive of right cranial abdominal region, due to
mechanical obstruction. Clearly this results regional peritonitis and/or steatitis. If the
in a wide grey zone that may be difficult to pancreas is enlarged, displacement of the
interpret. Therefore, it is still important to nearby organs may also be seen.
assess additional radiographic features that Enlargement of the right pancreatic limb may
can assist in making a diagnosis of result in lateral displacement of the
mechanical obstruction. Finally, when duodenum, with medial displacement of the
present, a well-visualized foreign body is cecum and ascending colon. Enlargment of
always helpful! However, without evidence the pancreatic body may result in widening
of obstruction (dilation/ileus), a foreign body of the pyloroduodenal angle. Enlargement
of the left pancreatic limb may result in
may pass, and surgery may not be required.
caudal displacement of the transverse colon.
Linear foreign bodies can be a challenging
radiographic diagnosis. The position, In feline pancreatitis, these radiographic
location and distribution of small intestinal changes occur less commonly. For both
segments that contain a linear foreign body dogs and cats, pancreatitis can be present in
are frequently altered, classically resulting in the absence of radiographic or
GI plication. However, GI plication can be ultrsasonographic findings.
difficult to identify radiographically, resulting
CONCLUSION
in many false negative diagnoses based
Radiography is an excellent screening test
solely on radiography. The addition of
for gastrointestinal obstruction. Specifically,
positive contrast media or the use of
it is fast, and allows for a multitude of
alternative imaging such as ultrasound may
diseases to be assessed. It is often used in
help confirm this diagnosis.
conjunction with abdominal
Intestinal wall thickening is not reliably
ultrasonography, which is appropriate.
assessed with plain radiography. GI
These two imaging tests are complimentary;
contents are soft tissue opaque, and border
ultrasound should not be used as the sole
effaces the mucosal surface, leading to an
imaging study in a vomiting patient.
erroneous observation that the GI wall is
thickened. The administration of positive
FURTHER READING
contrast media is required to identify the
mucosal surface and to accurately diagnose 1. Graham JP, Lord PF, Harrison JM.
mural thickening. Larger mural lesions can Quantitative estimation of intestinal
be detected as a mass, but it may not be dilation as a predictor of obstruction in the
possible to identify an intestinal mass lesion dog. J Small Anim Pract. 1998;39:521–
definitively, especially if there is concomitant 524.
peritoneal effusion. 2. Finck C, D’Anjou M-A, Alexander K,
Specchi S, Beauchamp G. Radiographic
PANCREATITIS Diagnosis of Mechanical Obstruction in
The canine pancreas is normally not visible. Dogs Based on Relative Small Intestinal
Abnormalities in pancreatic size may cause External Diameters. Vet Radiol
displacement of surrounding organs, Ultrasound. 2014 Sep 1;55:472–479.
specifically the descending duodenum, the
pylorus and the transverse colon. In obese
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Sonographic Evaluation Of The Vomiting

Patient

INTRODUCTION: Abdominal ultrasound (AUS) is a readily available, non-invasive cross-sectional

imaging modality that complements radiography. AUS has become more readily available and
less expensive in veterinary medicine. With the increased availability of AUS, the role of
abdominal radiography often comes into question. However, it is important to remember that
there is a very direct relationship between the accuracy and value of AUS and operator
experience. It requires years of experience to obtain and accurately interpret diagnostic AUS.
There are multiple pitfalls and artifacts, therefore the advantages and disadvantages of this
imaging modality when compared to abdominal radiography need to be completely understood.
Prior to performing AUS, specific questions should be asked of the abdominal ultrasound
examination based on the physical examination, clinical history and other laboratory data.

Computed Tomography (CT) is another cross-sectional imaging modality that is steadily

becoming more available in veterinary practice. CT uses x-rays to create thin slice images that,
like AUS, eliminates superimposition. With ever increasing speed, spatial resolution, and the
ability to create muliplanar reformatted images, CT can replace abdominal radiography and
ultrasonography in some applications.

For the purposes of this session, we will focus on the utility of radiography, ultrasound and
computed tomography for the diagnosis of gastrointestinal obstruction in the vomiting patient.

OBSTRUCTIVE DISEASES and in the context of clinical history and

suspicion, diagnostic accuracy increases.
Abdominal ultrasound (AUS) has long been
used to evaluate patients in which The mucosal and the serosal margins of GI
radiography is inconclusive or in cases segments can be reliably identified and
where additional information regarding the characterized using AUS. This allows
possibility of neoplasia may be desired. resolution of both the wall and the lumen as
Where abdominal radiography provides separate, distinct regions. Luminal dilation
contrast resolution that is limited to gas, fat, of small intestinal segments <1.5 cm is a
soft tissue, bone and metal, AUS provides a useful discriminatory finding for the
greater degree of contrast resolution that is diagnosis of moderate to severe distention.
based on acoustic impedance, which When this degree of intestinal distention is
determines echogenicity. This increase in observed, a search for a cause of
contrast resolution allows for mechanical obstruction should be initiated.3
discrimination of GI layers, and changes in Foreign bodies have a relatively
acoustic impedance/echogenicity often characteristic appearance sonographically,
accompany a multitude of disease showing a significant degree of distal
processes. Many of these changes can be acoustic shadowing and surface reflection
very non-specific, but when interpreted in that hints at their shape.
conjunction with abdominal radiography
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Due to the aforementioned superior abdomen in dogs and cats has been
contrast resolution, mural lesions are reported with increasing frequency. While
identified better with AUS than with still in relative infancy for the diagnosis of
radiography. Assessment of intestinal wall intestinal obstruction, CT has been shown
thickness as well as the presence, alteration to be more accurate, faster and better for
or absence of intestinal layering can be surgical planning compared to US in a
accurately performed with ultrasound, and population of dogs with suspected
can provide insight into underlying etiology intestinal obstruction. CT was as accurate
of mural lesions. In dogs, the presence of as US in the identification of intestinal
intestinal wall thickening and loss of foreign bodies, with equal sensitivity and
layering is 50.1 times more likely to result slightly lower specificity. In addition, CT has
from neoplasia than from enteritis. been show to more accurately identify the
Intestinal wall thickening and loss of location of an intestinal lesion, and can be
layering can also be seen with oomycoses used to identify plication associated with
such as Pythium and Lagenidium. The linear foreign bodies. Further, depending
presence of gastric wall thickening along on equipment, CT can be far more rapid,
with pseudolayering is highly correlated especially if performed under sedation. Due
with gastric epithelial neoplasia. And gastric to the tremendous number of images
wall thickening in conjunction with concave created in a CT dataset, interpretation time
mural defects and gas dissection is can be increased, and when considered
correlated with gastric ulceration. together, study and interpretation time for
Alterations in individual layer thickness CT and US are similar.
and/or echogenicity can also be evaluated
with AUS. The presence of linear striations
in the intestinal mucosa has been correlated PANCREATITIS
with lacteal dilation in the dog. The
presence of a mucosal stripe in cats has Ultrasonography can also be useful
been associated with fibrosis, possibily in the diagnosis of pancreatitis. Ultrasound
related to inflammatory bowel disease. And often allows direct visualization of all or part
the identification of muscularis layer of the pancreas; occasionally gas in the
thickening in cats has been linked to the stomach and/or transverse colon obscures
diagnosis of intestinal lymphoma. portions of the left pancreatic limb and
pancreatic body. In addition, gas in the
In patients with peritoneal effusion, AUS ascending colon and/or duodenum can
will allow visualization of structures that obscure the right pancreatic limb.
cannot be seen with radiography. In fact,
AUS can be indispensable in guiding In acute forms pancreatitis, the
sampling of effusion, and of abnormal affected region of the pancreas is
organs. In addition, AUS has been reported hypoechoic, reflecting edema associated
to be accurate in identifying free peritoneal with inflammation. Fluid may also
gas, and some consider it to be more accumulate around the pancreas as well as
sensitive than radiography. within the peripancreatic fat. The
surrounding fat is typically hyperechoic, and
hyperattenuating, which can interfere with
the ability to evaluate the regional
COMPUTED TOMOGRAPHY
structures, including the pancreas. Due to
Recently, the utility of computed the local inflammation, the duodenum may
tomography (CT) in the evaluation of acute be gas filled, or may appear corrugated.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

This corrugation reflects the irritation of the 3. Sharma A, Thompson MS, Scrivani PV, et
of duodenum due to regional peritonitis. al. Comparison of radiography and
ultrasonography for diagnosing small-
The sensitivity, specificity and
intestinal mechanical obstruction in
accuracy of ultrasound in the evaluation of
vomiting dogs. Vet Radiol Ultrasound.
pancreatitis has not been recently assessed.
2011;52:248–255.
Earlier studies suggest that ultrasound has a
sensitivity of approximately 66% for the 4. Tidwell AS, Penninck DG.
detection of pancreatitis. While advances in Ultrasonography of Gastrointestinal Foreign
ultrasound technology may have increased Bodies. Vet Radiol Ultrasound. 1992 May
the sensitivity of ultrasound detection of 1;33:160–169.
pancreatitis, it must be noted that some
cases of pancreatitis will not have
sonographic abnormalities, and other tests 5. Tyrrell D, Beck C. Survey of the Use of
should be used to confirm this diagnosis. Radiography Vs. Ultrasonography in the
Investigation of Gastrointestinal Foreign
Bodies in Small Animals. Vet Radiol
CONCLUSION Ultrasound. 2006 Jul 1;47:404–408.

The arsenal of imaging modalities available

for imaging gastrointestinal disease is
6. Penninck D, Smyers B, Webster CR, Rand
expanding. With advancements in
W, Moore AS. Diagnostic value of
technology, the cost of these modalities has
ultrasonography in differentiating enteritis
decreased, and the frequency of their use in
from intestinal neoplasia in dogs. Vet Radiol
veterinary practice is increasing.
Ultrasound. 2003;44:570–575.
Understanding the strengths and
limitations of each in the context of clinical
diagnosis is important to inform proper
decision-making for your patient. 7. Graham JP, Newell SM, Roberts GD,
Lester NV. Ultrasonographic features of
canine gastrointestinal pythiosis. Vet Radiol
Ultrasound. 2000;41:273–277.
FURTHER READING

1. Graham JP, Lord PF, Harrison JM.

Quantitative estimation of intestinal 8. Berryessa NA, Marks SL, Pesavento PA, et
dilation as a predictor of obstruction in the al. Gastrointestinal pythiosis in 10 dogs
dog. J Small Anim Pract. 1998;39:521–524. from California. J Vet Intern Med.
2008;22:1065–1069.

2. Finck C, D’Anjou M-A, Alexander K,

Specchi S, Beauchamp G. Radiographic 9. Hummel J, Grooters A, Davidson G,
Diagnosis of Mechanical Obstruction in Jennings S, Nicklas J, Birkenheuer A.
Dogs Based on Relative Small Intestinal Successful management of gastrointestinal
External Diameters. Vet Radiol Ultrasound. pythiosis in a dog using itraconazole,
2014 Sep 1;55:472–479. terbinafine, and mefenoxam. Med Mycol
Off Publ Int Soc Hum Anim Mycol. 2011
Jul;49:539–542.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

10. Penninck DG, Moore AS, Gliatto J. 15. Boysen SR, Tidwell AS, Penninck DG.
Ultrasonography of canine gastric epithelial Ultrasonographic findings in dogs and cats
neoplasia. Vet Radiol Ultrasound. with gastrointestinal perforation. Vet Radiol
1998;39:342–348. Ultrasound Off J Am Coll Vet Radiol Int Vet
Radiol Assoc. 2003 Oct;44:556–564.

11. Penninck D, Matz M, Tidwell A.

Ultrasonography of gastric ulceration in the 16. Shanaman MM, Schwarz T, Gal A,
dog. Vet Radiol Ultrasound. 1997;38:308– O’Brien RT. Comparison Between Survey
312. Radiography, B-Mode Ultrasonography,
Contrast-Enhanced Ultrasonography and
Contrast-Enhanced Multi-Detector
12. Winter MD, Londono L, Berry CR, Computed Tomography Findings in Dogs
Hernandez JA. Ultrasonographic evaluation with Acute Abdominal Signs. Vet Radiol
of relative gastrointestinal layer thickness in Ultrasound. 2013;54:591–604.
cats without clinical evidence of
gastrointestinal tract disease. J Feline Med
Surg. 2014 Feb;16:118–124. 17. Shanaman MM, Hartman SK, O’Brien RT.
Feasibility for Using Dual-Phase Contrast-
Enhanced Multi-Detector Helical Computed
13. Zwingenberger AL, Marks SL, Baker TW, Tomography to Evaluate Awake and
Moore PF. Ultrasonographic Evaluation of Sedated Dogs with Acute Abdominal Signs.
the Muscularis Propria in Cats with Diffuse Vet Radiol Ultrasound. 2012;53:605–612.
Small Intestinal Lymphoma or Inflammatory
18. Winter MD, Barry KS, Johnson MD, Berry
Bowel Disease. J Vet Intern Med.
CR, Case JB. Ultrasonographic and
2010;24:289–292.
computed tomographic characterization
and localization of suspected mechanical
gastrointestinal obstruction in dogs. J Am
14. Donato PD, Penninck D, Pietra M, Vet Med Assoc. 2017 Aug 1;251(3):315-321
Cipone M, Diana A. Ultrasonographic
measurement of the relative thickness of
intestinal wall layers in clinically healthy
cats. J Feline Med Surg. 2014 Apr 1;16:333–
339.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Índice
CARLOS PINTO
Carlos R. F. Pinto, MedVet, PhD, DACT
Professor of Theriogenology, School of Veterinary Medicine
Louisiana State University, Baton Rouge, Louisiana
cpinto@lsu.edu

1.5.1. Update on estrus synchronization ............................................................................ 126

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Update on estrus synchronization

INTRODUCTION: Various estrus synchronization protocols began to be developed and proposed

in the 1990’s and since then a variety of protocols have been devised for beef and dairy cattle.
The reason for so many different protocols lies on the intent to maximize their efficiency
according to their specific use. For example, some are designed for beef heifers; others are
designed for breeding by appointment or breeding that require estrus observation. The intent of
this discussion is not to present all existing synchronization protocols for cattle but to list a few
basic protocols and their rationale. Once we understand the basic pharmacology of commercially
available drugs and the concepts of reproductive physiology, it becomes easier to understand
them and even to propose some modifications depending of the availability of pharmaceutical
hormones in your region and the needs of your clients. The protocols discussed below are
example of those that preclude the need for estrus detection.

OVSYNCH trigger ovulation of a dominant follicle

and subsequently induce a new
Although PGF2α and GnRH (gonadotropin-
follicular wave. The very first follicle
releasing hormone) had already been used
wave begins ~ 1 day after ovulation in
for estrus synchronization for several years,
cattle.
it was not until 1995 when a publication
(Synchronization of ovulation in dairy cows  Exactly a week later, an injection of
using PGF2α and GnRH. Pursley JR, Mee PGF2α is administered to induce the
MO, Wiltbank MC. Theriogenology 1995 regression of any corpus luteum that
44(7):915-23) described the first might be present.
synchronization protocol for timed AI
o Some studies have shown that some
(breeding by appointment). That event
cows may benefit from a second PGF2α
sparked a series of investigations and
given 24 hours after the first PGF2α
publications describing a number of
injection.
protocol modifications. Until 1995, PGF2α
was the main hormone used to synchronize  Forty-eight hours following the
cows but PGF2α only affects the luteal PGF2α administration, another
function and not the development of follicle injection of GnRH is given to trigger
waves. The ability to induce or manipulate ovulation of preovulatory size
follicle waves is one of key events in follicles that are expected to be
ensuring success of synchronization present after the previous PGF2α
protocols and fertility outcome. injection.
OvSynch basically consisted of: o Greater conception rates have been
show by postponing this GnRH until 56
 An initial administration of an
hours
intramuscular injection of GnRH
(100µg ) at a random stage of the
estrous cycle. This GnRH treatment will
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 Artificial insemination is then  It has been proposed that cows with

performed at 12 to 24 hours following inactive ovaries may benefit from using
this last GnRH injection receiving a double OvSynch protocol,
with a week interval between the two
o Artificial inseminations are done
OvSynch.
without heat detection
 Timed AI is done at the second
PROTOCOL MODIFICATIONS OvSynch.
 Cows with already cycling ovaries are
CIDR (controlled internal drug release)
not affected by this protocol.
 CIDRs are an intravaginal device made MODIFICATIONS FOR BEEF CATTLE
of nylon coated with a silicone coat
Several modifications have been
that is impregnated with progesterone. proposed for beef cattle, especially to
Opposed to the action of PGF2α, a CIDR decrease costs associated with labor.
device mimics the action of a corpus
For example, when using the OvSynch
luteum and its withdrawal resembles a
protocol with CIDR, instead having the
rapid luteolysis. last GnRH injection given before timed
 A CIDR may be inserted in cows at the AI, GnRH is given at the time of AI,
beginning of a OvSynch protocol and typically 60-66 hours following the last
removed a week later at the time of the PGF2α injection.
PGF2α injection  When GnRH is given at the time of AI,
PRE-SYNCH the modified protocol is termed CO-
Synch
 Because merely exposing cows or  When CIDR is added to the CO-Synch
heifers to the OvSynch protocol may protocol, the modified protocol is
not guarantee that a new follicle will be termed CO-Synch + CIDR
initiated, it has been shown that adding  A 5-day CO-Synch + CIDR has been
a pre-synchronization scheme will proposed for beef cattle
improve ovulation synchronization and o At CIDR removal, a first injection is
subsequent fertility (pregnancy per AI). given followed by another PGF2α
 Pre-sycnhronization is typically done injection ~ 8 hours later
with 2 injections of PGF2α 14 days o AI is performed at 72 hours after CIDR
apart. removal and first PGF2α injection
o Then, OvSynch can start 14 days  GnRH is still given at AI
following the second PGF2α  For Bos indicus cows, another PGF2α
o To maximize conception rates, injection has been recommended to be
OvSynch may be started 11 or 12 days given along with CIDR insertion and the
following the last pre-synchronization first GnRH injection
PGF2α injection o AI is to be performed at 66 hours post
Double-OvSynch CIDR removal and not at 72 hours as it
is done for Bos Taurus breeds
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Clinical Management Of Accidents Of

Gestation In Cattle

FETAL MUMMIFICATION signs of estrus, thus, mummified fetuses

may be retained indefinitely. Spontaneous
Background
expulsion of mummified fetuses seldom
The overall incidence of fetal occurs; affected cows typically have a
mummification varies from 0.43 to 1.8% of history of failing to calve on time.
pregnancies but it can be as high as 3-4% in
feedlot heifers due to incomplete
regression of corpus luteum following Treatment
induced abortion. Mummification of the
The treatment of choice is PGF2alpha (25
fetus can only occur after calcification of the
mg dinoprost i.m); expulsion of mummified
fetal skeleton, therefore, fetal death
fetus is expected in 2 to 4 days. The
followed by mummification may occur
breeding prognosis good; cows typically
anywhere from 3rd to 8th month of
conceive in 1 to 3 months following
gestation; most cases occur during 4-6
expulsion of fetus. Surgical removal is
months. Causes may include torsion of the
indicated if fetus is not expelled after
umbilical cord, Campylobacter fetus, fungal
therapy with PGF2alpha.
infection, leptospirosis, Infectious Bovine
Rhinotracheitis and Bovine Viral Diarrhea,
etc. These infectious agents have in
common the fact they do not induce FETAL MACERATION
placentitis and endometrial release of Background and Pathogenesis
prostaglandin F2alpha; and are not
pyogenic. Fetal mummification may be seen The incidence of fetal maceration is 0.09%
in ewes that become infected with of pregnancies. Fetal death followed by
toxoplasmosis during early gestation. maceration may occur at any stage of
gestation. If it occurs prior to calcification,
the fetus will decompose in fetal tissue
Pathogenesis and Clinical Signs debris contained in a purulent liquid
material. If fetal demise occurs after fetal
In mummification, fetal death occurs calcification, and bacteria from the caudal
without luteolysis and adequate cervical reproductive tract gain access to the uterus,
dilation. It results in autolysis and fluid it will result in bacterial decomposition of
resorption in a non-pyogenic environment; autolyzing fetus and membranes. Clinically,
fetus & membranes become dehydrated, there will be a compact mass of bones in a
resulting in a dark brown, leathery fetus collection of purulent material. For these
with shrunken dried skin and bones. There reasons, fetal maceration with a closed
is no odor or exudate present. Cows cervix and a functional corpus luteum is
affected with mummified fetuses do not rare.
show signs of estrus because there is a
persistent corpus luteum that not only
keeps the cervix closed but also prevents
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Clinical Signs Normal amnion: The amniotic fluid is clear,

colorless, and mucoid in nature. Under
Usually a chronic, fetid reddish-gray watery
normal conditions, the volume of the
or mucopurulent discharge from the vulva is
amniotic compartment is regulated by the
seen over a period of several weeks to
fetal swallowing. In early to mid-gestation
months. In some cases, there may be toxic
the amniotic fluid is watery; in late
metritis early but systemic illness is typically
gestation, the fetal bladder sphincter
absent in later stages. Cows with macerated
prevents urine outflow and the amniotic
fetus may experience gradual weight loss
fluid becomes more viscid. The accentuated
and decline in milk production.
mucoid nature is owing to saliva and
secretions of the nasopharynx from fetus.

Treatment Hydramnios is a relatively uncommon

condition caused by autosomal recessive
No satisfactory treatment is available. Poor genes characterized by an abnormal
breeding prognosis due to severe accumulation of amniotic fluid.
endometrial damage. Surgical removal can Pathologically the amount of amniotic fluid
be attempted if warranted by the animal’s greatly increases up to 8-10 times (25-150
value but it is often a frustratingly liters in cows).Its incidence is only 5-10% of
unrewarding effort. uterine dropsy cases. The condition is
associated with a genetic or congenitally
defective fetus that has impaired
FETAL EMPHYSEMA swallowing. The increase of amniotic fluid is
Similar to fetal maceration in that gradual. Hydramnios is seen most
putrefactive bacteria invade the uterus commonly in cattle, and occasionally in
through an open cervix.It is often detected sheep.
in later term pregnant animals. Fetal death
may be associated with dystocia or
incomplete abortion in late gestation. Gross Clinical Signs and Prognosis
fetal changes include putrefaction, Hydramnios is characterized by a gradual
distension with fetid gases, crepitation, dry enlargement or filling of the amniotic cavity
hair and coat secondary to extensive fluid over several months during latter half of
loss and fetal dehydration. Dystocia gestation. The gradual abdominal
involving a fetal emphysema is a enlargement lasts leads to a pear-shaped
complicated and grave condition that is abdomen when the cow is seen from her
commonly fatal to the dam. In ewes, rear. It is often not noticed until parturition,
Clostridium chauvoei may be involved; when a large volume syrupy, viscous,
usually poor prognosis. meconium stained fluid is released during
calving. In examining cows suspected to
having hydrops, it would be important to
differentiate hydrops of the amnion or the
allantois compartment. In cows affected
with hydramnions, the placentomes, and
HYDRAMNIOS (HYDROPS OF THE often fetus can be palpated because the
AMNION) chorioallantois, amnion and placentomes
are normal. Dystocia is common due to
Background and Pathogenesis
uterine inertia and defective/abnormal
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

fetus. Retention of placenta is a common Occasionally develops as early as 5th month

sequela; milk production in subsequent of gestation in severe cases. It usually
lactation is generally poor. develops rapidly over 1 to 3 weeks during
late gestation; the distended uterus fills a
 The prognosis for future breeding
tense, barrel-shaped abdomen (bilateral
life of the dam is good, but the fetus
abdominal distension). The resulting
is invariably defective and
marked abdominal enlargement leads
nonviable.
farmers to question breeding dates or
HYDRALLANTOIS (HYDROPS OF THE suspicion of triplets! Eventually, the
ALLANTOIS) abdominal distension leads to digestive
symptoms such as anorexia, decreased
Background and Pathogenesis ruminations and ultimately constipation.
Normal allantois: The allantois fluid is clear, Hydrallantois can be misdiagnosed as
watery, and amber colored. There is only a indigestion, bloat, or traumatic gastritis.
small amount of allantois fluid produced The pulse is elevated (90-140/min),
from the allantois epithelium prior to accompanied by expiratory grunt.
functional fetal kidneys. The allantois cavity Reproductive examination: the excessive
stores fetal urine delivered through the fluid cause the uterus to palpate greatly
umbilical cord via urachus. In late gestation distended and tense; the distension in the
and under normal conditions, the volume of allantois compartment precludes the
fluid may reach 8 to 15 liters. palpation of placentomes or fetus.
Hydrallantois is a much more common Complications include uterine rupture,
hydrops condition than hydramnios (85- rupture of pre-pubic tendon, and ventral
90% of hydrops conditions); both beef and hernia. In mild cases, hydrallantois may not
dairy cattle are affected. In hydrallantois, be diagnosed until term, when an excessive
fluid accumulation may reach 50 to 200 clear, watery, amber fluid with
liters. Excessive fluid has specific gravity and characteristics of transudate is passed
characteristics of a transudate due to during calving. A greatly enlarged and
vascular disturbance occurring in allantois. atonic uterus may cause dystocia. Fetuses
It is generally characterized by a diseased are usually slightly smaller than normal and
uterus with many non-functional caruncles present with edema and ascites. Fetal
and some placentomes greatly enlarged. membranes may be tough and difficult to
Adventitial placentation is common, with rupture. The fetus is generally dead at birth
portions that are necrotic and edematous. or dies soon after. Fetal membranes may be
Cystic kidneys, hydronephrosis and heavy and edematous, and retained fetal
dysfunction of the fetal tubules with membranes and septic metritis are
resultant polyuria are seldom involved in common sequelae. These complications
pathogenesis of hydrallantois. It generally account for the relative high morbidity and
affects cows > 3 years, unless heifers are mortality of hydrallantois. The prognosis is
affected with congenital caruncle deficit. In therefore guarded for life and fertility.
older cows caruncle deficit may reflect prior Salvage by slaughter is the best option for
uterine infection or injudicious removal of most producers. Milk production in
fetus and/or retained membranes leading subsequent lactation is generally poor.
to a defective endometrium and caruncles.

TREATMENT OF HYDRAMNIOS AND

Clinical Signs and Prognosis HYDRALLANTOIS
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Varies with duration and severity of abdominal pressure are common; cervical
condition. In severe cases, an early decision dilation are often incomplete. A trochar or
to salvage is best while affected cows are plastic tube can be used to draw fluid off
still in good physical condition. Alternately, slowly over 24 hours prior to Cesarean
prompt termination of pregnancy is section. Rapid removal of large volume of
desirable and the best approach. Induction fluid may induce shock. Appropriate fluid
of parturition/abortion in affected cows can therapy in large volumes indicated before,
be achieved by administering 20 mg during, and after surgery. When
dexamethasone and 30 mg of PGF2alpha terminating hydrallantois by Cesarean
that result in cervical dilation and abortion section, the uterus may continue to fill with
within 24 to 48hrs. Inducing abortion is transudate for about 48 hours and it may
more successful with hydramnios. Dystocia require further draining. Retention of fetal
can occur in association with defective fetus membranes and secondary metritis is
(hydramnios) and uterine inertia secondary common; treat early with local and
to uterine distension (hydrallantois). Weak parenteral antibiotics and oxytocin to aid in
abdominal muscles and absence of strong continuing evacuation of the uterus.

Table 1. Hydrallantois and hydramnios

Characteristic Hydrallantois Hydramnios

Prevalence 85–95% 5–15%
Rate of development Rapid (within 1 month) Slow over several months
Shape of abdomen (Bilaterally) round and (unilaterally) pear-shaped, not
tense tense
Palpation (per rectum) of Nonpalpable (tense Palpable
placentomes and fetus uterus)
Gross characteristics of fluid Watery, clear, amber- Viscid, may contain meconium
colored transudate
Fetus Small, normal Grossly abnormal
Placenta Adventitious Normal
Refilling after trocharization Rapid Does not occur
Occurrence of complications Common Uncommon
Outcome Abortion or maternal Parturition at approximately full
death common term
Adapted from: M. Drost.
Complications during gestation in the
cow. Theriogenology 2007;68:487-491;
S.J. Roberts.
Veterinary obstetrics and genital
diseases (theriogenology) (3rd ed.)
1986:225;
V. Sloss, J.H. Dufty (Eds.), Handbook of
bovine obstetrics, The Williams &
Wilkins Co., Baltimore, MD 1980:89 .
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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UTERINE TORSION into birth canal and initiate the cervical

dilation and contractions (Ferguson
Reflex). Torsions or rotations of the
Background and Pathogenesis
uterus at 45 to 90º are often found
Uterine torsion is most common in
during pregnancy and generally correct
dairy cows, but occasionally seen in
themselves. Unusual cases involve 180
beef cows, sheep and goats. The
to 360º torsions that leads to
etiology involves anatomy, manner of
obstruction of blood supply to uterus 
lying down, and maybe sudden falls or
congestion, edema, shock, and may be
rolling. The lesser curvature of uterus in
gangrene of uterus. Under these
late gestation is supported dorso-
conditions, fetal death is unavoidable.
laterally by the broad ligament. The
greater curvature lies free in abdominal
Reproductive Examination: Diagnosis of
cavity resting on abdominal floor,
uterine torsion and its direction is done
supported by rumen, the viscera, and
via palpation per rectum. The amount
abdominal walls. In ruminants the
of tension on the broad ligaments and
gravid horn is in the shape of an arc or a
arteries indicates severity of torsion.
U-shaped loop with the vagina and
Vaginal walls spiral and a stenosis of the
ovary at the respective ends of the arc.
vagina is present but in pre-cervical
The ovarian end of the gravid horn
torsions there may be no vaginal
forms a narrow base upon which the
involvement. In ~ 75% of the cases, the
uterus rests. Torsion involves the
cranial portion of the vagina will show a
rotation of this arc on its transverse
characteristic twisting of the vaginal
axis, and involves both gravid and non-
folds. Torsions may be clockwise or
gravid uterine horns. Each time cow lies
counter-clockwise. Left torsions are
down or rises, the gravid uterus is
more common than right. A left torsion
suspended in the abdominal cavity, and
means that the right uterine (gravid)
a sudden slip or fall could cause torsion
horn moved to the left side. In most
(down front first; up back first). An
cases, the position of the fetus will be
increased incidence is seen in cows
dorso-pubic in 180º torsions. Prognosis
subjected to stall confinement in the
in torsions prior to term depends upon
winter. Torsion of the gravid uterus
duration and degree of torsion, and
occurs more frequent in pluriparous
severity of symptoms. If torsions > 180º
than primiparous animals; it generally
are diagnosed and treated early,
occurs in advanced pregnancy. Most
prognosis for dam and fetus are good.
torsions occur in late first stage or early
Prior to term, best methods of
second stage labor and may be
correction are rolling or via laparotomy.
associated with strong movements of
Complications include uterine rupture
the fetus. Uterine torsions <180º may
and hemorrhage from ruptured vessels.
be present for days or weeks without
Only rarely does torsion recur in the
clinical symptoms until labor begins and
subsequent pregnancy.
dystocia results.
TREATMENT OF UTERINE TORSION
Clinical Signs and Prognosis
Usually history of prolonged 1st stage of
A. Rolling the Dam
labor (i.e. restless, colic behavior);
 Disadvantage is manpower (3-6
abdominal straining is absent, or mild
needed).
and intermittent as fetus cannot enter
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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 Caste cow in lateral recumbency  Detorsion rod – 1 cm steel rod, 80-

onto side of torsion. 100 cm long with eye at either end.
 Tie both hind limbs and both  Loop passed over one fetal limb and
forelimbs together, leaving 8-10 loop on other side of rod passed
foot of rope free for pulling. over 2nd limb.
 Hold head extended with halter.  Aim to have loops just above
 Rotate cow rapidly onto opposite fetlocks.
side  body overtakes the more  Use short broom handle or large
slowly rotating gravid uterus. screw driver through eye in rod and
 If successful, the spiral folds and wrap chain tightly around it.
stenosis of birth canal will have
disappeared. If cervix dilated, fetus C. Laparotomy
may be palpated with ease and  Useful earlier in gestation, or when
there may be a rush of fetal fluids. cervix closed.
 May require 2 or 3 rapid rotations  Try rolling first if assistance
to succeed. available.
 Schafer's method requires less  Open on side of torsion and pass
assistance as the cow is rolled hand down between uterus and
slowly with a plank holding uterus abdominal wall and grasp fetal
stationary. limb. Rock up and down 
 Cow caste on side of torsion. momentum  lift in direction
 One end of a 3-4 meters plank (20- opposite to torsion.
30 cm wide) placed over cow's
para-lumbar fossa and assistant D. Cesarean Section
stands on plank.  Indicated when other methods fail
or when the cervix not adequately
B. Rotation of fetus and uterus per dilated.
vagina  In dystocia, cervix may have
 Only possible if cow at term & has a undergone constriction and
partially dilated cervix. emphysematous fetus now
 Must be able to introduce hand into present.
uterus to grasp fetus – access  Generally cervix only partially
depends on severity of twist. dilated due to atony of cervix and
 Rupture membranes first to release uterus(circulatory disturbance).
fluids  reduce size and weight of
the uterus. E. Complications/Sequelae
 Rock back and forth  momentum  Uterine rupture with peritonitis -
 vigorous twist in opposite Internal hemorrhage - Retained
direction to torsion. fetal membranes - Septic metritis.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Índice
ERNIE WARD
Ernie Ward, DVM, CVFT
E3 Management, LLC
Ocean Isle, NC USA

1.6.1. The 5 Most Important Things You Must Do During Every Appointment .................. 136
1.6.2. The 5 Ways To Make Your Clinic Happier, Healthier, And More Productive ............ 142
1.6.3. Adding New Services And Products Into Your Clinic ................................................. 145
1.6.4. Communicating About Pet Food: Top Pet Owner Nutritional Myths ....................... 148
1.6.5. Innovating The First Year: The 9-Month Pet Visit ..................................................... 152
1.6.6. Social Media Professional: Winning Social Media For Practice Success ................... 156
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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The 5 Most Important Things You Must Do

During Every Appointment

USING COMMUNICATION TO DRIVE has previously obtained. The doctor then

COMPLIANCE AND ADHERENCE asks any additional questions and we begin
the examination.
We see our patients once or twice a year on
average. We must develop systems to
maximize our time with clients to ensure
THE 5 CHIEF COMPONENTS OF THE
that pet owners understand what services
PHYSICAL EXAMINATION
and products their pet needs to optimize
health and well-being. The foundation of 1. General Condition, Ears, Eyes, and Nares
communication is the physical examination.
It is important that we develop a step-by- The technician gently lifts the pet onto the
step, systematic approach to the physical exam table. If the pet is large (over 30-40
examination to ensure consistency and pounds), we typically perform the
effectiveness. This session will review the examination on the floor where a larger dog
critical touchstones that drive compliance is often more comfortable.
during the physical examination. I start by performing a body condition
Performing a physical examination is a part scoring (BCS) and assessing the pet’s
of nearly every patient interaction in a general appearance. I make comments
veterinary hospital. Too often we fail to regarding the coat, stature, weight and
recognize the vital role this service plays in overall state of appearance. I then move to
creating value and confidence in our examining the ears, eyes and nares and
services. Further, how we perform and work my way back, articulating each part of
communicate our physical examination the exam. It is very important that you
plays a large role in our compliance with explain each step and point out any
recommended diagnostic and treatment abnormalities as you discover them. I start
offerings. While every doctor will have his the examination with the pet facing me to
or her own style and routine, it is important gain better access to the head and neck. It
that the examination be methodical, is important that you have a logical
efficient and conveys thoroughness and examination flow that incorporates natural
compassion to the client while keeping the transition points. Transition points are
pet as comfortable as possible. opportunities to change orientation
naturally so you appear coordinated and
Your Entrance rehearsed. Without a well-thought plan of
execution, your examination may appear
I believe the ideal physical examination
haphazard and incomplete. Further, by
begins with a warm entrance and greeting
training a coordinating with your staff, you
of the client and patient by names. I have all
avoid embarrassing gaffes such as bumping
of our staff greet by shaking palms and
into each other or having to ask them to
paws. We then sit down and the technician
turn the pet back to you because you failed
reviews the pertinent medical history she
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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to complete an aspect of your examination. ask the client to stand up (out of their chair)
Whatever your desired flow, you should and come close to the exam table and pet
discuss and role-play it with your staff so to show them any problem areas. I want
that everyone is on-board and understands them to see and smell any periodontal
your methods. disease. Many clients with pets that have
advanced periodontal disease will not
I like to dim the lights as we start the exam
routinely look into their pet’s mouth. Many
by looking into the ears and eyes. This helps
will actually avoid the oral cavity altogether
me in my examination and reinforces the
due to malodor or unsightly appearance. I
seriousness of the examination to the client.
believe it is important to confront
Dimming the lights is a natural transition
periodontal disease directly by having the
point in that it takes the client from the
client interact and see the issue(s). This
previous ten or twelve minutes to talking
doesn’t mean we should make pour clients
and discussing their pet’s medical history to
feel guilty; rather, it means we should be
the action of performing the examination.
thorough and demonstrate any areas of
We then create another natural transition
improvement whenever possible. Point out
point when we turn the room lights on
gingivitis, calculus, bleeding or inflamed
again.
gums, loose teeth and recessed gums. Have
I recommend detailing your findings the client smell the breath and discuss the
verbally whenever a client cannot see what cause of the offensive odor (pathogenic
you’re examining. This serves not only the bacteria). If the teeth and gums look
client but the staff member assisting you as healthy, take this opportunity to
well. When your staff is involved in the congratulate the client on their efforts. By
examination, they can help you complete actively engaging and interacting with
the physical examination report. While we clients, you’re more likely to impress upon
use a video-otoscope in diseased ears and them the seriousness of the condition. If a
nares, for most routine examinations we client remains physically distant and
use traditional otoscopes. Describe the uninvolved from the oral cavity, it is much
retina, lens, conjunctiva, tympanum, nares easier for them to ignore our
and other pertinent structures. This recommendations for dentistry. If a
reinforces to the client that you are veterinarian remains distant and
performing a thorough and complete uninterested, the client will assume that his
examination and are capable and or her own ignorance is justified. Make sure
competent. I use an ophthalmoscope you lift the lip and take a whiff with each
followed by a halogen penlight to test patient and client.
pupillary light responses. After describing
It is imperative to make the connection
my findings, I use the penlight to illuminate
between oral health and systemic diseases
the nares to assess patency, architecture,
such as endocarditis. Too many clients view
and the presence of any discharge or other
dentistry as merely a cosmetic procedure
abnormalities.
and see no value in keeping their dog’s
teeth “Hollywood-white.” It is our
professional obligation to make sure clients
2. Oral Exam understand the relationship between the
I then turn the room lights on as I begin the mouth and general health and well-being. If
oral exam. Because turning the lights on is a you note loose teeth, discuss pain. If you see
visually dramatic step, it also helps change gingivitis, remark about gum recession,
the level of involvement from the client. I tooth root exposure and the potential to
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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adversely affect adjacent teeth. It is 4. Thoracic Cavity, Abdomen and

important to keep in mind that few clients Hindquarters
thoroughly examine their pet’s oral cavity at
I next auscultate the chest. I prefer to close
home. Take this opportunity to lift the lip
my eyes to demonstrate my attentiveness
and educate your clients on the dangers of
and also as a signal to the client that it’s
periodontal disease.
time for quiet. Besides, closing my eyes
One final note: I recommend that you point allows me to concentrate better. I usually
out and briefly touch on an abnormal say to the pet and client that I’m going to
finding during the course of the feel their pulse as I listen to the heart. Again,
examination. I recommend that you reserve this provides me with valuable information
the more detailed discussion for the time regarding pulse strength and quality and
after your examination when you review further enforces to the client that their pet
pertinent findings. Additionally, you can is receiving a complete and thorough exam.
also have a trained staff member give more After I auscultate each quadrant of the
detailed information on conditions such as thorax, I open my eyes and briefly describe
periodontal disease after you exit the what I heard and then move to palpating
appointment. the abdomen. I start in the cranial abdomen
palpating the kidney(s), liver, spleen and
bladder. I pay close attention the any
3. Lymph nodes and Skin structures that I feel are enlarged or
abnormal in any respect. It is very important
With the pet still facing me, I then feel all that you explain what you’re doing and why,
the primary accessible lymph nodes, while especially when you are engaging in
explaining what I’m doing and why. I start seemingly incomprehensible actions. I make
with the submandibular lymph nodes and it a point to describe what I’m feeling as I
work my way caudally. I create a natural probe the abdomen. I also comment to the
transition point for turning the pet away patient and client if there is any tenseness
from me as I palpate the inguinal and or apprehension as I palpate their pet’s
popliteal lymph nodes. The assistant turns abdomen. Some pets are more accepting of
the pet and I palpate these caudal lymph this procedure than others. If a pet is
nodes. I next verify if the client has observed nervous or fearful, I must take great strides
any new lumps or bumps as I run my hands to calm both the patient as well as the
along the pet’s body. I make sure to client. If a client perceives that I am being
emphasize to the client to closely monitor rough or in any way less than gentle with
the areas of the lymph nodes for any their pet, I risk forever damaging my
swellings as I feel the body. Any masses are reputation and kind and compassionate.
noted and measured, and we generally take Often all that is required to allay even the
a digital photograph of any sizable or most challenging fears is communication.
suspicious masses to be included in the
pet’s electronic medical record. If there are Once I’ve completed palpating the
any new masses, we strongly advise the abdomen, I lift the tail to evaluate the
client to have a fine needle aspiration rectum and hindquarters. While this is
performed and submitted to the laboratory arguably the least glamorous part of the
for histopathological review. physical examination, it is critical that we
are thorough. This includes the anal region.
There may be an emerging perianal
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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adenocarcinoma that will go unnoticed until examination report and taking notes or
the groomer sees it in two months. entering charges.

5. Musculoskeletal System Once I’ve completed my review and

outlined a plan, I ask the client if they have
The final step in my physical examination is
any questions and tell them we’ll be right
the evaluation of the joints, limbs and paws.
back after we read any lab tests such as
With the pet still facing away from me, I lift
fecal parasite evaluation or heartworm
up and examine the rear paws and begin
tests, finish their paperwork or obtain any
flexing and extending the joints as I progress
recommended items. It’s important to
toward the hips. Any withdrawal or
maintain an open body posture at this time,
tenseness is noted. I repeat the same for the
facing the client as you prepare to leave. If
front limbs. I end by putting the head
you turn to the side or begin approaching
through a normal range of motion by
the door, you’re sending a signal that you’re
extending and flexing the neck up, down
ready to leave. Before I exit the room, I
and side-to-side.
make sure to shake “palms and paws.” I exit
the room leaving the assistant or technician
to tell the client what we’re doing and then
REVIEWING THE EXAMINATION WITH THE they also leave the exam room.
PET OWNER

Once I’ve completed my exam, we return

the pet to the floor, the client’s lap, or in the It is important to keep the amount of time
carrier and I resume sitting on my stool. I the client spends waiting alone at this point
pull close to the client, generally about 36 to to a minimum. One to three minutes to
42 inches away and at a 45-dgree angle to finalize reports, read basic lab tests, and get
the client. This is the ideal position for any products is about all it takes for most
seated communication. I review my findings uncomplicated, routine examinations. In
and outline a course of action. This is the sick pets, the time spent performing and
time to discuss more fully the importance of evaluating laboratory tests will be longer.
weight reduction and oral care. I have found Be sure to have a plan for dealing with
that by introducing a problem area during patients that require radiographs, blood
the examination and then reviewing it more tests or more involved discussions.
formally after the procedure is complete,
the client is much more receptive and
attentive. It sends a clear message to the TECHNICIAN REVIEW OF EXAMINATION
client when you take additional time and FINDINGS
effort to revisit a particular area of interest
Up until this point, the client has had a staff
concerning their pet’s health. It also
member with them for the entire
improves your communication when you’re
appointment. I like having a staff member
properly seated and without the distraction
‘velcroed’ to the client because I find it is a
that a pet on the exam table may create.
great way to build trust, ensuring that you
This discussion also reminds the assistant of
thoroughly educate and answer a client’s
topics you want them to enforce in the
questions and creating continuity of care
patient discharge. During this time the
within this appointment. It also helps
technician is filling out the physical
reduce missed charges and increase
compliance and follow-up care.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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The only time we leave the client alone is By strategically reinforcing the care a pet
when the technician and doctor leave the needs with the client throughout the
room to get any additional paperwork or appointment, you’ll gain increased
products and complete the written compliance and that means pets live longer,
discharge instructions. It is critical that you healthier lives.
are aware of the time you leave the client
Before the assistant enters the room to
alone in the room. This generally takes us
review the examination report, the first
one to five minutes, depending on the
step is to double check the doctor’s report.
complexity of the case (see above).
This will help the staff member remember
Once I’ve finalized my examination report, to get all your charges in and make sure that
the technician will return to the exam room there aren’t any typos or other errors. If
and begin the discharge. We are now there’s a problem, your staff should correct
approximately twenty to twenty-three it before it reaches the client and causes
minutes into the appointment with seven to embarrassment and diminished credibility.
ten minutes to review the reports and Even simple mistakes such as the wrong
recommendations and bill out the client. gender or age on an otherwise flawless
report can be enough to create doubt in a
The technician returns to the client and
client’s mind. Everyone, including doctors,
begins reviewing the doctor’s report with
makes mistakes and the team can help the
the client. My strategy is to repeat my
doctors look good to clients. Doctors may
recommendations three to five times during
forget that the patient was prescribed a
the appointment. This offers the most
drug or follow-up care and the technician
repetition and increases the likelihood a
will catch that mistake and that double-
client will take our recommendations
check helps reduce gaps in follow-up care.
seriously and act upon them. Reinforcing a
message through a variety of team The staff member then takes a seat and
members will help you improve your starts to summarize the written report. The
compliance with any service or product. assistant or technician should review the
physical examination and comment on the
The first opportunity to offer medical advice
normal findings as well as the abnormal
comes when the technician is obtaining the
ones. It’s important to point out where
medical history. For example, if she notes
clients are doing well so any areas that need
that a pet needs to lose weight, this is a
work don’t come across as a reprimand. The
great time to start the discussion of diet and
staff member takes a highlighter and
exercise. The next opportunity occurs when
highlights any test results or abnormal
I am performing the physical examination. If
findings and highlights any treatment or
I observe stage two or three periodontal
follow-up care instructions. The highlighter
disease during the exam, I will recommend
helps personalize the report and allows the
a dental scaling and polishing. The third
assistant to focus the client’s attention on
chance to offer recommendations happens
what the client really needs to do for their
when I sit down and review my examination
pet.
findings. The fourth and fifth opportunities
take place when the technician goes over
our written discharge report and when the
receptionist reviews the appointment at
billing.
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TIME being through and compassionate and our

patients deserve it.
In the real world, there is no set time for the
amount of time obtaining a medical history,
performing a physical examination,
5 IMPORTANT TOPICS TO ADDRESS
reviewing the exam report and billing will
DURING EACH EXAM
take. In general terms, we allocate thirty
minutes for the entire appointment with a While there are literally hundreds of issues
third of the total time allocated to 1) and areas we strive to address during each
Welcome, medical history and lab samples, exam, here are five universal topics you
2) Physical examination, and 3) Reviewing should consider for every patient during
the exam and billing. Some pets will require every appointment.
a longer history while others will require
fifteen minutes to perform the physical 1. Preventive Care – Vaccinations,
examination. The key is to know your heartworm and flea/tick
schedule and where are you in the preventive(s), basic hygiene
appointment both from a time as well as 2. Diet and Body Condition –
procedural perspective. Five minutes is a Thin, normal, or overweight?
long time if you’re staying on topic and What food should they feed,
discussing what the pet needs. Five minutes how much, how often, and
is a relatively short period if you’re why?
discussing the weather or church and then
realize you’ve neglected the pet’s obesity. 3. Behavior – “Is there anything
Scooter does that bugs you?”

4. Life Stage and Lifestyle – What

While there is no right or wrong way to should they expect from a 2-
perform a physical examination, I year old Lab? 5-year old? 10-
encourage you to develop a systematic year old? Why? What changes
approach that allows you to be as thorough should they make?
as possible in as short amount of time as
practical. Your clients will thank you for 5. When will they see you again?
– Follow-up care scheduled
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

The 5 Ways To Make Your Clinic Happier,

Healthier, And More Productive

INTRODUCTION: Our habits are the secret of our success or foundation of our failure. Much has
been written about what behaviors and customs help make you a success but little time is spent
on those troublesome thoughts and actions we repeat each day that sabotage our happiness.
Our routines define us. Repeating certain actions each day allows us to seek refuge from the
chaos and unpredictability of the real world. We carve out a space that is uniquely ours and we
control. For the most part, this is healthy. But what about habits we retreat to that are negative?
They’re more prevalent than you might think. Take the time to reflect on these five bad habits
and seek ways to minimize their influence on your life. Who knows, you just might find happiness
and success along the way.

Bad Habit #1 – “Why you’re wrong” - The What they really mean to say is they know
Change Killer better. They’re the authority or superior to
someone else. The net result is it stops cold
I meet negative people all the time. Rarely
any possibility of change in the person’s life.
do I conclude a lecture before someone
And if you’re not careful, in the lives of
points out why what I’ve been doing for the
those around you.
past twenty-one years in my practice simply
won’t work for them. And you know what?
They’re absolutely right. Whenever we fill
I was on a flight recently sitting next to a
our minds with “why it won’t work,” we
man and his teenage daughter. I couldn’t
release ourselves from the possibility that it
help but overhear their conversation about
might. This simple mental trick instantly
choosing a college. The young lady was
removes any chance of what we really don’t
excitedly showing him a brochure from a
enjoy – change. Change requires work and
quite famous Ivy League school. The father
action and lots of other potentially
remarked with a laugh that they’d have to
cumbersome things we’d rather avoid.
sell their home and cars to be able to afford
the college tuition. Bad habit appears (“why
it won’t work”). The girl replied that the
The problem with “why you’re wrong” and
school offered several scholarships and two
“why it won’t work” is that they don’t add
looked promising for her. The father scoffed
any value to the proposition. I realize that
that “he’d believe it when he sees it.” Bad
people who tell me this sincerely believe
habit resurfaces (“why you’re wrong”). I
they’re helping me better understand their
noticed the young girl’s shoulders slumped
unique situation or are pointing out a
as she slumped back into her chair. Not
hidden flaw in my idea. They’re also being
another word was spoken regarding the Ivy
polite in their disagreement as they hide
League college for the remainder of the
behind a thin veil of agreement.
flight. In fact, she began talking about a
large state school not far from their
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

hometown. I had just witnessed a dream common bad habit that serves no positive
shattering. purpose. There’s nothing wrong with
someone giving you their opinion, good or
“Why you’re wrong” rears its ugly head too
bad, after you’ve asked them for it. In fact,
often in our lives. We think we’re being
it’s vital that people agree and disagree.
helpful, wise, or experienced while in reality
we’re simply an impediment to progress,
hope, and change. Listen carefully to
What’s not warranted is to pass judgment
yourself and consider carefully before killing
on an answer when we specifically request
change. Open yourself up to the possibility
feedback about us. If you ask for someone’s
of new ideas, new ways of doing things, of a
opinion about you, what you’re doing, or
different future. After all, we’re not nearly
what you intend to do, accept it. Respect it.
as clever alone as we are together.
Assume the trusted person is being truthful.
This isn’t naiveté; it’s good interpersonal
relations. After all, you asked.
Healthy Habit # 1 – “That might work” try
it for yourself.

When you regularly rank people’s answers

(good or bad, accurate or inaccurate, agree
Bad Habit #2 – The Answer Ranking Game
or disagree) after you’ve requested their
“Do these jeans make me look fat?” opinion, they stop giving you accurate
advice. Why bother? After all, all you do is
“No, you look amazing!” dismiss their answer.
“You’re just saying that. Of course, I look For the next week, I want you to shift into a
fat.” neutral mindset. That is, you don’t pass
judgment on any advice or answers you
receive when you ask someone. Accept
Sound familiar? This and billions of other them for what they are. Respond with a
intimate conversations occur by each day. simple, “Thank you.”
The problem is, this conversation was
destructive. The subtle context was that the At the end of the week I guarantee you’ll
opinion of the trusted person was find you had fewer fights, pointless
meaningless. The person asking about the arguments with family and co-workers, and
jeans ranked the answer given as wrong, less contentious interactions. After three
insincere, and misleading. Was it? We can’t weeks, you’ll find “Thank you” becomes an
help but compare the other person’s automatic response, people will remark
answers with our. Perhaps we secretly feel how much easier you are to get along with,
the jeans make us look fat so when and people will view you as an open-
someone tells us otherwise, we reject it. I minded, welcoming person (all good traits).
think we must assume a position that This doesn’t mean you agree with everyone
people are truthful until proven otherwise. or everything, of course you won’t, it simply
My interpretation is that the person looked is a change in how you react to peoples’
great in those jeans. answers about you.

Healthy Habit #2 – “Stop judging answers

to your questions.” Try accepting other
Ranking or judging answers or responses, opinions and answers without ranking or
especially from people we’re close to, is a judgment
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Bad Habit #3 – Avoiding Apologies succeed and admitting our mistakes is an

essential element of effective collaboration.
Have you ever felt the sense of liberation,
You can’t get it right every time; when you
cleansing, or relief after uttering two simple
don’t, be brave enough to say you’re sorry.
words, “I’m sorry”? You felt better, didn’t
you? If this is true, why is it that so few of us
are willing to apologize?
Healthy Habit #3 – “I’m sorry.” Apologies
make you stronger.

Maybe we think our life is some sort of

contest with winners and losers. Maybe we
Bad Habit #4 – Not Thanking People
equate apologizing with losing or failure.
Enough
Maybe its’ too painful to admit we’re
wrong. Maybe we feel humiliated when we Perhaps the two most powerful words in
ask forgiveness. Maybe we believe that if the English language are “Thank you.” That
we apologize we appear weak or less phrase is so powerful that whenever I visit a
powerful. foreign country I always learn how to say
“thank you” in the native tongue (I also
learn how to say “I’m sorry”). For some
Whatever the reason, refusing to apologize reason, we don’t tell the people that matter
creates more problems in our relationships most “thank you” nearly often enough.
at home and work. If you look back at the
broken relationships in your life, I bet you’ll
find that many fell apart due to someone’s Why are we so cheap with gratitude?
refusal to say, “I’m sorry.” And that’s a Maybe we view it similarly to apologizing;
shame. we somehow feel less powerful or
important when we thank others. I
shouldn’t have to go around thanking
When you make a mistake, own it. people all the time. Of course you should be
Apologize for it. Don’t let your pride wreak doing your job excellently. Of course you
havoc in your life. You don’t earn a prize should provide excellent service to me. Of
when you die for winning the most. The only course you should love and cherish me. For
thing left behind are the memories of you the next week, I want you to tell people how
and the impact you had on the world. grateful you are for them whenever
possible. Not insincerely, you’ve got to
really mean it. People do amazing things for
By apologizing we release the past. We’re us each day. Take the time to thank them.
saying, “I can’t change what happened. I’m This is the easiest bad habit to break and
sorry for what I did wrong. I want to make it holds almost unlimited potential. You’re
better moving forward.” That’s hard to welcome.
resist, even for the most cold-hearted
among us.
Healthy Habit #4 – “Be grateful for
everything you have.” Practice gratitude
Truly successful, powerful, and significant each and every day. It’s better than an apple
people understand the power of the for keeping you healthy.
apology. We must work with others to
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11 al 13 Abril 2018

Bad Habit #5 – Waiting for the Heart Attack

“It won’t happen to me” is something few What I don’t wish for anyone is to wake up
people ever say out loud yet this is exactly with chest pains at age 48, 52, or 68. What I
how they live their lives. Sixty-eight percent don’t want is for you to feel breathless after
of US adults are overweight or obese. The ascending a single flight of stairs. I don’t
top four causes of death are caused, linked want you to be forced to sit down relegated
to, or exacerbated by excess weight: 1) to watching your children or grandchildren
Heart disease, 2) Cancer, 3) Chronic lower play soccer. I want you to play soccer with
respiratory diseases, 4) Stroke them – maybe even win. I want you to be
(cerebrovascular diseases) (latest CDC data vital, energetic, and independent well into
from preliminary 2011 report). Most highly your eighties. That is my wish for your life.
successful people realize the importance of
taking care of themselves. So why doesn’t
everyone live healthier? Healthy Habit #5 – “Good health requires
daily effort.” What are you going to do with
The reasons for being unhealthy are
your one amazing life? The answer begins
numerous and complex. I don’t have the
now.
answers; however, I do have solutions. The
most important decision you make today is
whether or not to pursue health. Every
single person, regardless of genetics, Life is a precious gift. A gift we choose to
socioeconomics, or even current state of enjoy to the fullest or one we waste, cut
health decides to do things each day that short in both duration and quality. Our
encourage or discourage better health. The decision to pursue (or not) personal health
multitude of tiny, seemingly insignificant extends well beyond ourselves; ultimately
decisions you’ll make during the next 24 our loved ones must pay any health debt we
hours add up to promoting health or incur. We owe it to the people that matter
destroying it. The choice is yours. And it is a most to take care of ourselves the very best
choice. we can.

Try going for a brisk walk or run each day.

Join a yoga class or a gym. Stop eating a bag Don’t wait for the heart attack; avoid it.
of chips or soda with lunch each day. Put Start a journey of change that makes life
down the candy bar or doughnut. Drink more enjoyable, fulfilling, and lasting. That’s
more water. Small changes can create what I’m trying to do: remaining “Fit to
tremendous positive health impact. Don’t Practice” for as long as possible. Longer,
think a heart attack won’t happen to you. even.
You can’t wish yourself to good health.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Adding New Services And Products Into

Your Clinic

INTRODUCTION: I’m always searching for ways to improve my patient care and client service.
Over the past 25 years, I’ve helped pioneer senior care programs, long-term drug monitoring
protocols, and weight management and nutritional counseling alongside regimented staff
training, communication role-playing, and innovations in veterinary hospital design. If you’re
considering adding a new product or different therapy or service in your clinic, try these simple
and straightforward steps to improve compliance and success.

Step 1: Believe It Numerous research studies conclude class 4

laser therapy helps reduce pain and
Successfully adding a new service or
inflammation while facilitating tissue
product into your daily practice begins with
regeneration. In simplest terms, class 4
personal experience and firm belief.
laser therapy can boost circulation to
Whenever veterinarians struggling to gain
damaged tissues, creating an optimal
acceptance of a new therapy confront me, I
healing environment. Scientific studies
ask if they’ve tried it themselves and believe
aside, I know firsthand the power of class 4
in it? It’s nearly impossible to recommend a
laser therapy.
medical procedure to your clients you
haven’t personally experienced and
sincerely trust. I wouldn’t offer a product or
Many of you may know my love of
perform a treatment on my personal pets I
endurance sports, especially the Ironman
didn’t wholeheartedly believe was safe and
triathlon. The Ironman is an event
effective and the same goes for my patients.
combining a 2.4-mile swim, 112-mile bike,
Nothing speaks louder than personal
and 26.2-mile marathon in a single day.
testimony. To testify convincingly, you first
Years of this sort of fun have caused a few
must believe.
scars and stresses on my joints. In 2011 as I
was preparing for an Ironman, I developed
debilitating bursitis in a previously injured
I’d like to illustrate this concept with the
shoulder. I was in real danger of not making
story of how I added class 4 laser into my
it to the starting line. Friends recommended
practice and why I say the first step to
a variety of remedies, none of which helped.
adding anything new into your clinic is to
Finally, an exercise physiologist buddy
believe in it.
suggested class 4 laser. He’d had success
and I had nothing to lose. After two
treatments I could move pain-free. Within
Class 4 laser therapy is an FDA-cleared two weeks I was back in the ocean
treatment. That's important to me as a swimming miles. I was a believer and
veterinarian because FDA clearance bought a class 4 laser unit for my practice. If
indicates a therapy is safe for my patients.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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it aided me so dramatically, I was eager to I recently visited a practice owner friend

share this new modality with my pet who had completed a new facility. He had
patients. bragged about all the latest gadgets he’d
acquired, and I was eager to see his dream
clinic. As he escorted me through his
My best advice for anyone considering sparkling high-tech temple, I didn’t see his
adding anything new to his or her practice is boasted high-dollar ultrasound machine
to first prove it to yourself before offering to anywhere. He led me to me a back room
your patients. Don’t believe the hype; where he kept it until needed. He told me it
believe in your interpretation of the data was simply too expensive to risk leaving out
and results. Evaluate the science, examine in his treatment area. I asked how often he
the safety record, and establish if the used the gleaming gizmo. At least a couple
service or product aligns with your core of times a month, he replied. Needless to
values. If it passes those three tests, try it. If say, I wasn’t impressed, and his investment
you’re satisfied with the results, ask your certainly wasn’t as profitable as it should’ve
team to review it and give their opinion. If been. Out of sight, out of mind, out of use,
your team loves it, you’ve got a winner. out of revenue. Use it or lose it, as the
saying goes.

What you’ve done is achieve belief and buy-

in the old-fashioned way: you earned it. Back to my story of successfully adding class
Lukewarm acceptance won’t cut it; your 4 laser and the importance of frequent use.
team needs to be excited and enthusiastic if Part of our daily clinic routine is to place our
they’re going to effectively promote the class 4 laser device in the treatment area,
innovation. If you and your staff genuinely turn it on, and confirm it’s ready to go on a
believe in what you’re recommending, your moment’s notice. Because our teams
clients are much more likely to act on your understand how class 4 laser can help heal
advice. inflammation and mitigate pain, I want its
presence to serve as a constant reminder
we can help. The more my teams remember
Step 2: Frequently Use It to use it, the better they’ll become using it.

I have a friend who worked in marketing at

Coca-Cola for many years. One evening we The better we become at something, the
were discussing the “cola wars” and he more likely we are to do it. Frequent use
revealed the secret to winning: accelerates learning and understanding of a
Accessibility. The goal of Coke, in his new product or service. If you only use or
opinion, was to be as close as possible to recommend something a couple of times
every human being on the planet. If Coke per month. You’re never going to gain the
was within arm’s reach, an individual was expertise our clients and patients need and
more likely to reach for it. I’ve taken those deserve. Have your class 4 laser unit easily
words to heart and applied it to my accessible and prepared for action; you’ll be
practices. If you want a recent addition to surprised at the number of opportunities
gain acceptance in your daily practice, it’s you have each day to use it.
got to be within arm’s reach, literally.

Step 3: Share It
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11 al 13 Abril 2018

As your confidence in a new product or media. Newspapers, radio, and television

service flourishes and your experience are always looking for local stories to
grows, you’ll want to share it with your highlight and pet news is always welcomed.
clients and community. Begin by creating a Other good outlets for sharing your news
“Success Book” detailing complex cases are weekly or monthly community or
with outstanding results. Take pictures of business magazines. I also recommend
your “new thing” (in my example, successful working with rescue groups and animal
class 4 laser therapy cases) at diagnosis, bloggers to distribute clinic news and
throughout treatment, and at completion of updates. Don’t make the mistake of
healing. Ask pet owners for a brief quote delaying a new service until you’ve
about their experience and if they’d published a press release and gained news
recommend the new service or product to media. Start with yourself, extend to your
others? Combining personal testimony with team, and then share with your clients and
client’s recommendations is powerfully community.
compelling and can aid pet owners in
making more informed veterinary care
decisions. KEEP AN OPEN MIND WITH NEW
PRODUCTS AND SERVICES TO SUCCEED

There’s one final element you need to

In today’s fast-paced and constantly
achieve sustainable success in practice and
changing medical environment, it’s more
in life: Keep an open mind. Don’t discount
important than ever to keep your clinic
new ideas, products or therapies simply
welcome brochures and website updated
because you don’t initially understand
with new services. Consider crafting
them. We live in an amazing time full of
personalized client brochures explaining
rapid changes, astonishing advancements,
what the “new thing” is, how it works, and
and wholesale upheavals. I’m not
why you’re excited to offer it. Take this
suggesting you accept every new thing; I’m
content and add it to your website and
advocating you investigate innovations that
repurpose for social media postings.
connect with your beliefs and practice
values. Approach new services and products
impartially and unbiased and you may
After you’re comfortable with the new
discover incredible improvements in your
product (accessory, drug, OTC, etc.) or new
patient care and client service.
therapy, it’s time to contact your local
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Communicating About Pet Food: Top Pet

Owner Nutritional Myths

INTRODUCTION: Nutrition is perhaps the most confusing, complex, and contentious medical
discipline. Innumerable approaches, overwhelming opinions, and conflicting conclusions
obfuscate consensus. In other words, there’s a whole lot of debate going on about nutrition and
clear answers are scarce. Veterinary medicine isn’t immune to this food-diet-lifestyle confusion.
Strong opinions abound and an increasing number of untrained, uncredentialed, and unlicensed
individuals are offering therapeutic recommendations based on personal experiences and
unsubstantiated claims. This is leading to confused pet owners and a surge of myths and
misinformation. Here are some of the top pet nutritional myths and how your team can politely
bust them.

(Presentation Note: Specific and current pet food and diet myths will be reviewed during
presentation. Below is a communication strategy you can use to create your own tactics to help
shape your client’s behavior and beliefs toward healthier and evidence-based approaches. EW)

MYTH BUSTING 101 FOR VETERINARY the best way to feed Buster.” or “I
TEAMS really appreciate the effort you’ve
taken to find information about the
Busting myths is hard. Whenever people
best way to feed your cat.” Begin
believe in something, regardless of how
each conversation tilted toward
illogical or unproven, it’s a real challenge to
positivity by thanking the client for
change their minds. Instead of attempting
their efforts, however potentially
to change someone’s beliefs or behaviors, I
misguided.
recommend trying to gently shape them.
Regardless of the myth, misperception, or 2. Find the Why – The next step in
potentially wrong behavior, here is a myth-busting and shaping behavior
strategy I’ve found helpful when politely is to determine why the owner is
busting untruths: interested in or made a dietary
change. “What made you
1. Start with Thank You – No matter
interested in the BARF diet for
the situation, I advise always
Buster?” or “Was there something
leading with compassion when
about your cat’s condition or health
interacting with others. Your
that made you switch foods?”
alternative is to be emotionally
neutral or negative; neither 3. Find the What – Myths may take
encourage collaboration and trust many shapes and forms. It’s
between two people. Start by essential you clarify exactly what
acknowledging your sincere the client means by “raw,” “BARF,”
appreciation that the pet owner is “no-grain,” “organic,” and other
seeking information to help their poorly defined terms. “Tell me
pet. “I’m really glad you’re more about Buster’s typical
interested in learning more about breakfast or dinner.” or “Walk me
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

through your preparation of a raw claims and toward an evidence-

meal for Kitty.” or “When you say based nutrition discussion.
grain-free dog food, is there a
6. Do you really, truly object? – Is it
specific brand you’re feeding or
harmful? Sometimes a client’s diet
what do you look for on the label?”
change, despite being
Try to solicit as much detail and
unconventional or a strategy you’re
specifics as possible: types of
unfamiliar with, is within the realm
proteins and where they’re
of possibility and safety. I’ve had
sourced, quantity fed or prepared,
clients feed a diet they drive 100
how the food is handled and stored,
miles across state lines to purchase,
and so on. Be sure to document this
the label makes some outlandish
information in the pet’s medical
claims, yet appears complete and
record.
balanced. That’s not a diet I’m likely
4. How does this make their pet feel? to dismiss or even attempt to
– Many pet owners are using new change unless I have evidence it’s
dietary strategies for a specific harmful or the pet has a medical
reason (see above). The next step is condition that needs another
to connect that change with how approach. Be careful not to dismiss
they perceive their pet’s feelings a diet or brand unknown to you;
and emotions. You’ll need to there are plenty of safe diets out
incorporate how the pet “feels” in there that aren’t my choice and
your advice. “How do you think others I don’t know much about.
Buster feels on the new diet?” After Before trying to change a behavior
all, helping a pet “feel better” is the or diet, be sure you really, truly
whole point of diet. Improving a object to it.
pet’s quality of life is often sought in
7. Facts Don’t Matter Most of the
the food bowl.
Time – Unfortunately, it’s rare that
5. Thank You Again and a Nudge – a medical professional can prompt
After you’ve obtained the basic diet sustainable change based on facts
history, thank the client again for alone (see: smoking, heart disease,
sharing. Keep in mind it can be obesity, substance abuse, etc.,
intimidating for a pet owner to etc.). people can cling to some
disclose these details, especially if pretty outrageous beliefs, despite
they fear judgment or an abundance of hard scientific
disagreement from the veterinary evidence to the contrary. Be
healthcare team. “Thank you again prepared with plenty of facts
for sharing this with me. The more supporting your claims and
details I have, the better medical preferences, but be aware that
advice I can provide to help you and you’ll rarely shape or change
Buster.” By adding “medical behavior solely based on the
advice,” you’ve taken the first step evidence.
in subtly shaping and reframing the
8. It’s Not a Debate – The natural
conversation. Use your authority as
tendency in these situations is to
a medical professional to politely
immediately counter inaccuracies,
move the message away from
dispute claims, and correct wrongs.
marketing and unsubstantiated
That’s probably not the best choice
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

when dispelling food myths with well-educated clients who are

your clients. Avoid interrupting, exposed to countless diets and
listen intently, and demonstrate ideas.
interest and concern regardless of
10. Why is your option better? –
what the pet owner is telling you (in
Sharing a few facts can help support
other words, no eye rolling). “I feed
your case, but if you’ve uncovered
him XYZ food because, as you know,
the real reasons for change (see
dogs are really just wolves.” Instead
above), this is where you put that
of pointing out that dogs are not, in
information to work. “I totally
fact, wolves, try a softer approach
understand that you were looking
when confronted with inaccuracies:
for a more ancestral, healthy diet
“I’m really glad you’re interested in
for Buster. I also understand your
what the best diet for dogs is; so
concerns about highly-processed
many dog owners simply buy the
dog foods. My primary concern is
cheapest food. In general terms,
that the raw diet you’re feeding,
dogs need… (insert your nutritional
which you said is mainly chicken
philosophy here).” Don’t use their
necks, liver, and hearts, is not
preferred terms; frame the topic in
nutritionally complete, leaving
your terms. In this example,
Buster deficient in many key
repeating “dog,” not “wolf” is best.
nutrients essential for a healthy
Even saying, “No, dogs aren’t really
immune system and preventing
wolves.” removes emphasis from
disease. Of course, I’m also worried
the topic at hand – finding the best
about your family contracting a
nutritional approach for their dog –
contagious food-borne disease like
and places it on whether dogs are
E. coli or salmonella, but I want to
taxonomically “wolves.” It’s not a
focus on Buster’s long-term health.
debate; don’t make it one.
With that in mind, and your interest
9. What’s the alternative? – The most in whole or less-processed foods,
important motivator for shaping or do you know about … (insert your
changing behavior is offering a option here: i.e., high-pressure
better alternative. The client pasteurized raw diets)? That may
originally made a change because be an excellent alternative that
they believed or were persuaded helps reduce some of my nutritional
that there was a better option than worries while giving you piece of
their current situation. Your next mind.”
alternative must be even better
11. Repetition is Key – You’re usually
(and easier, cheaper, something…).
not going to change people’s
This is the time to make sure you
behavior after a single interaction.
have a deep roster of alternative
Shaping behavior often requires
diets and dietary strategies to
patience, strategy, and persistence.
accommodate many clients. If not,
Many times, a client will politely
don’t be surprised that every client
listen, not change, but begin
doesn’t fit neatly into your limited
considering what you said. When
offerings. Long gone are the days
they return, whether in a week or a
when carrying a couple of brands or
year, you should re-engage and
only believing in a single nutritional
reinforce your message(s). It may
philosophy will work with today’s
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

take months to years before change

occurs; don’t take it personally if at
These techniques work on busting diet and
first you don’t succeed. Many
nutrition myths, promoting weight loss and
clients are also observing if you’re
dental programs, and any other medical
sincere by whether you bring up the
service or product you feel important to tell
topic in the future. Repetition often
pet owners about. Role play with your team
signals credibility; it’s so important
and explore the optimal ways you can
you talk about every time you see
effectively communicate your key messages
them. If you’re following your
to clients and good luck busting diet and pet
passion and scientific evidence,
food myths!
you’ll never waver, despite
rejection. In fact, your passion will
compel you to try and try again!
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Innovating The First Year: The 9-Month

Pet Visit

The first year in a pet’s life is arguably the 2006 and 2007, I had initiated several feline-
most important in terms of veterinary care. friendly programs within our clinics that
Healthy habits, immunizations, preventive were beginning to see positive results, but I
care, client education, and training occur knew we had to do more to continue to
within those first 12 to 18 months. The grow during such challenging economic
reality is veterinarians have traditionally times. I began to focus on the first year of
been left out of much of this critical life for puppies and kittens to search for
developmental period. After spay and opportunities to innovate. 2007 and 2008
neuter around 6 to 8 months of age, we were also the years we began seriously
typically don’t see our pet patients again developing novel ways to reduce stress,
until 16 to 18 months of age. This creates a improve handling and restraint, and
“gap year” and an “advice void” increasingly reinvent the veterinary experience for our
filled by providers outside the veterinary patients and clients.
profession. There is an elegant solution to
As I reviewed our clinics’ existing puppy and
this dilemma: the 9-month visit. This
kitten appointment protocols, I struggled to
innovative program will improve patient
uncover hidden opportunities. It would take
care and promote veterinary services and
innovation and creativity to solve this
products at a critical developmental stage.
problem. I vividly recall the stream-of-
The 9-month visit
consciousness brainstorming exercise in
1) creates an additional veterinary which I made the breakthrough. This
intervention point for behavioral, particular creativity method is one I use
nutritional, life stage, and parasite frequently when attempting to solve a
problems vexing problem. The exercise simply entails
taking a blank sheet of paper and writing or
2) Further establishes routine veterinary
drawing everything that comes into my
visit habits, especially of impressionable
mind for five minutes. Ideas can be ideas
Millennial pet owners
about the issue or, more often, completely
3) A unique opportunity to introduce random thoughts or images. And so I began.
additional veterinary services and products
I drew a line and labelled the left endpoint
and increase revenue
“Birth” and the right “Death.” I wrote “a
4) Ensures proper and accurate dosing of bunch of stuff” in between the two (told you
parasiticides, heartworm preventives, and it could be random). I then divided the line
food. at about the left-quarter mark and labelled
the two partitions “Puppy and Kitten” and
“Adult.
I created our clinics’ 9-month visit concept Next, I drew a new line that started at
in 2008. At that time, we were witnessing a “Birth” and ended at “Adult.” I marked a
decrease in pet visits coinciding with the spot labelled “6 to 8 weeks,” and additional
U.S. Great Recession of 2008 to 2010. In marks at 3, 4, 6, and 8 months. I jotted “First
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Core Vaccines” at the first mark and they returned at all, many important health
repeated those vaccines at 3 and 4 months. and hygiene habits were established. When
At the 4-month mark, I wrote “Rabies” and confronted with scientifically sound advice
at 6 months “Spay/Neuter.” Above from a licensed veterinary professional,
“Rabies,” I extended a line toward “Adult” many pet owners perceived they were
and labelled it “12 months later = First Adult being “sold” something by their
Core Vaccine Visit.” And then it hit me. I had veterinarian and viewed them skeptically.
been doing everything wrong for the past
20 years of clinical practice.
In short, we had created an “advice void”
that was being filled by non-veterinary
providers. Even worse, we had failed to
create real value in our services beyond
vaccinations and sterilization during the
first year. I realized at that moment why pet
owners equated veterinarians with “shots”
and our primary surgical expertise was spay
and neuter. Clients hadn’t been exposed to
our expertise in nutrition, behavior, internal
medicine, surgery, and more. There
experience with us during the formative
first months was limited to a quick jab with
a vaccine and a dose of heartworm
preventive. Armed with that insight, I set
out to innovate the first year of veterinary
care.

I studied my sketch and looked for an

appointment opportunity that was
physiologically and medically appropriate
for my patients and convenient and
economical for clients. I also wanted the
As I stared at scribbling, I began to realize timing of a new visit to be strategic to
we had largely abandoned our patients and maximize the chances of identifying and
clients during what I believe is a pet’s most intervening in emerging problems to
critical developmental stage: Between 6 optimize positive outcomes. It didn’t take
months of age and nearly a year-and-a-half. me long to find the perfect visit: 9-months
During this “gap year,” behavioral of age.
problems, nutritional questions, and
heartworm, flea and tick control were being
left to the pet owner. Not knowing the best
source to turn to for pet care advice,
concerned owners were asking providers
they encountered: Pet store personnel,
groomers, trainers, and the internet. By the
time they returned to the veterinarian, if
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a successful transition. First, write a brief

explanation of the concept and share it with
your managers, key team leaders, and
senior associate veterinarians. Be open to
suggestions, especially in messaging and
pricing, and gain consensus form your
leaders before presenting to the full team.
Next, schedule a staff training session to
review the new plan and solicit general
feedback. Continue to refine the new
service and discuss the implementation.
Train your staff on the topics and
The 9-month Visit was created. I knew from
information you believe are most important
my work in pet obesity that a veterinarian
during this rapid developmental period of a
could accurately predict adult cat obesity by
pet’s life. This initial process will typically
comparing the first obtained weight with
take about a month to complete. Don’t
what the kitten weighed at about 8 to 10
rush; get comfortable with a new service or
months of age. The weight gain during that
product before you begin offering it to
period served as a precise predictor of adult
patients and clients. That advice goes for
obesity in cats and evidence was mounting
the 9-month visit or a new flea and tick
for similar prediction in dogs. I also knew
preventive.
from behavior research that many
behavioral issues began between about 6
and 12 months of age. Weight gain after the
My advice on launching the 9-month visit is
last visit during sterilization could change
don’t make it a big deal to your clients. Pet
rapidly, jeopardizing accurate and effective
owners are used to coming in frequently
heartworm, flea, and tick preventive dosing.
during the first year and few question or
object when you schedule it. Many new pet
parents are young Millennials coming to the
Perhaps most importantly, I knew we
veterinarian with their “first real pet.” I’ve
needed a visit to talk about important
found the 9-month Visit helps establish
health issues other than vaccines. The focus
good pet care habits and reinforces the
of our 9-month Visit would be
importance of regular veterinary visits. The
1) Behavior 9-month Visit also positions veterinarians as
the primary pet healthcare information
2) Nutrition provider, both online and in-person.
3) Parasite Prevention

4)Future Veterinary Care Needs. If Be sure to change your current reminder

additional or overlooked booster protocols. Adjust the current 12-month
immunizations, fecal parasite testing, or appointment reminder generated by the
other services were needed, the 9-month Rabies vaccine (usually given at 16 to 20
Visit would serve as an important safety weeks of age which generates a reminder
backstop. 12 months later) to create a reminder 4
months later (at 8 to 9 months of age). Our
reminder text simply read, “9-month
If you’re interested in adding the 9-month Appointment.”
visit to your practice, here are some tips for
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accurate information and guidance. The 9-

month Visit creates additional
Nutrition, behavior, and ecto- and
opportunities and exposure to the diverse
endoparasite prevention are my focus for
services and expertise veterinarians
the 9-month Visit. Other clinics will be
provide. It encourages regular routine
excited to emphasize certain vaccinations,
veterinary visits and corrects the
additional diagnostic and parasite testing,
“veterinarian equals shots” falsehood. It
dentistry, and training. Whatever topics you
exposes young pet parents to proper
choose to discuss, the real emphasis is on
veterinary care and expertise. Ultimately,
reinserting the veterinary profession into
the 9-month Visit allows us to connect with
the “Gap Year” and allowing us to fill the
new pet parents in a more meaningful,
“Advice Void” with sound, reliable, and
impactful manner.
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11 al 13 Abril 2018

Social Media Professional: Winning Social

Media For Practice Success

INTRODUCTION: Have you ever played the telephone game? One person whispers a message to
an adjacent person in a group. The communiqué is passed along until the last player reveals the
message to everyone. Inevitably, and this has apparently been studied by academic types, the
final version of the message varies significantly, sometimes almost unrecognizably, from the
start. “Mary is wearing a green dress to the dance with Bill.” morphs into “Mary wore a green
dress while dancing with Phil.” I fear veterinarians have literally been playing the telephone game
with our clients. We’ve been relying on outdated and outmoded telephone conversations, faxes,
and mail while the rest of the world whisks away at the speed of electrons. We pass information
slowly by word-of-mouth, often creating confused conversations and mixed messages while
politicians move millions with 140 characters and Millennials modify their life by memes. It’s time
veterinarians get serious about winning social media for practice success. It’s time to hang up
the phone and tap that app.

HOW DID WE GET HERE? media and text message” lecture at the
2007 North American Veterinary
Over the past decade, it’s become
Conference. I may have been the first
increasingly apparent to me that many of
veterinarian to advise clinics to join
my colleagues aren’t keeping up with
Facebook and monitor this new thing I
communication technology. For most of our
thought would be important to the
profession’s existence, we thrived simply by
profession. I also touted text as the next
sending postcards. A pet owner received a
“postcard” and urged owners to pressure
notice in the mail it was time for her pet’s
software developers to implement these
vaccinations, and, voila, she booked an
features in their reminder systems. I was
appointment. No more. For starters, few
roundly laughed at and ignored for several
check their mail and when they do, tend to
years. It’s okay; I’m over it.
toss anything suggestive of marketing.
Secondly, young pet owners may not have a When our profession finally began
mailbox, at least not a physical one. Finally, approaching social media, email and text,
who has the time to read a postcard, dial a we were hampered by our postcard
number, talk to someone and haggle over a postscript. Emails weren’t much more than
date and time that works with everyone’s mailers mated to a screen. Text messages
schedule? And we wonder why visits and became intrusions screaming “Discount
revenues are plunging and pet owners are day!” or “How’s it going, client!” instead of
increasingly skeptical and unimpressed with brief, personal interactions. Social media
our services? Check your mailbox. became a mess for the few daring to dip into
its murky waters. Without a meaningful
It’s not that veterinarians are incapable of
vision, strategy, or comprehension, social
changing or taking action; it’s more often
media and digital communications became
our inability or stubbornness to take
haranguing hinterlands to be avoided or
appropriate action. I gave my first “social
minimally appeased. Thankfully, we’re
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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emerging from those dark days, and, expectations. You can think of it in terms of
although the electronic glare can be planning to attend a concert; the musical
overwhelming at first, progressive clinics genre and venue will largely determine how
are seeing growth in revenue, patient care, you dress and behave. Iron Maiden fans will
and client satisfaction by embracing Client typically look a bit different than those
Communication 2.0. attending an Adele performance. It’s fair to
say there are general expectations and
tendencies worth noting to prevent you
WHERE ARE CLIENTS LISTENING? from showing up at the Spandau Ballet
reunion clad in leather and safety pins. The
The first step toward transitioning to Client lesson is you need to dress your online
Communication 2.0 is understanding where content appropriately for the show.
your clients are talking. This is important
because a recent McKinsey Report
concluded that businesses who utilize social
DRESSING YOUR PRESENCE BASED ON
media and electronic communication
PLATFORM
experienced 20 percent more revenue and
60 percent higher profit growth (1). Over A common ‘dress code’ mistake I see is
half of all U.K. adults use Facebook on a applying the same branding, messaging,
regular basis with an estimated 78 percent and strategy across all social media
of over 18’s checking their status routinely. platforms. Because each platform operates
20 to 29-year-olds comprise the largest in a distinctive manner, here are a few tips
group of Facebook users followed by 30 to when creating content on the major social
39’s and 40 to 49’s. Over 14 million Britons media outlets:
Tweet, 36 million watch YouTube, and 40
percent of the nearly 20 million Instagram
addicts log in daily. About 15 percent of the FACEBOOK
estimated 10 million U.K. Pinterest
participants eyeball their boards every day. Facebook is the modern pub crawl. People
(2,3,4) check their Facebook feed to get the latest
gossip, trending news, and entertainment.
Facebook is where most funny cat videos
are viewed. A simple rule of thumb I follow
For most veterinary clinics, this means
is about 80 percent of content should build
focusing your social media efforts on
your brand, educate, and add value to the
Facebook and dabble in YouTube, Twitter,
veterinary profession and 20 percent can
Pinterest, and Instagram. I suggest securing
promote a service, product, or promotion.
clinic profiles on all social media platforms
Creating a weekly or monthly schedule can
(I’m talking to you, Snapchat, WeChat and
help balance your strategy. If you post daily,
the like), but concentrate on connecting
consider four or five posts per week consist
with your Facebook family.
of: breaking pet news, reposts of feel-good
animal stories, and advances in veterinary
medicine. One or two posts each week can
highlight your senior pet care program, a
HOW ARE CLIENTS LISTENING? weight loss promotion, or seasonal
emphasis on flea and tick products. You can
Facebook, Twitter, YouTube, Pinterest, further build your brand when sharing other
Instagram, texting and email each attract a posts by adding, “ABC Veterinary loves
unique audience and establish specific
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

research demonstrating the powerful videos, and information their clients are
human-animal bond! Check this out!” Show searching for. Video production is rapidly
your personality and passion in your posts. improving on YouTube; shaky smartphone
video with faint audio is a no-no. be sure to
An easy way to ignite engagement and
link to your clinic’s website and other social
educate on Facebook is by sharing pictures.
in each video’s description and optimize
After obtaining permission, nothing sparks a
end screens and cards.
smile and a conversation more than a
picture or video of cuddly puppy or a pet
combating a challenging condition. “We
INSTAGRAM
were all hugs today with these cuties in for
an intestinal parasite check and Pictures. Beautiful pictures. That’s it. I
immunizations!” or “Mabel is a 15-year old consider Instagram for clinics as a platform
kitty beating the odds. Diagnosed with to reveal ‘behind the scenes,’ ‘wow,’ and
kidney failure six months ago, her owners ‘gorgeous’ sides of practice. Messages that
are proof that love, compassion, and pop on other platforms can fall flat unless
commitment can make a difference. That’s fabulously framed for Instagram. What’s in
the face of a fighter! If your older cat is it for us? Showing your softer side and lots
drinking or urinating more, losing weight or of heroic pictures.
acting tired, let us check them out. Way to
go, Mabel!” Entertain, inspire, and educate.
PINTEREST

TWITTER A widely-publicized Pinterest stat is that 80

percent of its users are female. That looks
If Facebook is the neighborhood pub, great on paper, but I’ve found using
Twitter is a cruise ship. Loads of anonymous Pinterest as a standalone or primary social
people climb aboard hashtags and hurl media marketing platform to
clever quips and offensive oratory over underperform. Besides, Pinterest growth
cyberspace cocktails. For most clinics, has plateaued and appears to be on the
Twitter isn’t incredibly helpful. Use it to decline. Share original blog posts and
share hospital blog posts, a special event, or infographics along with how-to’s and
breaking news. I discourage tweeting YouTube videos. Showing up seems to be
discount codes, product sales, and other half the battle for Pinterest.
blatant promotions. Social media backlash
can be brutal, particularly around perceived
“advertising.” Tweet compassionately, SNAPCHAT
cleverly, and carefully.
Snapchat Stories brought business potential
to Snapchat but current demographics skew
YOUTUBE awfully young for veterinarians. About a
quarter of Snapchat users are under 18
YouTube is a search engine run by Google. years old and 60 percent under 25. (5) My
That’s critical to remember when creating advice is get onboard and monitor for now.
YouTube content for your clinic. Users Big changes are promised that should help
subscribe to channels to learn from or they small businesses connect with the next
find entertaining and interesting. Most generation of pet owners.
veterinarians should use YouTube to
provide virtual hospital tours, how-to
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11 al 13 Abril 2018

LIVE STREAMING

Facebook and YouTube have evolved into EMAILS

excellent live streaming services. While
Emails continue to serve as both the
these are the early days of live video, watch
primary mode of connection as well as a
this space closely. Try hosting a 30-minute
backstop to text messages. Our client
live Q-and-A, offer a five-minute highlight of
admission forms ask in what order they
a new product or service, or announce an
prefer to be contacted: phone, email, or
event. The live events are automatically
text. Use emails to remind about
archived for later viewing. With a little
appointments (see text rules about
planning and promotion, you could reach
incorporating ‘single-click solutions’), new
scores of clients and potential new clients
blog posts, announcements, seasonal
with little effort.
educational messages, and surveys. I’ve
found occasionally asking clients for their
opinion on adding new products or services
Today’s texting and email are like
to be an effective way to gauge interest and
yesterday’s phone call and postcards in
build awareness. Monthly clinic update
many ways. Each represents a different
emails are ideal for most accompanied by
communication opportunity than social
personalized reminders. Embedding a quick
media. Understanding how people use, and
video summary is bonus.
want to use, text and email is critical for
Client Communication 2.0.

WHO’S IN CHARGE OF YOUR PRACTICE’S

SOCIAL MEDIA?
TEXT MESSAGES
Nearly everyone on your team should be a
This is my preferred way to remind clients
part of creating social media content,
and check on patients. Five texting caveats:
snapping photos, writing blogs. Creating
1) If you’re requesting to schedule an
isn’t the same as posting. Before you press
appointment, the mechanism to make that
publish, an administrator should verify,
appointment needs to be embedded in the
clarify, and proofread every message
text. No dialing or texting back-and-forth.
bearing your brand. This is another reason I
Click here or reply to book. No more. 2) If
encourage you to use a calendar to guide
confirming an existing appointment, same
your outreach and solidify your strategy.
rules. 3) If checking on a patient, make it
Simply posting cute kitten pics, lost dog
personal and be prepared to discuss.
posters, and homeless pets isn’t a plan and
Texting creates a sense of urgency and
won’t grow your business.
when a client responds; they expect you to
be available to reply. If the client responds
after hours, have an autoresponder with
WHAT’S THE ROI ON ALL THIS?
what to do in an emergency in place. 4) Text
checkups are best for minor medical Does social media make business sense for
conditions and routine visits. Call after your clinic? I’ll repeat what I’ve been saying
surgery, anesthesia, and major diagnoses. since 2007: Return on investment (ROI) on
5) Limit text messages to only when social media is hard to measure and
necessary. You don’t want your number perhaps the traditional ways to calculate it
blocked because you sent a cat owner a don’t apply. Internet conversations about
generic sales pitch for a dog product. you are happening with or without you. It’s
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

far better to insert yourself in these

discussions than pretending they aren’t
BOOSTING YOUR CLINIC MANAGEMENT
real. It’s even better to influence the
SOFTWARE
conversations and control your image and
protect your reputation. Many Veterinary practice management systems
veterinarians get interested in social media continue to serve as the mixing board and
after discovering a poor review or negative amplifier for our client communications. To
post. That’s great, but it’s always better to get the most out of your clinic software,
be proactive with communications than make sure you’re dialing up the volume by
reactive. following these simple tips:

Social media and electronic OPTIMIZE EMAIL REMINDERS: Link services

communications are also important to and products to a specific email reminder
elevate the bond you share with clients and that reminds pet owners not only that
patients. We often mistake client’s desire something is due, but why it’s important to
for increased access with extending office do it. For example, an immunization or
hours. What many want is a richer, more preventive reminder should be coupled
frequent method to interact with us. Social with a few sentences explaining why fleas
media, texts, and apps provide a are problem in your geography, any
contemporary way to connect with clients prevalence data, and consequences of flea
that an increasing number of other bites. Vaccinations should include a short
professionals offer. My own physician has statement detailing why their pet is at risk
an app and online portal through which I of a specific infectious disease (what I call
can access my medical information, test “individualized immunizations” based on a
results, and chat with a medical “Lifestyle risk assessment”), why the
professional around the clock. Systems for immunization is given at a certain
veterinarians are just beginning to appear frequency, and disease dangers. For the
and I expect them to be universal within two past decade, we’ve been sending out at
to three years. Apps and websites won’t least two email reminders scheduled one to
replace social media and texts; they’ll two weeks prior to due date, a week
augment each other. following deadline, and then a final email
ten to fourteen days later before resorting
to mail. Use pet name, age, gender, and any
Finally, determining ROI is a challenge other pertinent information to make your
because social media allows you to expand outreach as personal as possible.
your reach farther and more focused than
traditional marketing. Sure, you need to
boost a Facebook post to get it in front of TEXT MESSAGES: In addition to email
your audience, but boosting allows you to reminders, ask clients if they prefer SMS
precisely target pet lovers within your reminders and updates. I’ve had success
professional perimeter. Even better, it’s with monthly medication refills and
possible to showcase your personality, preventives, weekly weight and progress
passion, and expertise in ways we could updates, and daily critical care check-in’s
only imagine a decade ago. Go ahead, turn over text. Be respectful of your client’s
up the volume on your social media and be preferred communication platform and
prepared for the celebration of the century!
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

crank up your software’s text features to be correspondence, generating survey

heard above the email crowds. contacts to conduct client satisfaction
research, and connecting with your blogs
and breaking news. I recommend you’re
SOCIAL MEDIA: Your management software your management system to send a
can also help grow your social media by monthly electronic newsletter highlighting
adding Facebook or Twitter links to all hot social media posts or stories, embedded
with direct signup and sharable links.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Índice
CAMILA PARDO
Maria Camila Pardo, DVM, MS
Experta en Enfermedades Infecciosas, Zoonosis, Vacunología y Desarrollo de Productos
Biológicos
Athens, GA USA

1.7.1. Moquillo Canino ........................................................................................................ 163

1.7.2. Parvovirosis Canina ................................................................................................... 164
1.7.3. Leptospirosis, Enfermedad Zoonotica: Diagnostico Y Prevencion ............................ 166
1.7.4. Leucemia Felina Subclinica Y Repercusiones En Salud Felina ................................... 168
1.7.5. Inmunizacion O Administracion De Vacunas…No Es Lo Mismo. ............................... 170
1.7.6. Programas De Vacunacion: Puntos Clave.................................................................. 171
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Moquillo Canino

RESUMEN: El virus de Moquillo canino/Distemper parece haberse generado en el Perú y de allí

se expandió a España en el Siglo 17 y de allí a todo el mundo eventualmente.

Este virus no solo afecta a perros, sino a todos los cánidos y a muchas otras especies de
mamíferos, desde félidos salvajes, a mustélidos y prociónidos.

Hoy en día la enfermedad produce alta mortalidad en poblaciones de canidaes no expuestas

previamente al virus o libres de vacunación: 1999 brote de DC en la Isla Santa Catalina, California
USA afectando la población de zorros nativos pasando de 1.330 individuos a menos de 100. En
el año 2001 en la Isla de Pascua, Ecuador se registraron 596 casos de DC en perros silvestres; 275
murieron por la enfermedad y 294 fueron sacrificados ya que estaban con sintomatología.

Todas las vacunas disponibles tienen la capacidad de proteger perros contra VDC, lo de la
“nueva” tipificación quiere decir que gracias a nuevas técnicas moleculares se está aprendiendo
más del virus y de las cepas circulantes en el mundo.

Hay que comprobar el diagnostico con la detección del virus, por Kits comerciales o por PCR en
laboratorios disponibles (los cuales han validado la técnica de detección).

Las vacunas a virus vivo modificado contra distemper, pueden producir depresión del sistema
linfoide por unos días después de la inoculación, lo que es altamente riesgoso en ciertas
poblaciones de perros débiles, desnutridos, y/o estresados. Esto es un factor de consideración en
ese tipo de animales, donde la respuesta a la inmunización no solo contra distemper, sino
también contra otros antígenos presentes también en la vacuna aplicada [adenovirus (hepatitis),
parvovirus] puede afectarse. Algunas cepas de vacunas a virus modificado de distemper tienen
la capacidad de producir encefalitis post-vacunal, y aunque la incidencia de este problema es
muy baja, es importante analizar esto y evitar utilizar vacunas a virus vivo modificado de
distemper en animales débiles, desnutridos, y/o con problemas inmunitarios. Al diseñar el
protocolo de inmunización de cada paciente, tener en cuenta que solo la vacuna de distemper
recombinante vectorizada cruza la barrera de anticuerpos maternales (como se hizo hace 50
años con la vacuna de sarampión humana aplicada a cachorritos). Por su inocuidad y alta
protección la vacuna recombinante de distemper ha estado ayudando desde 1998 a que
poblaciones de especies salvajes susceptibles a esta enfermedad estén prosperando; Leopardos
de las nubes, pandas gigantes, pandas rojos, y hurones de patas negras.

REFERENCIAS: Disponibles por petición a la Conferencista.

 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Parvovirosis Canina

INTRODUCCION: El virus de parvovirus canino se propaga a través del contacto oral

con heces infectadas o por superficies contaminadas (el suelo, pasto, zapatos,
juguetes), en lugares donde se concentran cachorros/perros jóvenes; “socialización
temprana”, criaderos y perreras, tiendas de mascotas, parques, entrenamiento: clases
de agilidad/obediencia, etc.
Produce una muy buena inmunidad en perros que sobreviven la enfermedad.
Se le denomino PVC-2, para distinguirlo de otro parvovirus ya presente; el “minute virus
of canines; (MVC)”. Fue identificado y aislado por primera vez hace 40 años, en 1978
por los Dr. Max Appel & Dr. Leland Carmichael del James A. Baker Institute for Animal
Health, parte de la Facultad de Medicina Veterinaria de la Universidad de Cornell, Ithaca
NY. USA. Con pruebas de laboratorio se empezaron a hacer muestreos y se detectó
que el virus original (CPV-2) no era el único circulante en el campo, se detectaron dos
variantes adicionales de campo a las que se les denomino respectivamente CPV-2a en
1979 y CPV-2b en 1983. Gracias a la nefasta moda de “Vacunación y Socialización
temprana” empezando a vacunar cachorros a las 4 semanas de vida, acabando el ciclo
a las 8-10 semanas de vida, se empezaron a tener brotes de parvovirus en Europa y
USA en el año 2000-2002, cuando desde hacían muchos años no había brotes de esta
enfermedad. Esta situación intereso a investigadores en Italia, Dr. Nicola Decaro y Dr.
Canio Buonavoglia los que identificaron una tercera variante de campo por esa época
llamándola “Glu-426”, la cual fue definida después como CPV-2c en 2002.
Subsecuentemente se encontró en muestras congeladas de heces que CPV-2c ya
estaba presente en el mundo desde 1996…solo que nadie la había detectado ya que
las técnicas de laboratorio antes de los años 2000 no la podían detectar.
REFERENCIAS: Disponibles por petición a la Conferencista.

vacunación / desafío con perros SPF

[libres de patógenos específicos = sin
INTERROGANTES COMUNES EN LA
ninguna inmunidad previa a CPV].
CLINICA:
-Brunet, Toulemonde, Minke:
• Cual vacuna debo utilizar en mi
Presentado Públicamente International
clínica? Hay CPV-2c en Colombia,
Parvovirus Meeting, Bari, Sept 2007.
Perú, Venezuela, Ecuador?, tiene
Lineas de vacuna Eurican / Hexadog /
que tener la vacuna de Parvo que yo
Recombitek del laboratorio Merial
uso la cepa CPV-2c?
(ahora BI)
Respuesta: No es necesario tener el
-Spibey N, Greenwood NM, Sutton D, et
antígeno CPV-2c en la vacuna para
al. Canine parvovirus type 2 vaccine
proteger contra esta variante, ya que
protects against virulent challenge with
todas las vacunas de parvovirus canino
type 2c virus.Vet Microbiol. Presentado
protegen contra todas las variantes;
en el WSAVA Praga 2006. Linea de
CPV-2a, CPV-2b y CPV-2c. Eesto se ha
vacuna Nobivac del laboratorio Intervet
demostrado bajo estudios de
(ahora MSD).
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

-Dr. Ron Schultz et al. Wisconsin maternales al diseñar el programa de

University. Presentado en 2007 vacunación para ese perro?, A qué edad
CRWAD, Chicago, USA,, demostró que se le administró la ultima dosis de
todas sirven!. vacuna?, Estaba el cachorro libre de
stress, de fiebre, parásitos, de
• Si todas las vacunas de
tratamiento con corticoides en los días
parvovirus canino protegen
inmediatamente previos o posteriores a
contra todas las cepas y
la aplicación de la vacuna?. Se ha
variantes de campo porque
considerado si antes de recibir el ciclo
cachorros con 1 o hasta 3 dosis
de al menos las primeras 2 dosis de
de vacuna contraen
vacunas ese cachorrito estuvo aislado
parvovirosis?
en casa, sin contacto con ningún otro
Respuesta: Primero que todo, hubo perro, sin salir nunca de casa, y con la
diagnóstico de parvovirus excretado en absoluta certeza que nosotros no
sus heces (Kits), o solo se sospecha de introducimos el virus de parvovirus a
parvovirus por tener el cachorro diarrea nuestros hogares?.. No podemos
con/sin hemorragia? Si, sí hubo descartar que se hubiese contagiado
diagnóstico definitivo el problema muy antes de recibir su curso de
probablemente no es la vacuna en sí, vacunaciones. Hay que recordar que el
sino el animal; ¿se tuvo en cuenta la antígeno de parvovirus es de los más
interferencia de los anticuerpos resistentes a desinfección y es
altamente contagioso.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Leptospirosis, Enfermedad Zoonotica:

Diagnostico Y Prevencion

INTRODUCCION: La enfermedad de Leptospirosis es una zoonosis grave y una de las más

comunes en todo el mundo. Ha resurgido considerablemente en perros & humanos en las últimas
dos décadas en humanos ya fuese en zonas urbanas por sobre población de roedores, al practicar
deportes acuáticos en zonas endémicas, y en perros por el aumento de viviendas en áreas en las
que habitan portadores infectados (roedores, capibaras, mapaches etc.) aumentando el riesgo
al contacto e infección y también porque en algunos países como USA, desde hace unos años se
asumió que la vacunación canina contra esta enfermedad no era “core” o vital. Estudios de
epidemiologia con reislamiento de espiroquetas y relacionados con serología correspondiente
con niveles de más de 1:1600 MAT han sido demostrado con serovares de L. grippotyphosa en
USA, Alemania y Brazil & Alemania, L. hebdomadis en Japón.

REFERENCIAS: Disponibles por petición a la Conferencista.

POBLEMAS Y RIESGOS AL NO HACER correspondiente (no a todos los que

DIAGNOSTICO ADECUADO muestren resultado “positivo” de 1:40,
de 1:100, 1:200). Ya que no es inusual al
En la clínica humana, así como en la clínica
tener infección activa por una serovar y
veterinaria esta grave enfermedad muchas
generar respuesta elevada a esta, el
veces no es diagnosticada a tiempo por
tener también reacciones cruzadas
varias razones:
(falsos positivos MAT) para otras
- Falta de sintomatología serovares.
patognomónica, (la descrita ictericia no
- A muchas personas y perros aun así sin
se vé en casos con infección por
tener diagnóstico definitivo, se les
serovares como L. grippotyphosa, L.
administra antibióticos, pudiendo tener
pomona o L. canícola, sino más que
una mejoría; pero si el tratamiento no
todo se presenta con la infección con la
es adecuado (a largo plazo y con
serovar L. icterohaemorrhagiae.
doxiciclina) el animal puede seguir
- Interpretación de serología MAT: Si se eliminando espiroquetas por la orina y
mandan sueros al laboratorio para sigue siendo portador intermitente.
hacer serología MAT, muy pocas veces
- Cuando los niveles de BUN y la
se submiten muestras pareadas, pero
creatinina están elevados, ya hay un
sobre todo muy pocas veces el Clínico
daño grave del riñón, la enfermedad es
comprende los resultados; solo el título
crónica, el animal ha estado excretando
≥1:1600 es indicativo de infección
espiroquetas por mucho tiempo,
activa y acerca de cuál es la serovar
aumentando el riesgo de infección a
involucrada, solo hay que tener en
otros y la probabilidad de salvar la vida
cuenta el resultado de los anticuerpos
del animal es muy baja.
más elevados a la serovar
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Bacterinas contra esta enfermedad han sido

relacionadas en el pasado con reacciones
NOVEDADES EN DIAGNOSTICO PRACTICO
post-vacunales, pero el tipo de reacción
Existen kits muy buenos que detectan
generalizada como urticaria con estas se
antígeno en la orina diagnosticando
veía en los años 80, pero desde entonces no
leptospiuria (sin determinar por cual
se ve con la misma incidencia ya que
serovar), junto con la correcta
muchos laboratorios hoy en día ofrecen
interpretación de serología MAT, y el
vacunas con muchísimo menos contenido
cuadro clínico se puede hacer un buen
de suero albúmina bovino (BSA) y otras
diagnóstico de esta zoonosis (tendremos
proteínas (remanentes del medio de
ejemplos de casos a discutir).
cultivo) las que producían las reacciones
adversas. El causante de reacciones locales
(nódulos) que aún se ven con las bacterinas
PERCEPCIONES NO ADECUADAS ACERCA de leptospira es el adyuvante que aún está
DE INMUNIZACION CONTRA ESTA presente en algunas presentaciones, es por
ENFERMEDAD: esto importante indagar su contenido y el
Muchas bacterinas en el mercado no nivel de protección contra leptospiuria en
generan el mismo nivel de protección, pero las vacunas que usa en su clínica.
algunas han demostrado
experimentalmente mejor nivel de
protección, con fracción preventiva mayor a RECOMENDACIÓN DE INMUNIZACION:
90% contra leptospiuria bajo condiciones
Para perros que salen a la calle, que están
experimentales de desafíos altamente
en su jardín, que están en contacto con
virulentos (es decir perros en el campo
cualquier otro animal están en contacto con
nunca estarían expuestos al nivel tan
suelo, Es por todo esto, además de ser
elevado de infección) contra serovares L.
zoonosis, que para mí la bacterina de
icterohaemorrhagiae, L. grippotyphosa, L.
leptospiras es una vacuna CORE anual
canicola y L.pomona comparado al índice de
global.
leptospiuria en perros no vacunados.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Leucemia Felina Subclinica Y

Repercusiones En Salud Felina

INTRODUCCION: En los Estados Unidos, Canadá y muchos países europeos hoy en día esta
enfermedad retroviral es menos común ya que desde por lo menos dos décadas los animales
infectados se pueden diagnosticar con kits que detectan el antígeno p27 del virus circulante en
la sangre, y estos animales se sacrificaron o vivieron en aislamiento sin salir nunca de casa y sin
ningún contacto con otro gato en la casa. Este es el manejo apropiado para evitar la difusión y
reducir la incidencia de esta enfermedad. Por el efecto destructor en el sistema inmune, muchos
gatos con leucemia felina sufren de una gran variedad de enfermedades y patologías felinas; es
importante recordar esto durante el examen clínico sospechando así infección inicial por este
virus. Ninguna vacuna en el mercado complica el diagnóstico con los kits disponibles, esto es muy
importante que este claro y discutiremos la razón de esto.

PATOLOGIAS Y MORBILIDAD POR

LEUCEMIA FELINA:

La mayoría de gatos infectados morirán de

enfermedades degenerativas, una minoría
desarrollará enfermedades neoplásticas y
proliferativas. Los gatos persistentemente
virémicos sucumben a enfermedades
relacionadas a VLFe dentro pocos años (2-4)
después de la infección inicial. Es muy
importante enfatizar que gatos con
estomatitis para los que se sospecha DIAGNOSTICO:
infección por calicivirus, muy
probablemente tuvieron infección inicial Previamente, se creía que los gatos adultos
con VleF. El virus de FeLV se inserta en el con infecciones “abortivas” eran los que
genoma celular del gato, resultando en tenían una viremia transitoria seguida por el
activación del oncogén induciendo “despeje” de infección viral. Sin embargo,
actividad neoplásica en cualquier célula mejoras en la sensibilidad de la prueba de
afectada. Grafico adjunto de patologías Reacción de Polimerasa en Cadena (RCP)
felinas por este virus. revelo que gatos que “solo tuvieron 1
resultado positivo” y luego fueron antígeno
negativo (p27 negativos), todavía tienen
provirus de VLFe en sus tejidos resultando
en infección regresiva. Los gatos con
infecciones regresivas generalmente son
avirémicos, no excretan el virus infeccioso.
Así que muy probablemente pasan
desapercibidos en los estudios
epidemiológicos en los que solo se usa
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

como criterio el p27 y tampoco desarrollan VLeF CTL’s). Es por esto que pruebas de
enfermedades asociadas a VLFe, sin serología contra el virus de leucemia felina
embargo, son portadores con el potencial de no son utilizadas para el diagnóstico de la
reactivación y futura excreción. enfermedad.

RESPUESTA INMUNE: PREVENCION:

Después de la infección con el virus de Varias vacunas están disponibles,

campo, altos niveles de linfocitos T preferiblemente usar las que generen
citotóxicos- CTLs específicos de VLeF, respuesta celular y que no contengan
aparecen antes que los anticuerpos se adyuvante.
formen en los gatos que se recuperaran de
la exposición al VLeF. En contraste, la
viremia persistente se asocia con un REFERENCIAS:
silenciamiento de los mecanismos inmunes
del huésped (respuesta virus-específica Disponibles por petición a la Conferencista.
humoral y mediada por células efectoras
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Inmunizacion O Administracion De
Vacunas…
No Es Lo Mismo

RESUMEN: Inmunidad celular y humoral, que tipos de vacunas generan estas. Revisaremos
conceptos prácticos básicos, que son útiles para comprender la respuesta inmune a los productos
biológicos.

Para que haya Inmunización, no solo hay que analizar el tipo de producto biológico… sino el
ESTADO del paciente que recibe el producto.

¿Está Sano?

¿Está estresado? Hace cuando fue destetado, separado de su camada, ¿y en un nuevo hogar?

¿Está parasitado, desnutrido?

¿Está con dermatitis?

¿Está bajo tratamiento contra la corticoides y por hace cuanto tiempo? ¿Que dosis de
prednisolona puede afectar la respuesta vacunal?

¿Es muy joven y aún podría tener inmunidad pasiva maternal?

TODO puede afectar la respuesta a la vacuna.

Es por esto que antes de aplicar un producto bilógico, hay que preguntar y analizar

 De donde proviene la mascota?,

 Cual es su historia vacunal?,
 Historia de reacciones post-vacunales previas?,
 Cual es la epidemiologia de la zona?
 Cual es el estilo de vida del paciente
De acuerdo a su concepto médico se PRESCRIBIRA (o no) vacunar y que vacuna es la apropiada
para cada paciente.

REFERENCIAS: Disponibles por petición a la conferencista.

 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Programas De Vacunacion: Puntos Clave

RESUMEN: Hoy en día el Médico Veterinario tiene a su disposición una amplia gama de
antígenos, ya sea en presentaciones, monovalentes, bivalentes, con o sin adyuvante, o de
grandes combinaciones, de pequeño volumen etc., para diseñar el producto que mejor cumpla
con las necesidades individuales de sus pacientes.

Recordando un poco la epidemiologia y patología de los antígenos que producen la enfermedad

se pueden seleccionar las vacunas que son necesarias solo en animales joven (por ejemplo
parvovirus canina y leucemia felina) y las que siempre hay que usar (rabia, leptospira), sin
importar la edad del animal y así sea que salen de casa “casi nunca” o “muy pocas veces al mes”
porque estas son enfermedades zoonóticas. También discutiremos la importancia de reconocer
el entorno epidemiológico, la frecuencia de vacunación en perras adultas y la influencia de la
presencia de la inmunidad pasiva /la inmunidad maternal conferida por la ingestión del calostro
al diseñar programas de inmunización en animales de menos de 4 meses / 16 semanas de vida.
Explicare que significa tener en una vacuna un titulo alto y bajo, o nivel de pasajes alto o bajos,
y si esto realmente influencia o no el diseño del plan de vacunación individual de cada paciente.
Algo que tiene mucha importancia indagar, es el grado/ nivel de protección que confiere cada
producto; disminuye la sintomatología?, ayuda a la reducción de enfermedad?, o previene la
enfermedad?.

Ya hay “Guías de Inmunización” para perros y gatos enfocados en América Latina; COLAVAC pero
hay que recordar que estas son guías, sugerencias disponibles y prácticas, pero es el Médico
Veterinario la única persona que decide PRESCRIBIR O NO la administración de una vacuna, y de
que tipo (inactivada, con o sin adyuvante, a virus vivo modificado, o recombinante); de acuerdo
al estado de salud del animal, a su historia previa de inmunizaciones y la de su madre (en caso
de cachorros), al riesgo de infección por su localidad y al estilo de vida del paciente.

REFERENCIAS: Disponibles por petición a la conferencista.

 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Índice
DOUG MADER
Douglas Mader, MS, DVM, DABVP (C/F, R/A), DECZM (Herpetology)
Marathon Veterinary Hospital, 5001 Overseas Hwy, Marathon, FL 33050 USA

1.8.1. Common Diagnostic Techniques and Procedures in Dogs and Cats ......................... 173
1.8.2. Fracture Repair in Reptiles ........................................................................................ 181
1.8.3. Local Analgesia in Dogs and Cats .............................................................................. 185
1.8.4. Radiology in Reptiles ................................................................................................. 188
1.8.5. Why won’t my Reptile Eat ? ...................................................................................... 192
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Common Diagnostic Techniques and

Procedures in Dogs and Cats

OBJECTIVES –

1 – Learn how to perform a myringotomy, nasal biopsy, Transtracheal wash and Bronchoalveolar
Lavage
2 – Understand the potential complications of each of the procedures
3 – Discuss the potential results of these tests

Myringotomy – middle ear to the nasopharynx. The

continuity of the mucous membranes from
Indications –
the nasal passageways and pharynx is a
Patients with middle ear disease (otitis natural pathway for the spread of
media). pathogens from the nose and throat to the
middle ear and mastoid antrum.
Myringotomy allows access to the inside of
the middle ear for diagnostic (obtain
samples for diagnostic evaluation) and
Supplies –
therapeutic (lavage the tympanic cavity)
purposes. • Otoscope with sterilized speculum (a
video otoscope is a bonus, but not required)

• 3” spinal needles (22 g) or sterile catheters

Anatomy –
(e.g. 3.5 Fr Tom Cat catheter, 3.5 Fr Feeding
The ear has three portions: Outer canal tube)
(external acoustic meatus), Middle ear and
• Syringes for collection of samples and
Inner ear.
flushing (3, 6, 20 ml)
The Middle is a laterally compressed cavity
• 3 way stop cock
in the petrous portion of the temporal
bone. It is defined laterally from the bony • Sterile, non-bacteriostatic saline
external acoustic auditory meatus by the
• Ceruminolytic agent for cleaning the ears
Tympanic Membrane (the ear drum) and
medially from the internal ear by a bony • Culture swabs
wall in which are found two small windows,
each covered by a membrane: the fenestra • EDTA tubes
vestibuli above (oval window) and the • Clean microscope slides
fenestra cochleae (round window) below.
The posterior wall of the of the middle ear • At least one assistant
has a large opening which leads into an air
space (mastoid antrum). Anteriorly, the
auditory (Eustacean) tube connects the Patient preparation –
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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• General anesthesia is required (use • While holding this position, an assistant

appropriate pre- and anesthetic protocols, flushes 1 cc of the sterile saline into the
including necessary laboratory analysis, middle ear. Immediately afterwards, the
lubricating the eyes to protect the corneas) saline is aspirated. This can be utilized for
microbial culture and cytology
• In these cases inflammation of the
external canal is often a hallmark of disease. • This process is then repeated several
NSAIDS or a short course of gluccocorticoids times until the fluid aspirated after flushing
may be needed to help visualize the TM returns clear

• The patient should be intubated with an • No treatment is needed to close the small
inflated cuff to prevent any possible hole in the TM
aspiration of material that may emerge
• NSAIDS, systemic antibiotics and topicals
from the Eustacean tube during the
based on the results of the culture and
procedure
cytology
• Position the animal in lateral recumbency
(healthy ear down) or sternal (if
interrogating both ears) Complications –
• Sterile drapes with a small fenestration to • Neurological signs (head shake, head tilt,
fit over the pinna Horner’s) may result from overly aggressive
lavaging, accidental over-deep penetration
• Surgeon should wear proper protective
of the middle ear, reaction to the
gear and sterile gloves
ceruminolytics

Procedure –

• Clean and dry the external ear canal

Nasal Biopsy –
- sterile saline or ceruminolytics
(not in cats due to the risk of
neurological complications or if Indications –
there is a ruptured TM)
• Patients with evidence of nasal pathology:
- Always flush any ceruminolytic epistaxis, nasal discharge, sneezing,
after application stertorous breathing, radiographic changes
and surface masses or disfigurements of the
- Suction and dry the canal prior
nasal profile or hard palate
to the myringotomy

• Visualize the TM with the otoscope

Caution –
• Using one of the catheters flush any
remaining debris from the deep recesses of • A coagulation profile is encouraged prior
the canal using only saline. to obtaining nasal biopsies
• Using either a 22g, 3” spinal needle, or the • Proper dental assessments should be
sharply angled cut tip of the 3.5F Tom cat made to ensure that changes in the nasal
catheter, perform the mytingotomy by cavity are not from dental disease
puncturing the TM at the ventral margin
between the 6-7:00
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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• Disease of the paranasal sinuses can be • Physiologic saline for flushing, irrigating.
difficult to evaluate without invasive Pre-warmed to 37 degrees
surgery
• Gauze for packing the pharynx during the
• Small dogs, brachcehpalic dogs and some procedure
cats are nearly impossible to adequately
• Oral speculum or support for the head
scope the entire nasal cavity
during the procedure

• Sterile, water soluble lubricant

Anatomy –
• Biopsy instrument (flexible cup style or
The caudal portion of the nasal cavity is small rigid)
separated by a bony septum. A
• 35-60 ml syringes for flushing
cartilaginous septum divides the rostral
portion of the nasal cavity into left and right • Pathology specimen jars
chambers.
• Pre-cleaned microscope slides
The rostral chambers are each
divided further by dorsal and ventral • Epinephrine or hemostatic agent
turbinates (endoturbinates). The caudal • 2% lidocaine
nasal chamber is filled with
ethmoturbinates which extend into the • At least one assistant
frontal sinus. The frontal sinus and nasal • Surgeon should wear proper protective
cavity are interconnected by narrow ostia. gear and sterile gloves
The caudal nasal cavity is separated
from the cranial cavity by the cribiform
plate, a porus bony partition that extends Patient preparation –
dorsally to the frontal bone and ventrally to
• General anesthesia is required (use
the presphenoid bone.
appropriate pre- and anesthetic protocols,
The blood supply to the nasal cavity including necessary laboratory analysis,
originates from the external carotid artery lubricating the eyes to protect the corneas)
via branches of the maxillary artery.
• The patient is anesthestized, then
The inaccessible paranasal sinuses intubated and the cuff properly inflated.
include the frontal sinus, which extends
• The caudal oropharynx is packed with
approximately from the medial canthus of
saline soaked gauze
the eyes to the temporal line. The maxillary
sinus is dorsal to the roots of the third and • The patient is placed in sternal
fourth premolars and medial to the recumbency with the head propped up on
infraorbital canal. Cats, but not dogs, have rolled towels or suspended from a cross bar
a small sphenoid sinus. to allow straight, comfortable access by the
operator.

• 1 – 2 ml of 2% lidocaine is dripped into

Supplies –
each nostril prior to inserting the otoscope
• Otoscope with speculum or various sized or biopsy forceps
cones (a video otoscope is a bonus, but not
•After several minutes, gently irrigate both
required)
nasal cavities with the warm saline using the
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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large syringe. It may take a few tries, but • Flexible biopsy instruments can be
generally you can flush through to the inserted through working chanels or
nasopharynx. Material that is flushed through the otoscope if large enough. If too
through the nares can be saved in EDTA small, then the flexible or rigid biopsy
tubes for cytological analysis instrument can be passed alongside the
scope to the region of interest.
• If necessary, place a suction apparatus in
the caudal pharynx to minimize flooding of • Always mark the instrument to the level of
the work space resulting from the irrigation the medial canthus of the eyes. This line
process should never be passed. Have your
assistant watch this mark while you are
concentrating on the procedure. This will
Procedure – prevent inadvertent damage to the
cribiform plate
• Always begin with the less affected side
• In small patients it may not be possible to
• Coat the otoscope/endoscope with the pass the biopsy instrument either through
lubricant. If a lidocaine lubricant is or alongside the scope. In these cases it is
available, that is even better possible to perform “blind” nasal biopsies.
• Start by aiming the scope dorsally under This is fondly referred to as the “Ram and
the nasal planum, then immediately jam” technique
redirecting ventromedially (toward the • GENTLY insert a pre-marked biopsy
base of the opposite ear) into the ventral instrument, with the jaws closed, to the
meatus level of the suspected lesion. The jaws are
• At this point it may be necessary to opened and then it is GENTLY rotated on its
perform additional saline irrigation long axis to seat the mucosal tissue in the
cutting surface. The jaws are closed, the
• NOTE – Even in the healthy nose the instrument is GENTLY twisted, and then
mucosa is normally friable and bleeds retracted.
easily. It is not uncommon to lose
visualization of the region due to • Patient’s may sneeze even while
hemorrhage anesthetized – so protective gear is highly
recommended
• With large patients and appropriately
sized equipment, it is possible to • Sample 3 – 6 sites if possible
interrogate all the way to the posterior • The samples are transferred to fixative for
nares and the nasopharynx processing
• After evaluating this region, retract the • In some cases, it may be prudent to make
scope and interrogate the dorsal meatus impression smears of the samples prior to
and ethmoid turbinates immersion into formalin

Biopsy techniques – Complications –

• ALWAYS take biopsies, brushings or swabs • Aggressive technique could damage the
from multiple sites unless an obvious cribiform plate, especially if there is severe
foreign body is found disease and existing bony damage
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• Epistaxis (direct pressure, cold packs or • Non-bacteriostatic physiologic saline (pre-

epinephrine sprayed into the nostril will warmed)
help control this)
• 3 way stop cock

• #11 scalpel blades

• Sterile plain Red top and EDTA tubes

Transtracheal wash –
• Pre-cleaned microscope slides

• Sterile gloves for surgeon

Indications –
• Sterile dressing for the skin post
• To obtain samples from the airways procedure
(trachea, primary and secondary bronchi)
• One assistant
for cytology and bacteriology sampling in
medium to large dogs and the upper
airways in small dogs and cats
Patient preparation –
• Can be performed in awake (+/- sedation)
patients • General anesthesia is not required

• I sedation is used, keep it light enough that

the patient maintains the cough reflex
Caution –
• The patient can be sitting or sternal with
• Refractory or difficult to handle patients the head and neck pulled back and up
may need heavy sedation – caution not to
oversedate so that the patient loses its • The fur should be clipped from the larynx
cough reflex to the mid cervical region

• Patients with severe respiratory • Sterile scrub

compromise may have difficulty with the
procedure
Procedure –

• Using the local anesthetic, block the skin

Supplies – and SQ at a site directly over the
• Supplies needed for aseptic preparation of cricothyroid ligament or anywhere between
the skin (clippers, scrub) the rings from 3 – 5 ventral to the larynx

• Through-the-needle jugular catheter (19 – • Stabilize the trachea with one hand and
22 g, 20 cm for dogs < 10 kg; 19 g, 30 – 60 using the #11 blade, made a small stab
cm for dogs > 10 kg) incision though the skin in the desired
location
• Alternate option is a 3 – 6 Fr
polypropylene male urinary catheter and a
12 – 14 g over-the-needle catheter • When using the through-the-needle
• Lidocaine or bupivicaine catheter, insert the needle though the
desired location into the trachea, angled
• Variety of syringes, 1, 3, 6 10 and 20 ml down the lumen
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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• Advance the entire catheter through the

needle then withdraw the needle
• For either technique, when finished
• Attach the 3-way stop cock to the end of aspirating, remove the catheter and apply
the catheter gentle pressure to the site for a few minutes

• Inject the warm 0.9% saline into the • Apply a light dressing over the region
catheter (0.5 ml/kg)

• It is not uncommon for the patient to

Laboratory analysis –
cough at this point
• Cytology – fluid in EDTA tube and freshly
• As soon as you are done injecting,
made smears
immediately aspirate back, pulling the full
length of the syringe • Culture of the fluid from the syringe (not
from the EDTA tube)
• Repeat this process up to three times to
maximize return of aspirate

• Repositioning the patient, tipping the Complications –

patient into a head down position and
coupaging may help increase yield • If the patient becomes compromised,
abort the procedure and start it on high flow
oxygen immediately
• When using the over-the-needle • If the patient has difficulty post
catheter, place the catheter into the lumen procedure, consider a bronchodilator
of the trachea as previously described, then
remove the needle • Laryngeal or airway spasm (especially
feline patients)
• Thread the polypropylene urinary
catheter through the large bore IV catheter • Compromise to the patient from the
to the approximate level of the carina (4th added pulmonary fluid
intercostal space) • Accidental aspiration of the catheter into
• Attach the 3-way stop cock to the end of the trachea
the catheter • Trauma to the lower airways from the tip
• Inject the warm 0.9% saline into the of the catheter
catheter (0.5 ml/kg) • SC emphysema
• It is not uncommon for the patient to • Pneumomediastinum
cough at this point

• As soon as you are done injecting,

immediately aspirate back, pulling the full
length of the syringe

• Repeat this process up to three times to

maximize return of aspirate

• Repositioning the patient, tipping the

patient into a head down position and
coupaging may help increase yield
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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• Position the animal in either lateral or

sternal recumbency (NOTE – if radiographs
Bronchoalveolar Lavage (BAL) –
suggest unilateral disease, place the
Indications – affected side DOWN)

• To obtain samples from the airways • If there is excessive mucus or discharge in

(trachea, primary and secondary bronchi) the oral cavity, wipe with gauze and flush
for cytology and bacteriology sampling with saline

• Prior to intubating the patient, measure

the length of the catheter compared to the
Caution – length of the ET. Mark the packaging of the
• Minimal sampling from the bronchioles catheter so that when inserted, the end
and lower airways protrudes through and past the end of the
ET by at least 4 – 6 cm
• Patients with severe respiratory
compromise may have difficulty with the
procedure Procedure –

• Insert the sterile ET after induction – be

Supplies – careful to avoid oropharyngeal
contamination of the end of the tube by
• Sterile endotracheal tube touching the oral cavity
• 4 – 6 Fr. Male dog urinary catheter • Carefully cut the end of the packaging
(polypropylene or red rubber) from the sheath of the catheter
• Non-bacteriostatic physiologic saline (pre- • Advance the catheter through the ET by
warmed) pushing the outside of the packaging – thus
• 3 way stop cock avoiding surface contamination of the
catheter as it passes through the ET
• 10 and 20 ml syringes
• Attach the 3-way stop cock to the end of
• Sterile plain Red top and EDTA tubes the catheter
• Pre-cleaned microscope slides • Inject the warm 0.9% saline into the
catheter (0.5 ml/kg)
• Sterile gloves for surgeon
• As soon as you are done injecting,
• One assistant
immediately aspirate back, pulling the full
length of the syringe
Patient preparation – • Repeat this process up to three times to
maximize return of aspirate
• General anesthesia is required (use
appropriate pre- and anesthetic protocols, • Repositioning the patient, tipping the
including necessary laboratory analysis, patient into a head down position and
lubricating the eyes to protect the corneas) coupaging may help increase yield
• The patient should be intubated with an • If you can add supplemental oxygen
inflated cuff during the procedure it would benefit the
patient
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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• If the patient becomes compromised, • Culture of the fluid from the syringe (not
abort the procedure and start it on high flow from the EDTA tube)
oxygen immediately

• When the aspiration is completed

Complications –
withdraw the catheter and place the patient
on oxygen until recovery • Laryngeal or airway spasm (especially
feline patients)
• If the patient has difficulty post
procedure, consider a bronchodilator • Compromise to the patient from the
added pulmonary fluid

• Accidental aspiration of the catheter into

Laboratory analysis –
the ET
• Cytology – fluid in EDTA tube and freshly
• Trauma to the lower airways from the tip
made smears
of the catheter
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Fracture Repair in Reptiles

INTRODUCTION: Fractures in captive reptiles are common, usually being secondary to primary
nutritional deficiencies. Specifically, pathological fractures frequently occur as a result of
Nutritional Secondary Hyperparathyroidism (NSHP), which is a general lack of dietary calcium,
excessive phosphorus or deficiency in exposure to ultraviolet light/vitamin D3. Even traumatic
fractures, which under normal conditions with healthy bones would not occur, are more likely
due the generalized osteopenia associated with NSHP.

Extremity fractures are rarely compound or comminuted. As a result, most fractures are readily
treated with external coaptation. In addition, since most fractures are often associated with
demineralization and softening of the bones, internal fixation is usually not indicated. In the
unlikely event of a traumatic fracture involving normal bone, internal fixation can be utilized.

Regardless of the etiology, nutrition and diet should be thoroughly evaluated in all fracture cases.
Before attempting any repair calcium homeostasis should be established. The medical
management in these cases is equally as important as the surgical attention.

OBJECTIVES –

1 – Understand the most common causes of fractures in reptiles

2 – Learn the best techniques on how to repair fractures
3 – Discuss expected healing timelines for fractures in reptiles.

GENERAL CONSIDERATIONS stabilization, minimal disruption of soft

tissue and conservation of the blood supply
Frye states that most fractures occur as a
is paramount. The forces acting on the
result of low impact forces, thus making the
fracture (bending, rotation, compression
incidence of comminuted fractures
and shear) must be evaluated and
uncommon. In addition, due to their
neutralized to promote rapid healing. In
relatively inelastic skin, open or compound
general, the more forces that must be
fractures are infrequent.
neutralized by the type of fixation, the
Little information is available on fracture higher the incidence of complications and
healing in reptiles. No controlled studies failures.
have been conducted. Most of the
Additional considerations when deciding
information that is known comes from
upon type of fracture repair include the
anecdotal reports relating treatment
patient's functional requirements (pet lizard
successes/failures in cases of NSHP. It is
in a terrarium vs. a Komodo dragon being
generally accepted that reptilian bone heals
returned to the wild), cost limitations set
slower that either mammalian or avian
forth by the client, the cost and availability
bone, requiring from two to eighteen
of the required materials and the
months to completely heal.
experience of the veterinarian.
When planning fracture repair in reptiles
Most long bone fractures will heal in time
general principles of orthopedic
with nothing more than strict cage rest.
management apply. Proper alignment, rigid
Although there may be some severe
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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malunions, these complications do not Bone is a dynamic organ, undergoing

seem to affect captive reptiles in an adverse constant remodeling. During prolonged
manner. hypocalcemia/hypovitaminosis D, the
mineralization process lags behind the
The size of the patient and its nutritional
formation of organic bone matrix, resulting
state may have a direct impact on the type
in the formation of hypomineralized bone.
of fixation required. Large, heavy bodied
When this occurs in young, growing animals
lizards and turtles may require internal
it is called rickets, and in adults, it is known
fixation, whereas small, delicate lizards may
as osteomalacia. Pathological fractures
do well with a light splint.
occur when the calcium content decreases
The general condition of the patient often to approximately one-third of its baseline.
plays a major factor in the selection of Aside from pathological fractures of the
fixation methods. In many of these NSHP long bones and appendicular skeleton, soft,
animals it is physically impossible to utilize swollen mandibles and long bones (fibrous
any type of internal fixator, as the bones osteodystrophy), stunted growth,
just are not physically strong enough for the deformed heads and abnormalities in
implant to gain purchase. ambulation are common.

As in anything in veterinary medicine, the These bones are too soft to provide support
dollar is often the deciding factor in final to the implants used in internal fixation
determination of fixation technique. techniques. IM pins, cerclage wires and
Internal fixation carries a higher price tag bone screws all penetrate, crush and pull
due to the cost of the materials, the time out when used in these wax-like bones. An
necessary for application and the training of IM pin may be utilized for alignment in long
the surgeon. Although internal fixation may bone fractures, but when used, it should be
be the best for the patient, it is not always in conjunction with external coaptation.
an option.
Once the calcium homeostasis is corrected
the healing progresses rapidly, with a bony
callous forming in about three to four
EXTERNAL COAPTATION weeks. Correcting management and
External coaptation involves the use of husbandry deficiencies and providing
splints, slings, casts and any other technique proper dietary and supplemental calcium is
needed to immobilize a fracture. This is by needed. In addition, treating the patient
far the most commonly utilized technique in with synthetic salmon derived calcitonin
reptilian fracture repair. In general, the best helps speed recovery by inhibiting the
splints/casts are those that are lightweight actions of parathyroid hormone, blocking
and comfortable for the patient. If the the actions of the osteoclasts, stimulating
patient's activity is restricted lightweight the osteoblasts and providing bone
splints/casts are effective. analgesia. 50 IU/kg of calcitonin, IM in the
triceps, administered q 1 week for two
When treating pathological fractures treatments is the recommended dosage. It
secondary to nutritional disease external is important that the patient is eucalcemic
fixation is the treatment of choice. NSHP is prior to the administration of the calcitonin.
the most common disease presenting to
reptilian veterinarians, and most frequently There have been numerous methods
seen in the Green iguana. reported in the literature for external
coaptation in reptiles. There is no one right
way. Whatever technique works best in
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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your practice situation is the best method to Splints/casts can be easily applied to any of
use. The most important thing to the long bones in lizards. When applying
remember is that the best splints/casts are splints/casts it is important to follow
the lightest and most comfortable to the general principles of fracture stabilization.
patient. The joints both proximal and distal to the
fracture should be immobilized.
When applying external coaptation
remember that the patient is most likely in For both humeral and femoral fractures a
pain. Anesthesia or sedation is modified spica-type splint must be used.
recommended for patients that struggle or The splint should incorporate the distal
if extensive manipulation of the fracture(s) joint, and then have a portion that crosses
is required. over the body. For the femur, the band
should cross cranial to the vent so that it
The initial padding around the limb can be
does not interfere with elimination. In
performed with many different types of
humeral fractures, the band can cross
bandage material (Specialist Cast Padding,
diagonally across the chest, passing
Johnson & Johnson, New Brunswick, NJ;
between and under the front legs.
Conform, Kendall Co., Boston, MA). Make
sure that the padding is cut to the Chelonians can also be splinted, but
appropriate width to prevent bunching of modifications in technique are required. It
the padding around the joints. is usually not possible to apply a splint to a
proximal long bone (humerus/femur).
Tape stirrups should be incorporated into
These bones can be reduced (with
the padding when applying the splint/cast
sedation/anesthesia as needed) and then
to prevent slippage. It is not uncommon for
taped into the leg opening in the shell. I
the splint/cast to slide down the leg after
recommend covering the limb with cast
the cast padding compresses.
padding to add stability to the "set limb"
This padded limb can now be reinforced by before taping over the opening. I also
adding aluminum rods, tongue depressors recommend taking a radiograph of the leg
and light weight casting material. It is folded up within the shell to make sure that
important to conform the shape of the fracture alignment is appropriate.
splint/cast to the natural angles of the limb.
Splints/casts do not provide rigid fracture
This will prevent the development of
fixation. As a consequence, fracture healing
fracture disease, or periarticular fibrosis, in
is not as rapid as it would be with a plate or
the immobilized joints.
external fixation device. However, the bone
Veterinary Thermoplastic (IMEX Veterinary, will heal.
Inc., Longview, TX), Hexcelite (Hexcelite
I recommend re-checking the fit of any
Medical, Dublin, CA) and Orthoplast
splint/cast within one week of the initial
(Johnson & Johnson, New Brunswick, NJ)
application. You should always check for
are rigid at room temperature, but
slippage, swelling of the distal extremities
malleable when heated in a water bath. The
and pressure sores. Splints/casts are
Veterinary Thermoplastic is easy to apply
usually left on for a minimum of four, and
when heated and cools to make a rigid
usually six to eight weeks. Follow-up
splint. It comes in different sizes and
radiographs should be taken at four weeks,
thicknesses, making it convenient for
and again when the cast is removed.
different size patients.
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INTERNAL FIXATION AMPUTATION

Internal fixation is warranted for long bone When there is severe tissue trauma, loss of
fractures in reptiles where external blood supply or granulomatous infection in
coaptation is not a practical option. Large, the limb, fracture repair may not be a viable
heavy, active and otherwise healthy reptiles option. Amputation of either the fore- or
all do well with internal fixation. Internal hind limbs is a viable option in reptiles, as
fixation techniques utilized in mammals and they do quite well with three limbs.
approaches to the long bones are similar to Amputation of digits or limbs can be
those employed in reptiles. accomplished with excellent cosmetic and
functional results.
Steinmann pins, Kirschner wires, spinal
needles and stylets can all be used as IM When amputating limbs it is best to remove
pins in reptiles. In addition, these devices the entire appendage. Disarticulation at
can all be used as parts for External Skeletal either the scapulohumeral or coxofemoral
Fixation (ESF). ESF can be used in a variety joints is recommended. Limb muscles are
of fracture types in reptiles of all sizes. transected distally and then elevated
proximally. The joint is exposed and the
When using these delicate implants as a
limb removed. The muscle bellies are then
part of the ESF, the external connecting bar
sutured over the joint space to provide soft-
and clamps are replaced by a
tissue padding. Nerves can be transected
methylmethacrylate polymer. This is
with a scalpel and injected with bupivicaine
inexpensive, easy to use and light.
to provide local analgesia post-operatively.
Pin loosening is a common problem with
In chelonians after a limb amputation it may
ESF. Whenever possible it is recommended
be necessary to provide some sort of
to use threaded pins. The threads should be
prosthesis. A block of wood, a plastic skid
applied to the outside of the pin, not cut
or a furniture roller can be glued to the
into it.
plastron to aid in locomotion.
Bone plating can be utilized, but in general
ANALGESIA
requires a larger patient. Cuttable plates
(Synthes, Paoli, PA) with 1.5 mm diameter As healthcare providers we have to assume
screws can be applied to bones as small as 3 that any patient suffering a fracture must be
mm diameter. Finger plates are also experiencing some type of pain or
applicable in certain situations. discomfort. A thorough discussion of
analgesia is beyond the scope of this
In general, plates do not need to be
presentation, but, those treating reptiles
removed. IM pins and ESF should be
with such injuries should address these
removed when there is radiographic
concerns. NSAIDs and narcotics should be
evidence of bone healing. In some cases a
considered.
fibrous union may be all that is needed to
ensure eventual healing, thus allowing the
removal of loose pins as needed.
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Local Analgesia in Dogs and Cats

INTRODUCTION: It used to be believed that “Pain keeps them quiet!” in reference to our
veterinary patients. If you provided pain relief, the patient would be active and potentially cause
itself harm. Fortunately, that old school thinking is not longer acceptable. Analgesia, or the
“absence of pain” is mandatory for all procedures in veterinary medicine, whether it is something
minor like a small mass removal, or for major surgery.
Local analgesic blocks render complete anesthesia to the surgical site – meaning that there is no
sensation of pain. The sensation of pain is alleviated or even eliminated for the duration of the
block. Local anesthetic drugs work by blocking sodium channels in nerve membranes. Decreased
permeability to sodium slows the rate of depolarization so that the threshold potential is not
achieved and an action potential is not propagated, thus the pain impulse is not propagated.
It is always best to prevent pain – that is – prevent the phenomena called “wind up.” This is done
by utilizing local analgesia prior to or before a surgical procedure, so that when the patient
recovers, it immediately feels less pain and discomfort. The clinician does not have to “chase”
the pain that the patient experiences when it awakens, thus, providing for a more comfortable
post operative period.
Of significance, when utilizing pre-operative pain medications, especially local analgesics, less
general anesthesia is needed. This is referred to as “multimodal analgesia/anesthesia.”
OBJECTIVES –
1 – Understand the need and benefits of Local Analgesia
2 – Learn about the different drugs commonly used
3 – Learn the most common procedures used

ADVANTAGES OF LOCAL ANALGESIA - Lethal dose in dogs: 16-28 mg/kg

- ‘Toxic dose’ in cats reported as 6-10 mg/kg
- Lower cost
- The general recommendation for clinical
- Minimal systemic side effects
use is ≤ 6 mg/kg in the dog and ≤ 3-4 mg/kg
- No or minimal recovery period
in the cat.
- Safe in high-risk patients
 Bupivacaine
- Decrease MAC of inhalant anesthetics
- Prevents “wind up” - Onset of action:
- Overall better patient pain scores approximately 5-10 minutes
after injection (up to 20
minutes)
COMMONLY USED LOCAL ANESTHETIC
- - Duration of action: 4 to 6
DRUGS IN VETERINARY MEDICINE
hours
INCLUDE
- Dose 1-2 –(4) mg/kg (use the
 Lidocaine lower end of the dose in cats)
- Toxic dose in dogs: 5-11
- Onset of action: rapid (less than 5 minutes) mg/kg or potentially any
- Duration of action: 60-120 minutes amount given IV
- Dose 2-6 mg/kg (use the lower end of the - Data is mostly anecdotal in
dose in cats) the cat but the general
- Convulsive dose in dogs: 11-20 mg/kg
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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feeling is that 3 mg/kg is the sensitive to local anesthetics and IV

toxic dose. boluses can result in cardiovascular
- The general collapse.
recommendation for clinical
 ONLY LIDOCAINE CAN BE
use is ≤ 2 mg/kg in the dog
ADMINISTERED IV (and never with
and ≤ 1 mg/kg in the cat.
epinephrine).
- • Augmentation
- - Additives such as  Methemoglobinemia – rare, but
epinephrine, hyaluronidase, can occur in cats.
bicarbonate
 Motor and autonomic nerves are
also blocked by local anesthetics,
ADVERSE EVENTS CAUSED BY LOCAL and so motor weakness and
ANESTHETIC DRUGS: vasodilation may occur with certain
Extremely rare but can include any of the techniques.
following: ALWAYS CHECK DOSE – LOCATION
Main disadvantages are: – ASPIRATE PRIOR TO
ADMINISTRATION!
- Does NOT provide restraint
or sedation Three common uses for local analgesia
- Can cause nerve damage - Topical analgesia
- Overdose possible (densensitization and
analgesia to the skin)
 Local tissue effects – swelling, - Local tissue analgesia
bleeding, inflammation, (infiltration)
‘paresthesia? (unknown if this - Regional analgesia (IV or
occurs in animals). Epidural)

 Anaphylaxis – rare
Examples of Topical Analgesics
 Central nervous system – muscle
- Analgesic creams
tremors, seizure, coma
- 5% lidocaine patch
 At lower concentrations, - Topical Sprays
depression of inhibitory - Proparacaine HCl drops
neurons occurs and can - Tetracaine HCl drops
cause cerebral excitation, - Physical coolants – local
which may lead to seizures. HYPOTHERMIA (Ethyl
At higher concentrations, Chloride)
profound CNS depression
with subsequent coma,
respiratory arrest and
death can occur. The latter
is more likely following IV
LOCAL TISSUE (INFILTRATION) ANALGESIA
boluses of large doses.
• Field Blocks
 Cardiovascular system – the
myocardial conduction system is - Non specific
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- Skin, Nerves, Periosteum, - Nerve locators available

M. membranes >> SQ, Fat,
Muscles, Bone
- Debriding abscesses, Regional Analgesia
removing skin tags, small
masses • IV ((Bier block)
• Line Blocks (Ring Blocks) • Plexus block
• Intrathecal
- Precise - morphine
- Administered between site - lidocaine
of invasion and spinal cord
- Post operative incisional
blocks Special thanks to Dr. Mark Epstein for
• Nerve Blocks (e.g. Dental Blocks) assistance in preparing this manuscript.
Portions of these proceedings were
- Most Precise presented at the NAVC Institute, May 2013.
- Small amount of drug
needed
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Radiology in Reptiles

OBJECTIVES –
1 – Learn the best techniques to produce diagnostic images
2 – Learn radiographic anatomy
3 – Evaluate radiographs from clinical cases

Some form of imaging is mandatory in into their shells in novel surroundings, thus
reptilian diagnostics. While certain clinical making positioning easy. However, some
skills such as auscultation and palpation will walk endlessly regardless of their
may be useful in some species like snakes placement. These animals can be placed in
and lizards, others, like most tortoises, are a a radiolucent container such as a lucite
literal black box when it comes to physical restraint box, or in a simple alternative such
examination. as a rigid cardboard box with the bottom cut
out.
Radiology is the most common diagnostic
tool in reptilian imaging, followed closely by If an animal is restless, it can often be
ultrasound, and more frequently, computed calmed by placing an inverted bucket, small
tomography and magnetic resonance trash can, or cardboard box over the pet for
imaging. Nuclear scans and other contrast a few minutes. By leaving the animal in a
procedures are also gaining use. dark, quiet place, it will often calm down
Unfortunately, where in mammalian long enough to take the radiograph. The
medicine we have years of experience and plate should be marked, the beam
“normals” to rely on for comparison, in the centered, and the control unit set. When
field of reptilian imaging there are still a lot everything is ready, the rotor is started and
of “seat-of-the-pants” interpretations. the cover is removed. The radiograph is
There is the added difficulty of obtaining exposed before the animal has a chance to
high-resolution, diagnostic-quality films move.
through the thick, often ossified dermis.
A simple vagal response can be elicited by
With the advent of digital imaging, this
taping cotton or gauze over the patient’s
obstacle has been less of an issue.
eyes. Many times this can be used in lieu of
Fortunately, many of these problems can be chemical restraint.
overcome with practice and patience.
I personally like telazol
Patience is probably the most important
(tiletamine/zolazepam) for brief restraint in
ingredient in successful reptile medicine,
my reptile patients. Some with less
and in reptilian imaging, it is absolutely
experience using the drug prefer other
essential.
medications such as dexmedetomidine,
morphine, ketamine, propofol, and others.
Regardless, make sure that patient’s
RESTRAINT
condition is stable and that it is able to
As with small mammals, many reptiles can handle any chemical immobilization.
be easily radiographed without sedation. Remember, it is more important to have a
Turtles and tortoises will often withdraw
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live patient than a dead one with quality its widest part (just cranial to the rear legs),
radiogaphs. its highest point (at the crown of the
carapace), and its maximum length (from
POSITIONING
the caudal most portion of the carapace to
Many of the same radiographic positions the gular notch).
used in mammal medicine apply to reptiles.
The craniocaudal and lateral view horizontal
Perhaps the one big difference is the
beams permit good visualization or the air
preference of the dorsoventral (DV) view in
spaces. Evaluation of the “fullness” of the
herps over the ventrodorsal view commonly
gastrointestinal system is possible, but
taken in mammals.
detail of the gastrointestinal structures are
lost in these views. Animals in good flesh
will have filled intestinal loops. In anorectic
CHELONIANS or cachectic patients, the air space seems
The DV view in turtles and tortoises is useful uncharacteristically large.
in evaluating osseous integrity, overall Extremity views (including the head and
conformation, gastrointestinal disorders, neck) of chelonians are usually overexposed
and urinary tract (specifically, bladder) when using techniques for evaluating the
abnormalities. It is of little use in evaluating shell or internal structures. Additionally,
the respiratory system. many of these animals are so confined
To properly evaluate the lung fields and air within their shells, the scutes from either
sacs, horizontal beam radiographs must be the carapace or the plastron obscure the
taken. Some references advocate using a limbs from view. It is necessary to extend
vertical beam and just spatially positioning these body parts for proper measurements
the animals as is performed with mammals. and exposures. Light gauze tied to the
However, in the experience of this author extremity can be used to extend the body
better visualization of the pulmonary part for a brief time to allow exposure.
spaces can be obtained with the use of Gentle traction is more effective than brute
horizontal beams. Cardboard boxes, lucite force.
pedestals, and foot stools all work well to However, in some chelonians, it is not even
place the animal in a position for a possible to gain access to the limbs. In these
horizontal beam. patients, it may be necessary to use
Unfortunately, with some of the newer sedation to get the appropriate views.
digital radiographic units, it is not possible
to capture horizontal beams because the
imaging plates are in a fixed position. In SNAKES
these cases, patient positioning becomes
Snake radiology is technically much easier
paramount.
than in chelonians. The DV and lateral views
Measurements for establishing are necessary for proper assessment. Avoid
radiographic techniques in turtles and the pitfall of coiling the snake in the bottom
tortoises can be a challenge. Technique of a plastic bucket and making a quick
charts vary with the machine used, but, in exposure of a coiled patient. The DV can be
general, settings that are adequate for skull obtained much the same as with a tortoise.
settings for dogs provide proper Place the patient in a radiolucent, rigid
penetration of the osseous shell in restraint tube (these come in various sizes
chelonians. The shell should be measured at for various size snakes). The inside diameter
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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of the tube should approximate the animals must be covered with lucite boxes
circumference of the patient. This will to prevent them from darting off the
prevent the snake from turning back on radiology table. Sedation and
itself within the tube, or “kinking” during tranquilization may be warranted if proper
the radiograph. When the snake is safely positioning cannot be accomplished by
restrained within the tube, it can then be standard techniques.The body
positioned for DV, lateral, and oblique conformation of many of the large body
radiographs. This technique is invaluable lizards allow for basic DV and lateral views.
when working with venomous or dangerous However, some of the lizards, such as the
animals. monitors, are dorsoventrally flattened, thus
making consistent lateral radiography
Radiographs of small snakes in a straight
difficult. Even with this technical difficulty, a
line (as when they are placed in a restraint
lateral view should always be a part of a
tube) can often be performed on a single
radiographic survey.
plate. DV views of an entire animal can be
accomplished by allowing the patient to curl
up in the bottom of a box or bucket,
CONTRAST STUDIES
providing that the animal doesn’t overlap
on itself. Contrast studies are often indicated in the
same way as in small animal medicine.
Larger patients need to be radiographed
Thirty percent weight to volume barium
sequentially. This is especially important
sulfate suspension is the most commonly
with animals many feet in length, because
used contrast medium for gastrointestinal
many sequential body sections are nearly
tract studies. Approximately 25 ml/kg given
identical. Each film should be marked with a
by gavage tube into the crop is the
sequencing number on each side of the
suggested guideline. Radiographs are taken
plate (eg. 1–2, 2–3, 3–4, etc.) A small piece
when contrast is given and 30 minutes, 1, 2,
of labeling tape, placed directly on the
4, and 24 hours later. In some of the larger
patients scales, works well for this. A small
tortoises, gastrointestinal transit time may
area of overlap should be included on each
be as long as 1 week, so daily exposures may
film. If possible, the lateral views should be
be indicated. Double contrast studies, use
included in the same orientation and
of organic iodine mediums in GI studies,
position on the same plate next to the DV
intravenous excretory studies, and
views.
urography have been also described.

LIZARDS
SUMMARY
Radiology in lizards presents the greatest
A working knowledge of reptilian anatomy
challenge to the reptilian practitioner. Not
is essential for proper evaluation of
only can these animals be very skittish,
radiographs. Fortunately, reptilian anatomy
many of them have such diverse body
is fairly basic compared to mammalian
shapes that normal positioning is nearly
anatomy. Written descriptions of pathology
impossible.
are no substitute for actually visualizing
Many of the tricks for restraint mentioned radiographs of normal and clinical
for tortoises and snakes can be employed conditions. Once a basic level of
for lizards. Patience and gentle handling will competency and confidence has been
allow positioning for most DV views. Some attained when performing radiology in
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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these animals has been attained, the

practitioner can then utilize the various
RECOMMENDED READING
special techniques commonly employed in
1. McArthur S, Wilkinson R, Meyer J,
mammalian radiology to enhance
eds. Medicine and Surgery of Tortoises and
visualization of the various organ systems.
Turtles. Ames, IA: Blackwell; 2004.
Gastrointestinal barium contrast studies,
venography, bronchography, etc can all be
performed just as is done in dogs and cats.
2. Rübel GA. Atlas of Diagnostic
Radiography can greatly augment the Radiology of Exotic Pets. Small Mammals,
reptilian practitioner’s diagnostic Birds, Reptiles and Amphibians. Prescott,
capabilities. As with anything in non- AZ: Wolfe; 1991.
domestic pet medicine, it is just a function
of taking our knowledge of domestic animal
internal medicine and adapting it to the 3. Silverman S. Diagnostic imaging. In:
peculiarities in the species of our special Mader DR, ed. Reptile Medicine and
interests. Surgery. 2nd ed. St. Louis, MO: Elsevier;
2006:471–489.

Table 1. Recommended radiographic exposures for reptiles.

Dorsoventral* Craniocaudal Lateral
Chelonians
Respiratory tract  
Digestive tract 
Genitourinary systems 
Carapace and plastron   
Skeleton 
Snakes
Respiratory tract 
Digestive tract  
Genitourinary systems  
Skeleton  
Lizards
Respiratory tract 
Digestive tract  
Genitourinary systems  
Spine  
Extremities 
*Vertical radiograph beam.
Horizontal radiograph beam.

Reproduced with permission: Mader DR. Reptile Medicine and Surgery. St. Louis, MO:
Elsevier; 2006.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Table 2. Species of monitors (Varanus species) in which mineralized hemibacula are present
within hemipenes.

Mineralization present Mineralization absent

V acanthurus (spiny-tailed) V bengalensis (Bengal)
V beccarii (black tree) V dumereli (Dumeril’s)
V cVaudolineatus (stripe-tailed) V exanthematicus (savannah)
V eremias (desert pygmy) V griseus (desert)
V giganteus (Perenty) V mertensi (Merten’s water)
V gilleni (Gillen’s pygmy) V niloticus (Nile)
V gouldii (Gould’s) V rudicollis (roughneck)
V indicus (mangrove) V salvator (water)
V karlschmidti (peach-throat) V timorensis (Timor)
V komodensis (Komodo)
V olivaceus (Gray’s)
V panoptes (Argus)
V prasinus (green tree)
V salvadori (crocodile)
V storri (Storr’s)
V tristis (freckled)
V varius (lace)

Structures are easily visualized on radiographs and can be used for sex determination.
Reproduced with permission: Mader DR. Reptile Medicine and Surgery. St. Louis, MO: Elsevier;
2006.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Why won’t my Reptile Eat ?

OBJECTIVES –

1 – Understand the feeding response in reptiles

2 – Learn the most common causes of anorexia
3 – Discuss treatment options

There is no question that the most common hunger and satiety centers are located in
health problems associated with captive the brain.
reptiles are diet related. These can be from Stimulation of the lateral hypothalamus
nutritional deficiencies, such as is so initiates the feeling of hunger. Activation of
commonly seen in the Green Iguana, the ventromedial hypothalamus results in
excessive calorie consumption, as in satiety. Several neuroendocrine and
overweight animals, or the most common metabolic factors affect these feeding
problem, anorexia, or a lack of appetite. control centers. Of clinical importance, the
There are numerous causes for a senses of taste and smell play major roles in
reptile to lose its appetite. These the triggering of these responses.
underlying causes must be identified and There are several factors that play a role in
corrected before the problem will be anorexia. The major task of the small
resolved. mammal clinician when faced with an
When an animal is "off-food" there anorectic reptile is to determine whether
has to be a reason for it. It may be the condition is caused by pathologic,
psychological, or it may be medical. physiologic or psychologic embarrassment.
Although this may seem elementary to most There are many diseases that can disrupt
readers, it bears mentioning. It is essential the normal neurologic, endocrine or
that the veterinarian understands the mechanical processes involved in the
natural history and biology of the particular feeding response. A pure division into
type of reptile that they are treating. If they categories is not possible, as many diseases
do not know, they must have a ready have components that overlap. In some
reference source. If one is not available, situations, the cause is obvious (such as
then, ethically, they should refer it to gross malocclusion in turtles), and in others,
someone that has the proper training. elusive (cancer cachexia).
In order to more easily arrive at a Categorizing signs and laboratory data may
proper diagnosis, a brief discussion of the help in assessing the problem. In general,
normal feeding response is in order. anorexia may be classified as either primary
An animal normally eats to satiety. The or secondary with respect to disease. In
cessation of the feeding response prior to addition, there is a third, more category,
the satisfaction of caloric needs is termed called pseudoanorexia, which is not directly
anorexia. Clinically, this is referred to as an related to suppression of the feeding
"absence of hunger." centers in the brain.
The body is naturally, continuously in a state Primary anorexia should be considered in
of hunger. Eating is the process that any case where the inciting factor directly
satisfies or controls that hunger state. The involves the feeding centers of the
hypothalamus, or from psychological
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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disorders that have a direct impact of neural anorexia. Two common psychological
control of the feeding response. influences include the alteration of social
Any cranial injury or insult, such as trauma, structure within the animal's environment
cerebral hemorrhage, cerebral edema or (addition of a new animal to an established
hydrocephalus (acquired or congenital) may group) and the offering of a new food type.
cause anorexia. In humans, severe Secondary anorexia includes diseases or
headaches, such as migraines, may be influences from outside the brain and have
directly responsible for appetite a direct effect on the neuroendocrine
suppression. Diseases or pathology within control of hunger. Some conditions or
the cranial vault, such as diseases may produce signs associated with
encephalitis/meningitis or neoplasia, can anorexia such as nausea and vomiting
have a direct or indirect effect on the (although the latter is not seen in reptiles).
hypothalamus. It is believed that the stimuli associated with
Any such condition, whether primary to the these conditions are similar and the
hypothalamus or merely affecting the controlling centers within the brain are
hypothalamus, may also have other most likely neuronally interconnected.
neurological manifestations in addition to Abdominal pain is a common cause of
anorexia. Thus, a thorough neurological anorexia in reptiles. Constipation may
examination, as part of a complete physical contribute.
evaluation of the patient, is imperative. Inflammatory conditions, such as
Psychological disorders are more easily coelomitis, hepatic, renal, pancreatic or
characterized in people, as our veterinary visceral inflammation can all lead to
patients are less likely to articulate their anorexia by directly or indirectly stimulating
emotional state. As a result, at the risk of the appetite centers.
anthropomorphizing, it is often necessary to Exogenously or endogenously produced
attempt to interpret what the anorectic toxins can affect the appetite by either
patient may be "feeling" in a given situation. directly affecting the feeding centers, or
For instance, although an owner may enjoy indirectly by affecting other areas of the
taking their pet reptile to the movies, the body, such as the abdominal organs. Drugs
reptile may respond differently to the and toxins can also affect the
darkened, air conditioned interior of the chemoreceptor trigger zone which
theater, the bright flashing lights of the produces nausea and anorexia, or can act
projector, the laud responses of the directly on the hypothalamus.
audience and the artificially buttered Endogenously produced toxins, such as
popcorn. azotemia or hyperammonemia, as seen in
Anorexia nervosa, a disease common to renal or hepatic failure, respectively, have
young human females, has not been serious consequences on appetite.
documented in animals. "Maladaptation Hypercalcemia, by yet an unidentified
Syndrome," a condition common to factor, also leads to anorexia.
recently captive animals, may have some Neoplasia and cachexia are frequently
psychological or physiological similarities, associated together. However, oftentimes,
but, this is not a likely problem in the the cachectic patient still has an appetite.
captive reptile. Cancer patients may not always desire food,
Any external influence that incites stress or as the peptides and nucleotides associated
anxiety (identified as fear or depression in with certain neoplastic diseases are known
people), such as changes in the to cause anorexia. Neoplasia should be on
environment (temperature, caging, air the differential list for anorectic patients.
exchanges, noise etc.) can result in
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Miscellaneous causes of anorexia should Radiographs, laboratory analysis (including

include any systemic illness. Cardiac, complete blood counts, serum chemistry
pulmonary or pancreatic disease (eg. analysis and urinalysis) should be a part of
diabetes - although not well documented in every minimum data base.
reptiles) can be contributing factors. Anorexia and food deprivation has serious
Lastly, pseudoanorexia, which is a physical consequences on a patient, especially to
inability to eat, rather than the lack of desire those that are convalescing.
to eat, must always be considered with the Tissues such as the brain, the red blood
clinically anorectic patient. Dental disease, cells, renal medullary cells and neural tissue
or malocclusion as seen in many turtles, is a has an obligate glucose requirement. To
frequent contributing factor in reptiles. maintain blood glucose, body protein is
A thorough physical examination is rapidly affected. The ramifications of food
warranted for every case, including cases deprivation are far beyond the scope of this
with apparent obvious explanations for the discussion, but it is obvious that it will have
anorexia. In addition, a proper cranial nerve serious consequences.
examination must be conducted. An open Anorectic reptiles need to be supported
mouth oral examination (using sedation as with appropriate diets. Appropriate gruels
needed) must be performed. can be administered via syringe feeding,
Equally important as a the physical findings and when necessary, nasogastric tubes.
is the collection of a thorough history. Attention must be given to the animal's fluid
Discern if there have been any changes to balance and other medical needs, such as
the animal's environment, including caging, the administration of antimicrobials and
food, conspecifics, ambient temperatures analgesics, as required.
etc.
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Índice
DON J. HARRIS
Don J. Harris, DVM
Avian & Exotic Animal Medical Center
Miami, FL

1.9.1. Avian Pediatrics ......................................................................................................... 197

1.9.2. Avian Restraint and Physical Exam ............................................................................ 200
1.9.3. Clinical Appearance of Avian Viral Disease ............................................................... 202
1.9.4. Therapeutic Avian Techniques .................................................................................. 209
1.9.5. Avian Diagnostic Testing ........................................................................................... 216
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Avian Pediatrics

INTRODUCTION: Veterinary continuing education is filled with discussions surrounding an

infinite variety of illnesses and appropriate medical approaches for such. Less time appears to
be spent on basic husbandry and veterinary participation in the care of “normal” animals.
Increasing numbers of exotic pets presented to veterinarians have illustrated the tremendous
need for information regarding the basic husbandry of exotic animals being kept as pets.

Pet birds probably comprise the largest group of exotic pets. Years ago most parrots, macaws,
cockatoos, etc. were imported as adults or juveniles. With these birds came problems associated
with the stress and crowding experienced by the birds during quarantine. Now that importation
no longer exists most birds supplied to the pet trade are bred within the U.S. and sold at the
consumer level as babies. A large proportion of individuals acquiring these babies is grossly
under-educated and inexperienced in caring for them. To add to the complexity, little
information has been disseminated to owners or to veterinarians on proper handfeeding and
weaning practices.

BASIC HUSBANDRY resultant aspiration pneumonia or

asphyxiation.
The vast majority of avian pediatric cases
presented at Avian & Exotic Animal Medical Thirty years of personal experience has
Center are the result of incorrect feeding resulted in a feeding and weaning protocol
practices. Many novice owners are told which drastically reduces the number of
“the crop should be filled each time it feeding related problems. The maximum
empties until the baby becomes self- volume of formula that should be fed to any
sufficient”. Problems arise from the lack of baby prior to actual weaning should
a definition for “full crop” and a failure to approximate 10% of his body weight. The
recognize what constitutes reasonably feeding interval (the length of time between
“empty”. Sometimes owners are simply feedings) is determined by the amount of
directed to feed a certain volume a certain time that it takes the crop to empty. An
number of times each day. Novice owners empty crop is defined as one in which little
will force babies to eat specified volumes at or no food can be palpated in the crop,
regular intervals regardless of the signals although the crop may remain slightly
displayed. The weaning process pendulous. Once a day (preferably at night)
exacerbates this scenario because weaning the crop is allowed to remain empty for an
age babies have completed their log phase additional 33-50% of the calculated interval,
of growth and require substantially less providing one longer period for complete
nutrition than a younger bird. If babies are emptying. For example, if the crop empties
over-fed at this age they may not become every 4 hours, the feeding interval would be
hungry enough to desire other food. In 4-5 hours from 6 A.M. until midnight, with
some cases a baby will attempt to resist a at least a six-hour period of time for
feeding only to have the formula forced extended crop emptying. This allows
upon him. A struggle such as this often ends residual food (with increased numbers of
in tracheal aspiration of the formula with bacteria) to be eliminated (and provides the
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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feeder with often-needed rest.) As the baby are actually experiencing illness unrelated
grows, the absolute (not relative!) volume to the crop. Lower gastrointestinal
will increase while the frequency decreases. disturbances, chlamydiosis, bacterial
Recent experience suggests that in some septicemia, or metabolic diseases such as
species it may be better to maintain hepatic lipidosis are all examples of
frequency and decrease volume as babies conditions that may present with crop
grow. Most importantly, never should the slowing or stasis as a part of the clinical
volume per feeding exceed 10% of the picture.
baby’s weight. As the baby matures a time
will come where a feeding will be resisted.
The baby may initially be responsive, but it FIRST AID
will then resist and retreat. At that point, all
feedings are permanently reduced in The presentation of a sick psittacine baby is
volume to the quantity consumed eagerly. often featured by the presence of a large
When feedings are being administered pendulous crop full of spoiled hand-feeding
three times a day, and the quantity is being formula. The term “sour crop” is descriptive
reduced, solid food in the form of softened of the condition of the crop contents at
pellets or table food is introduced. Solid presentation but rarely is it a disease in
food will usually be consumed over the next itself. Food that has stagnated in the crop
2-3 weeks allowing cessation hand feeding. spoils similarly to food which has remained
sitting unrefrigerated in a warm
environment for several hours. The
bacterial density of this formula becomes
Failure of a baby to thrive with the above
excessive while bacterial toxins accumulate.
protocol often suggests illness. When a
Regardless of the reason for the stagnation
baby refuses food, it is critical to note the
the spoiled food becomes a significant
manner in which it resists. It is perfectly
source of pathogens and the toxins
normal for a juvenile to act eager to eat
produced by them. In order to stabilize the
then refuse food. He may accept some
patient this material must be removed.
formula then spit it out and refuse any
more. He may even run when approached.
He simply has reached a plateau of growth
where his nutritional demands are In most patients the spoiled formula can be
drastically reduced. This must be removed through a feeding tube passed
contrasted with the baby who is depressed, orally. Depending on the particle size of the
inactive, and shows no interest in food. formula, either a standard red rubber or a
Crop stasis is often accompanies illness in ball-tipped metal feeding tube can be
babies and may be the first indicator of a introduced into the crop. The crop contents
real problem. A depressed baby bird can than be aspirated by direct suction. It is
demonstrating crop stasis is a medical sometimes necessary prior to aspiration to
emergency. thin the spoiled material by introducing
warm water or electrolyte solutions into the
Crop stasis is one of the most common crop. The contents can then be mixed by
legitimate reasons for the presentation of palpation and aspirated. It is important to
juvenile psittacines to a veterinary practice. palpate the tube in the crop during
While “sour crop” is the term most often aspiration to prevent the crop wall from
used to describe the condition, rarely is the being suctioned against the end of the
crop the problematic organ. The vast feeding tube. Once the crop has been
majority of babies presented for “sour crop” reasonably emptied it should be lavaged by
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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repeatedly filling it with a warm balanced Those that are ill are even less able to
electrolyte solution, massaging the crop and thermoregulate. Care should be taken to
mixing its contents, and aspirating the fluid provide hospitalized pediatric patients with
until clear. adequate environmental heat. High
humidity should be maintained to avoid
The vast majority of babies presented for
contributing to dehydration.
crop stasis will be moderately to severely
dehydrated. The lack of fluid intake from
the static crop combined with the
Pharmaceuticals other than broad-
continued high fluid losses that accompany
spectrum antibiotics are not usually
much pediatric illness results in fluid deficits
indicated in the initial care of pediatric
that can be life threatening. Once the crop
illnesses. Regardless of the primary
contents have been removed it is necessary
etiology, the bacterial overgrowth in the
to tend to the fluid needs of the patient.
crop and the remainder of the
Handling a baby with a full crop to
gastrointestinal system (GI) must be
administer I.V. or I.O. fluids can easily
addressed. While antifungals may
precipitate regurgitation with subsequent
ultimately be useful, antibacterials are far
tracheal aspiration. Subcutaneous fluids
more urgently needed in acute pediatric
may be beneficial prior to crop washing, but
illness. Occasionally antifungals may prove
once the crop is empty I.V. or I.O. fluids are
to be more appropriate, but rarely is fungal
preferred.
pediatric disease acutely fatal, whereas
Psittacine babies that have not fully bacterial illnesses are often rapidly fatal if
feathered often require environmental not quickly addressed.
temperatures of 29-32C (85-90F).
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Avian Restraint and Physical Exam

During the initial encounter between Capture of the patient may be effected
veterinarian and patient, a number of very through a few basic techniques. Rarely does
important dynamics occur. The patient is a pet bird surrender willingly to the
approached; eventually it is captured and entrapment of the handler. Almost always,
consequently restrained. Ultimately, the some form of mechanical assistance, in the
patient is examined by the veterinarian so form of a towel, net, etc. must be utilized.
its condition may be assessed. Various
diagnostic and therapeutic procedures may
be rendered in the process. While the The most obvious means of handling large
veterinarian is usually focusing on the psittacines (capable of biting off a digit of
physical exam, it is the handling of the the handler) is a pair of thick gloves, such as
patient by the doctor that the client is most welder’s gloves. This is also probably the
aware of. single worst method of handling a pet
psittacine. The gloves can be traumatic,
they prevent the handler from adequately
For the veterinarian, the physical exam is monitoring the patient’s movements and
one of the most important aspects of his resistance, and they teach the bird to be
initial visit with a patient. This is when the afraid of hands. There really is no place for
veterinarian develops a first impression of gloves in pet bird medicine. Gloves are a
the patient’s condition, and much depends standard part of falconry, but never are they
on his or her ability to detect even the used to restrain a raptor. Instead, they are
subtlest of details. This first encounter used to protect the falconer’s hand as it
between veterinarian and patient is functions as a perch for the bird.
extremely important for the client as well,
but for very different reasons. This is where
the client develops a first impression of the A net is occasionally useful in an avian
veterinarian. Everything the veterinarian practice. There comes a time when a
does with the patient suggests to the client flighted bird is able to evade capture by
how thorough, perceptive, knowledgeable, even the most skilled handler. High ceilings
etc. the veterinarian is. For this reason the or large rooms allow an escapee to stay just
veterinarian is judged not only by how well beyond reach of those in pursuit. A
he relates information, but also for how well long-handled fine-mesh net allows the
he relates to the animal. Nothing can extension of reach necessary to corner the
destroy the confidence an owner has in a bird. A short-handled net also may be
veterinarian faster than incompetent useful to corner and trap an especially quick
handling of the patient during an exam. escapee. The fine mesh is essential to
Therefore, before the physical exam may prevent tangling of the bird’s legs, wings, or
ensue, the patient must be captured and head.
restrained with minimal distress to both the
patient and the owner.
The single most useful tool in a bird capture
arsenal is a towel. A regular terrycloth
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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towel can be tossed lightly over an Once the patient is restrained the physical
unsuspecting patient temporarily exam should be completed as quickly and
disorienting him and allowing his capture. atraumatically as possible. All details of all
As the towel is quickly but smoothly draped visible aspects of the patient should be
over the bird the handler takes hold of the noted. The best way to ensure
patient’s neck from behind. The handler’s completeness in a physical exam is to adopt
hand encircles the neck somewhat a step-by-step routine in which the
stretching apart the head and shoulders. assessment of every feature of the exam is
The bird’s neck is held by one hand while its planned. When a checklist-type approach is
torso and legs are encircled through the used, oversight is less likely to occur.
towel by the other hand. The wings are
usually naturally kept at the bird’s side by
the weight of the towel. Once the bird is The best approach is one in which a logical
under control the legs are held from the progression is followed through the patient.
anterior aspect while the head and neck It may be best to begin with general
continues to be held from the posterior observations such as respiratory rate and
aspect, and the bird is stretched as much as character, cardiac auscultation, etc. in order
possible without it being injured. A snugly to ensure that the patient is in no danger
restrained bird resists much less than one from the exam itself. Once vital signs are
held timidly. noted the exam may proceed in whatever
sequence the examiner chooses, provided
A small bird or a cooperative large bird may
the sequence is complete and logical.
be captured with bare hands. Always, the
Randomly examining the oral cavity, then
bird should first be captured from the rear
the legs, then the ears, etc. will inevitably
and behind the neck. When the handler’s
cause omissions of anything from small
hand acts as a wide snug collar around the
details to large body parts. Regardless of
bird’s neck, it is practically impossible for
the presenting clinical signs, omissions
the bird to bite the hand that holds him.
should not be allowed. More than one bird
Even the bird’s feet will have difficulty
has been presented for a nasal discharge
reaching up to the restraining hand when
only to have a cloacal problem discovered.
the bird is properly held.
Once the exam is complete and the bird is
An aid to the capture of quick patients is released, his response to handling should be
darkness. Turning off the lights in a closed noted. Often, poor stress tolerance will be
exam room may temporarily freeze the a major indicator that illness exists.
bird's attempts to escape. The handler can
The physical exam should always take into
position himself near the patient, an
account physical features of the bird’s
assistant can turn off the lights when
visible environment. The bird’s droppings,
prompted, and the bird can be captured in
feathers lost in the cage, spots of blood on
darkness. This can be quite effective
the floor, etc. all may reveal important
whether a net, towel, or bare hands are
information about the patient. Every detail
employed.
is a significant detail, even if only to
document normalcy.
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Clinical Appearance of Avian Viral Disease

INTRODUCTION: Viral disease in avian species is much more significant than once believed. In
the early days of avian medicine, bacteria were cited as the primary causes of avian illness. It
was eventually recognized that bacterial disease in birds is often secondary to malnutrition,
stress, or other predisposing factors. In recent years, it has become obvious that viruses are
extremely prevalent and significantly pathogenic in certain avian populations.

A practitioner is constantly faced with the challenge of trying to determine the etiology of a
clinical presentation. While almost no illness can be diagnosed based on clinical signs, certain
diseases provide visual cues that should lead a practitioner to suspect a viral etiology. Never
should the possibility of a viral etiology be dismissed; too much is at stake in a facility where
others could be exposed to potentially fatal disease. Advance warning of the presence of a
certain viral disease however allow action to be taken which more directly and efficiently allows
an illness to be characterized and appropriately treated.

PAPOVAVIRUSES: POLYOMA infection, the virus may circulate through

the flock causing the flock itself to act as a
carrier.
Polyomavirus is currently one of the most
threatening of all avian pediatric diseases.
It appears in two primary forms based on In all other psittacines Polyomavirus
affected species: Budgerigar Fledgling generally produces either rapid terminal
Disease and non-budgerigar Psittacine illness or transient inapparent infection.
polyoma infections. Both presentations Again, the age at which the bird is infected
affect neonates most severely and are determines how it is affected. The younger
characterized by peracute to acute death in the host, the more serious and rapid the
pre-weaning babies. Prominent feather disease.
signs and carrier states that commonly
occur in budgies are rare in other
psittacines. In non-budgerigar psittacines less than 16
weeks of age the infection is usually fatal.
Budgerigar Fledgling Disease may appear as
Birds 3 to 6 weeks old may die without
sudden death or death following a brief
clinical signs. Those 5 to 16 weeks old often
illness with depression, cutaneous
display sudden widespread ecchymosis
hemorrhage, feather abnormalities, and
visible in random patterns throughout
abdominal distention. If babies are infected
subcutaneous regions. Most often the
later than a few weeks of age, they may
hemorrhage is seen along the ventral aspect
exhibit feather dystrophy. “French Molt” is
of the neck where normal feeding reflexes
a mild to fatal condition of budgies in which
cause rupture of the fragile vasculature.
the majority of flight and contour feathers
Bleeding may be observed in the absence of
are markedly dystrophic. Polyomavirus is
other clinical signs although some degree of
one cause of this condition. While
depression, anorexia, crop slowing,
individual birds may clear themselves of the
regurgitation, etc. usually occurs. The vast
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

majority of babies that die of polyoma do so areas explains the hemorrhage and
at fledging, the period when flight feathers transudation.
have matured and contours are emerging.

Treatment of affected patients is purely

Young birds between the ages of 16 and 21 supportive. Survival once hemorrhage is
weeks of age demonstrate variable visible is unknown. Prevention depends on
response to polyoma infection. Anything minimizing exposure and vaccination.
from subtle feather dystrophy to fatalities Babies older than 3 weeks of age may be
with characteristic signs may be observed. vaccinated every two weeks until they are 9
The maturity and condition of the immune weeks old. Protection is significant after 7
system probably determines the severity. weeks of age. Those vaccinated after that
Birds which are malnourished or weakened period require one initial vaccination and
by other ailments are more likely to fall one booster at 2 weeks. Vaccination of
victim to the serious effects of the virus. adult birds is controversial but undoubtedly
Once birds exceed five months of age most would help prevent circulation of the virus
will experience a brief viremia with or through a susceptible flock.
without obvious signs and fully recover
from the infection. In fact, evidence
indicates that there are far more subclinical PAPOVAVIRUSES: PAPILLOMA
adult infections than fatal neonatal ones.
Unlike budgies, the carrier state in other
psittacines is undetermined. No doubt, Papillomaviruses have been identified in
non-budgie psittacines can transmit the many mammalian species as causes of
virus, but it is unclear whether these are isolated epidermal masses. The common
transient versus latent infections. wart in humans is a typical example of the
well defined pedunculated growth that
occurs. These growths appear as small
Antemortem diagnosis of polyoma infection fleshy pedunculated masses originating
involves DNA probes of cloacal/choanal primarily from featherless areas such as the
swabs or whole blood. feet of face. Their clinical significance
depends on mechanical effects.

Necropsy of deceased babies usually reveals

random areas of profound hemorrhage, PAPILLOMATOSIS
usually in the subcutaneous spaces.
Musculature and internal organs may be
extremely pale due to exsanguination. The most common association of
Other findings include hepatomegaly, papillomavirus with disease in pet birds
pericardial effusion, splenomegaly, and involves “papillomatosis”, granulamatous
ascites. Diagnosis is confirmed through a masses that develop in the cloaca, choana,
DNA probe of affected tissues. oropharynx and to a lessor degree other
Histopathology may reveal hepatic necrosis areas of the gastrointestinal tract. Fact is,
with karyomegaly and intranuclear papillomavirus has never been identified in
inclusion bodies in the liver and spleen. The these lesions. In fact, no virus or any other
bursa of Fabricius may be depleted of infectious agent has ever been identified as
lymphocytes. Vascular necrosis in many the cause of this syndrome. Although some
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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evidence supports an infectious etiology, For many years the cause of Psittacine Beak
other situations produce conflicting and Feather Disease (PBFD) was unknown.
evidence. For example, the introduction of The suspected etiologies included
an affected bird in certain populations has autoimmune disease, endocrine disorders,
resulted in increased prevalence of the infectious agents, etc. Ultimately a virus
disease in that population, while in other was discovered representing the smallest
situations the mates of affected birds have class of viruses known to infect animals.
remained unaffected. These viruses are currently classified as
Circoviridae.

The clinical significance of papillomatosis

depends in part on the location of the The primary site of viral replication in the
lesion. Large granulomas in the cloaca may avian host is epithelial cells. As with
reduce breeding potential although in one polyoma, the severity of disease depends
aviary the highest production came from on the species of bird involved and the age
the isolated papilloma colony. Secondary at which he is infected. Birds more than a
bacterial infections are common in few months old do not develop clinical
protruding inflamed tissue. Aside from the disease but rather experience a transient
mechanical effects, papillomatosis has been viremia, then clear the infection. In some
suspected to be related to the development species, especially juvenile African Gray
of bile duct carcinomas. Also, some Parrots, the virus may cause fatal peracute
association has been suggested with the disease attacking primarily the thymus and
Herpes virus of Pacheco’s Parrot Disease. cloacal bursa with no epithelial component.
Typically however the epithelium of
growing feathers and to a lessor degree the
In recent years, evidence strongly suggests epithelium of the feather follicle, beak, and
that the etiologic agent may be a Herpes nails is affected. Clinical signs are entirely
virus. Birds exhibiting papillomatosis have related to the age of exposure and the
demonstrated antibodies to parrot Herpes. extent of epithelial damage. The hallmark
Also, many birds suffering from cloacal of PBFD is the occurrence of deformed,
papillomatosis have eventually developed stunted feathers many of which are
bile duct carcinoma, a condition thought to strangulated at the base and fall out
be related to Herpes virus infection. prematurely. The percent of plumage
affected depends on what stage of molt the
bird is in at the time of infection. Baby birds
Because the agent has not been confirmed, producing their first growth of plumage may
means of control are not clearly established. show no normal feathering while an older
Isolation and hygiene are probably bird already beyond the juvenile molt may
effective. Flock closure has not prevented demonstrate scattered feather dystrophy.
the disease from occurring. Pronounced Evidence indicates that birds of any age
lesions may be excised but recurrence is showing clinical signs were in fact infected a
likely. very young age. Incubation is minimally 4
weeks but may be as long as months to
years. Onset of clinical signs correlates to
PSITTACINE CIRCOVIRUS the onset of significant molting.
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A variation of PBFD is the peracute illness POXVIRUSES

seen frequently in African Gray Parrots,
among others. It is characterized by sudden
depression and anorexia with death Poxviruses are the largest and most diverse
occurring within one to five days after group of viruses known to infect avian
onset. These birds demonstrate profound species. Unlike some of the other viruses,
anemia with variable leukopenia. Although poxviruses are highly host specific and
birds have been known to survive this form severity of infection is highly dependent on
of the disease, it is usually fatal. One the species of both host and virus involved.
survivor confirmed by DNA probe
demonstrated a PCV of 4 at the peak of
illness. Pox infections occur in three forms which
are represented by particular species in the
pet bird population. The cutaneous form
Diagnosis of PBFD is accomplished with a consists of discreet 2-4mm crusts that
DNA probe of blood or epithelium. appear on the eyelids and feet and is
Histopathology of developing feather shafts frequently seen in lovebirds. The
or follicles demonstrates both intranuclear diphtheritic form is characterized by
and intracellular inclusion bodies. It is ulceration and the formation of
imperative that diagnosis be confirmed; pseudomembranes in the oral cavity and
birds have been euthanized which upper airways, a common finding in
ultimately proved to have disease not Amazon Parrots especially when
related to psittacine circovirus. Also, importation was practiced. Canaries
asymptomatic adults testing positive to the commonly suffer from the worst form, a
DNA probe but showing no clinical signs fatal septicemia.
may mount an effective immune response
to the virus and entirely clear the infection.
Euthanasia of these patients is not Transmission of avian poxviruses is highly
warranted, but strict quarantine is. dependent on precipitating factors. The
virus can be destructive once introduced
into the host but it is unable to penetrate
Control of PBFD centers around eliminating intact epithelium. In order for the virus to
clinically affected individuals which are the gain entry there must occur a break in the
sources of infection for susceptible epithelium such as a wound or insect bite.
individuals. A vaccine does not currently As such, mosquitoes pose a serious threat in
exist so preventing spread of the disease is transmitting the disease.
the only means of control. Clinically normal
individuals which test positive should be
isolated until a subsequent test is negative. The severity of illness depends on the
Those testing positive and demonstrating manifestation of disease and the degree of
typical feather signs are unlikely to recover secondary problems. The cutaneous form is
and euthanasia may be warranted. No rarely fatal unless it produces a viremia. The
successful therapy exists and these diphtheritic form may result in fatalities due
individuals shed inconceivably high to oropharyngeal discomfort and inability to
numbers of viral particles posing eat leading to starvation. Viremia produces
tremendous threats to susceptible babies. hepatic necrosis, myocarditis, pneumonia,
air sacculitis and peritonitis.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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yellowing of the urate portion of the

droppings. The sudden appearance of
Diagnosis is accomplished by visualizing the
yellow urates with death occurring in less
pathognomonic “Bollinger” inclusion
than 24 hours should send chills down the
bodies via histopathology. Vaccination is
spine of any aviculturist. The vast majority
available for some species but is not
of outbreaks witnessed by the author have
commonly practiced. Minimizing exposure
begun this way. In contrast to traditional
to mosquitoes and avoiding other causes of
beliefs, most of these outbreaks have lasted
epidermal disruption greatly reduces
3 - 7 days and resulted in no more than 20%
incidence. Treatment is directed at
of the flock being lost. Reports of outbreaks
secondary problems.
support the variability of expression. Flock
losses range from one bird to 100% of the
colony.
HERPESVIRUSES
Transmission of herpesviruses is typically
through close contact. Husbandry and
The viral infection most frightening to many hygiene may have an influence on spread of
aviculturists is “Pacheco’s Parrot Disease”, the disease. Outbreaks may follow the
or avian herpesvirus. Pacheco’s disease has introduction of a carrier into a flock
been known to kill as many as 7000 although most arise somewhat
psittacines in one outbreak. Its ability to spontaneously or after periods of increased
strike quickly and with little or no warning stress. Virulent strains of the virus produce
and its relative disregard for age or species death in 3 - 10 days after introduction. Any
has caused many an aviculturist to awake to bird that survives infection is believed to
large numbers of dead specimens. become a carrier. The virus which infects
psittacines does not affect non-psittacines.
Not all psittacines develop disease when
Herpesviruses are one of the most infected. Some acquire the infection in the
ubiquitous viruses in nature. In most cases absence of clinical signs and become
in the animal kingdom, the viruses exist in a carriers.
latent stage shedding periodically with few
or no clinical signs. In psittacines it is
believed that there are pathogenic and non- Diagnosis is based on clinical features and
pathogenic strains. At the very least, the necropsy samples. Deceased birds display
virus may remain dormant for an extended an enlarged yellowish-brown liver,
period of time surfacing during periods of splenomegaly, and vascular congestion in
stress. Historically, Patagonian and Nanday almost any organ. Histopathology
conures are accused of being the primary demonstrates necrosis, congestion, and
carriers of this disease, but almost any hemorrhage within the liver, spleen, and
psittacine is capable of surviving an kidney. Intranuclear inclusions may be
outbreak and becoming a permanent demonstrated in the above organs as well
carrier. as the pancreas and esophagus. Although
the inclusions are suggestive they are not
pathognomonic for Pacheco’s disease.
Clinical signs of a Pacheco’s outbreak often Confirmation is achieved with electron
don’t exist. When they do they are microscopy, cell culture, Antigen detection,
extremely brief, vague, and consist simply or DNA probe.
of listlessness, depression, anorexia, and
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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that PMV-1 does. PMV-2 and PMV-3 cause

variable illness, if any, in some passerines
Of all the viral diseases, Pacheco’s is the one
and psittacines.
which responds to some degree to antiviral
therapy. Acyclovir has been used effectively
in outbreaks to reduce the duration and
Paramyxovirus type 1 is more easily
severity of the disease in the flock. The
recognized by the familiar name of
greatest benefit is obtained in birds not yet
“Newcastle Disease”. Four classifications of
showing clinical signs. Those already
disease exist based severity of illness. In
showing clinical are not likely to survive
order of increasing severity they are
even with treatment.
lentogenic, mesogenic, velogenic, and
viscerotrophic velogenic. It is the latter
which destroys poultry flocks. Poultry
Prevention depends on vaccination and
display acute diarrhea, respiratory distress,
avoiding exposure, but neither is foolproof.
and neurologic signs with death occurring
There is no way to guarantee that a carrier
within a few hours. Psittacines infections
does not exist within an aviary. Colonies
are usually less severe and appear as
which have been closed for four years have
conjunctivitis, rhinitis, diarrhea, depression,
broken with Pacheco’s. A vaccine is
torticolis, tremors, paralysis, and seizures.
available which affords some protection,
Often the clinical signs may escape
but it is likely that serotypes exist apart from
detection or be inapparent.
that included in the vaccine and therefore
not affected by it. The best means of
preventing large losses from Pacheco’s is to
Transmission occurs via virus laden
practice good avicultural hygiene. Birds in a
secretions which can be passed directly or
collection should always be handled in a
indirectly. The virus survives well outside
manner which minimizes the spread of any
the host making insects, pests, and man
agent from bird to bird.
possible vectors. Incubation period is 3 to
28 days. Birds with inapparent infections or
those recovered from illness may shed virus
PARAMYXOVIRUS
for as long as one year. The virus is zoonotic
and can cause vague illness with
conjunctivitis in man.
In the early 1970’s The USDA imposed
restrictions on the importation of exotic
birds. Paramyxoviruses are a large and very
Gross lesions vary from none to
diverse group of viruses, one of which
cardiomegaly, splenomegaly, hemorrhage,
causes spectacular losses in domestic
pulmonary and tracheal congestion, and
poultry flocks. This virus, paromyxovirus
edema of the respiratory and
type 1 (PMV-1), is not endemic in the United
gastrointestinal systems. Microscopic
States but was known to have been
lesions reflect hemorrhage, edema and
introduced via birds imported for the pet
necrosis of the described systems as well as
trade. Even though legal importation is
the brain. Intranuclear or intracytoplasmic
essentially non-existent, smuggling still
inclusion bodies are rare and found in the
creates the possibility of an epidemic in
brain. Diagnosis is confirmed with virus
domestic poultry populations. Other
isolation, paired serum samples, or electron
paramyxoviruses exist in avian populations
microscopy.
in this country, but none present the threat
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Control of paromyxovirus in poultry is birds may harbor the virus while never
through vaccination, but this vaccine may showing clinical evidence of its presence.
be fatal in psittacines.
Necropsy in gastrointestinal cases may
PMV-2 and especially PMV-3 are the reveal a proventriculus enlarged to the
paramyxoviruses endemic to avicultural capacity of the abdomen and thin-walled
populations in the U.S. PMV-2 causes mild enough for ingesta to be seen through the
to no illness in passerines but more serious proventricular wall. Pathology of deceased
disease in psittacines. Illness is nonspecific individuals demonstrates an accumulation
and includes tracheitis, pneumonia and of lymphocytes and plasma cells in the
enteritis. PMV-3 causes vague illness in gastrointestinal tract, spinal cord, and brain.
psittacines and is common in grass Necropsy of other Borna infections may
parakeets. Diagnosis is as for PMV-1. show no gross lesions at necropsy. Suspect
submissions should include brain and spinal
cord.
AVIAN BORNAVIRUS
Because the epidemiology and
Blue and Gold Macaws were the first pathogenesis of PDD has not been
species reported to suffer from a disease in completely proven, hygiene and careful
which the proventriculus became paralyzed management is the only means of
and dilated resulting in wasting away and prevention. Most birds showing
death of the bird. Thus “Blue and Gold gastrointestinal signs of this disease die.
Wasting Disease” eventually acquired the Rare cases have demonstrated classic signs
names Psittacine Wasting Syndrome, and survived. Treatment has been directed
Proventricular Dilatation Syndrome, at feeding highly digestible, low bulk foods,
Neuropathic Gastric Dilatation, Splanchnic and controlling secondary infections,
Neuropathy, and others. “Proventricular dehydration, etc. NSAIDS such as Celebrex
Dilatation Disease” (PDD) is the term may improve the prognosis of affected
currently employed, the etiology of which is individuals.
avian Bornavirus.

Birds with terminal PDD usually present

CONCLUSION
with three characteristic signs: vomiting,
weight loss, and passage of undigested food The most important characteristic for a
in the droppings. Another form of the serious avian practitioner to posses is open-
disease which often goes undiagnosed is a mindedness. Most of the viral diseases
peripheral weakness manifested by described here were defined only after
decreased leg strength when perching or years of clinical encounters in which the
unsteadiness when ambulating. Weakness etiology remained unidentified. It is likely
may occur with or without proventricular that in the future new viruses will be
involvement. Finally, a large percentage of discovered amidst problems being
experienced today.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Therapeutic Avian Techniques

INTRODUCTION: The practice of avian medicine is highly mechanical. While it may be obvious
to anyone that a bird is dehydrated and in need of intravenous fluids, not everyone will be
prepared to install a catheter and fulfill that need. Administering fluids intravenously to a patient
weighing as little as 15 grams is challenging. Knowing what to do in a given situation is not
enough; being able to accomplish various tasks involving avian patients often determines success
or failure.

GROOMING injury. No one technique is appropriate for

all birds. Clipping more than a few primary
While maintenance of the avian patient’s
flight feathers from an African Gray’s wings
cosmetic features may not always be
may cause it to fall too rapidly resulting in
therapeutic, it can in some cases constitute
injury. Cockatiels may practically require
preventative maintenance. Wing clipping
wing amputation to prevent flight.
may deter escape and prevent injury from
Trimming one wing versus two is a matter of
ceiling fans, windows, and other potential
personal preference, except possibly in
dangers. Overgrown nails may require
cases where asymmetric landing (to avoid
trimming to prevent avulsion from
keel impact) is desired. Birds which
entrapment of the nail in caging or fabric.
traumatize the fleshy wingtips should
Wings probably not have the first primaries
clipped too closely. The one rule which may
As simple as wing clipping appears, it has be consistent in most (not all!) cases is that
been the subject of more controversy than prevention of flight requires clipping of a
any other mechanical technique in avian variable number of primary flight feathers
medicine. Everyone who uses a particular only. Rarely is it necessary to trim
method seems to believe that his or her secondary flight feathers, and never should
technique is the only correct one. In reality, secondaries be trimmed instead of
only one thing must be accomplished: the primaries. Figure 1 illustrates commonly
bird’s wings must be trimmed in a manner employed patterns of wing trimming.
that prevents flight but does not allow
 at about that level where the nail forms a
quarter-circle (figure 2).

Clipping with human clippers is

preferred for smaller species (canaries to
cockatiels) because the human clippers trim
the nail much more cleanly than
conventional cat or dog trimmers. If the
nail’s vasculature is encountered it can be
controlled with chemical cautery such as
ferric subsulfate or silver nitrate. Human
clippers can be useful in larger birds for
removing the sharp tip of the nail, especially
in juveniles.

Figure 2

The cautery tool sometimes used consists of

a fine U-shaped wire attached to a battery
handle (figure 3). The wire becomes red hot
and melts through the nail cauterizing as it
cuts.

Figure 3

Figure 1

Nail trimming is necessary to

minimize direct (i.e. entrapment, tangling)
or indirect (i.e. arthritis, decubitus ulcers)
injury to the bird or to minimize owner
discomfort during handling of the bird. Figure 4
Three methods are routinely employed:
The electric hand grinding tool
clipping with standard human clippers,
(figure 4) is extremely useful in larger birds.
cutting with a cautery tool, and grinding
It quickly cuts, cauterizes, and smoothes
with a handheld grinding tool. The length to
nails as they are trimmed. A conical sanding
which the nail should be trimmed is usually
bit has traditionally been used, but the
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

author prefers a cylindrical bit with a suffice. Use of the concrete perch available
concave end (figure 5). The latter offers the in most retail pet shops has tremendously
advantages of a defined edge for cutting reduced the incidence of this problem.
and a concave end into which the tip of the When the condition is observed in a clinical
nail can be inserted for smoothing. When setting, the excess keratin can be scratched
using either of these bits, bleeding is usually away with a thumbnail or sanded off using
controlled by cauterization from heat the grinding tool with a conical bit.
generated in grinding. If bleeding still
occurs it can be controlled by applying light
pressure with the bit, heavy pressure with Respiratory Support
the grinder’s collet, or simply using chemical
cautery. Oxygen can be extremely beneficial
in the early stages of critical care.
Beak Respiratory emergencies certainly require
oxygen administration, and since many
A normal beak never needs
critically ill patients are acidotic their
trimming. It is a misconception that pet
conditions can improve with oxygen
birds’ beaks require routine trimming. The
supplementation. The method of
length of a bird’s beak is self regulating
administration depends on the primary
through normal occlusion, and the
problem.
thickness is controlled through surface
wear. Two conditions require corrective
action: malocclusion and dorsal
hyperkeratosis.

Malocclusion occurs as lateral

deviation (scissors beak), prognathism, or
brachygnathism. Causes include genetics,
injury, infection, and malnutrition. In some
cases, especially younger birds, shaping the
beak with the grinding tool may
permanently correct the deformity. Care Figure 5
must be taken not to enter vital areas when When possible, it is best to humidify
shaping. More often than not, malocclusion and warm the oxygen prior to delivery to
requires surgical intervention or repeated the patient. This is best accomplished by
trimming at regular intervals. bubbling the gas through warmed isotonic
Dorsal hyperkeratosis is the frequent and or half-strength saline solution. A canister
direct result of a “concrete perch can be devised by using rigid tubing and an
deficiency”. A bird rubs the dorsal surface empty I.V. fluids bottle immersed in warm
of the beak on the perch to remove water (figure 6).
accumulating keratin, which accompanies Chamber
normal beak growth. Many an owner has
commented on the pet bird constantly Any patient that can benefit from
“cleaning” his beak on the perch. Standard oxygen administration can initially be rested
wooden dowels supplied in cages lack the in an enclosed container into which oxygen
abrasiveness necessary to wear down the is delivered. Although commercial
normal keratin buildup. Mineral blocks and chambers are available for this purpose,
lava rocks sold for such purposes do not even a cardboard box will suffice. All that is
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

required is that the oxygen be somewhat tracheal causes of dyspnea but it is

contained so as to increase its atmospheric contraindicated for pulmonary causes.
concentration.

Commercially manufactured
intensive care units offer the advantage of
being able to supply heat and humidity in
addition to oxygen. The unit can be kept in
a “ready” configuration so the oxygen, heat,
and humidity are immediately available in
an emergency. In situations where extreme
hypothermia is part of the presentation,
increased humidity minimizes the risk of
Figure 6
rebound hypovolemia caused by warming
the periphery of the patient before the body The type of tube utilized depends
core. Effective warming humidity can be on the size of the patient and the urgency of
provided by placing the bird on a grid over a the situation. In small birds a 2-3 cm section
pan of moderately hot (not scalding) water of I.V. tubing will suffice. In larger birds a
in the ICU. standard 3.0 mm I.D. cuffed endotracheal
tube can be modified for abdominal
Mask
installation. The tube is trimmed just above
Oxygen can be supplied via a typical the air line thereby preserving the integrity
anesthesia mask. The cone can be placed of the cuff. A 1 X 3 cm strip of Elasticon is
over the heads of large birds while small wrapped around the endotracheal tube 2-3
birds can be placed completely into the mm above the cuff. Inflation of the cuff
cone as though it were a chamber. Care after placement in the bird offers the
should be taken that the patient does not advantage of securing the tube in place and
struggle and aggravate its already fragile more importantly expanding the air sac
condition. thereby improving the patency and
effectiveness of the tube (figure 7).
Air sac cannula
The breathing tube can be installed
Tracheal obstructions from foreign
into the caudal thoracic air sac either
bodies, neoplasia, fungal granulomas, etc.
between the last two ribs or just behind the
initially require the creation of an alternate
last rib, just dorsal to the dorsal edge of the
breathing passage. The existence of the air
pectoral muscle. The patient is secured in
sac system in birds provides a means of
lateral recumbency and the area is
ventilation not possible in mammals.
surgically prepped. The leg is flexed and
Effective respiration can be achieved by
abducted (not pulled cranially or caudally)
intubating the caudal thoracic air sac.
to expose the last rib. A stab incision is
Anesthesia is helpful in birds that made through the skin with the point of a
are capable of resisting restraint. Those #15 scalpel blade. A fine mosquito
which are severely dyspnic may offer little hemostat is used to bluntly dissect through
resistance and the urgency of establishing the intracostal or abdominal muscles
effective respiration may preclude forming a hole barely large enough to insert
anesthesia. It is critical that the patient be the breathing tube. The tube is inserted and
evaluated for the cause of the dyspnea if secured either by suturing or inflating the
possible; air sac cannulation is life saving for cuff, or both. Patency can be tested by
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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holding a microscope slide at the opening to over 100 grams because it can be cut at any
observe for breathing-induced fogging. length at it will still fit snugly on a standard
Once secured, the bird can breathe freely syringe tip. Birds are fed by sliding the tube
through the tube or an air line can be over the tongue toward the right side of the
connected for oxygen administration or bird’s neck (where the esophagus proceeds)
anesthesia. and depositing formula in the crop. An oral
speculum is used when the bird has enough
strength to bite and damage the tube. A
Nutritional Support safe volume of formula for feeding directly
into the crop is roughly 3-5% of the bird’s
Maintenance of nutrient intake is normal body weight. Feeding should always
critically important in avian patients. Due to proceed slowly to avoid overfilling and
their high metabolic rates, negative effects reflux. Force-feeding should never be
of starvation occur quickly. When a bird performed on birds that are recumbent as
fails to eat due to illness or injury, it must be regurgitation may occur leading to
nutritionally supported by force-feeding pulmonary aspiration and its consequences.
directly per os, via a gavage tube, or through
an indwelling alimentary catheter.

Composition of supportive formulas is a Esophagostomy

matter of individual preference.
Certain situations mandate
Commercial products are available that
bypassing the crop and depositing food
provide calories and other nutrients for ill
directly into the proventriculus or beyond.
patients. Pelleted diets can be fine-ground
Babies suffering from crop burns or those
and mixed with water or electrolyte
with refractory crop dysfunction, and birds
solutions. Hand-feeding baby formulas can
with severe beak injuries benefit greatly
also be utilized. When determining a
from an
feeding schedule it is extremely important
indwelling
to consider and meet the patient’s fluid
needs.

Birds that have been domestically

hand raised often accept warmed liquid
foods orally. Even untamed birds will
sometimes voluntarily accept oral feeding.
proventricular feeding tube installed via an
Often however force-feeding is necessary
esophagostomy. A 14 French red rubber
and use of a gavage tube or indwelling
feeding tube is passed down the esophagus
feeding device becomes inevitable.
of an anesthetized bird, manipulated
through the crop and into the thoracic
esophagus,
Tube feeding and
The simplest way to force feed is to employ continued
a ball-tipped metal or rubber tube to to the
deposit liquid food into the crop. Various
commercial sources are available for tubes
of both types specifically designed for this
purpose. The size14 French red rubber
feeding tube is an ideal size for most birds
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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proventriculus until resistance is felt. At cavity. The femur and humerus are not
that time a 1 cm longitudinal incision is used because of their pneumatic properties.
made on the right side of the neck over the
When utilizing the ulna, the most important
feeding tube identified within the
landmark to identify is the dorsal condyle of
esophagus (figure 8). The tube is isolated
the distal ulna (figure 10). The carpus is
and transected beneath the
flexed and the ulna is identified by
Fluid Administration palpation. Once the insertion site is located
a surgical prep of the area is performed.
The needle is directed under the dorsal
ulnar condyle and proximally into the shaft
of the ulna. Once the needle is placed the
stylet is withdrawn and the needle is capped
and secured with tape or stay sutures..

The approach to the tibiatarsus is similar to

that for a normograde pinning of the bone.
The cranial cnemial crest is identified on the
Figure 10
anterior aspect of the proximal tibiatarsus
Parenteral fluid administration is between and just distal to the femoral
one of the most important aspects of avian condyles (figure 11). The area is prepared
critical care. Principles of fluid replacement for sterile technique and the spinal needle
follow those in other fields of veterinary is directed into the tibial plateau just
medicine. Methods of replacement are not posterior to the cnemial crest and distally
so traditional. into the marrow cavity of the tibiatarsus.
The stylet is withdrawn and the hub is then
Subcutaneous taped or sutured in place.
Subcutaneous administration of With either technique fluids should be
fluids is an acceptable but not ideal practice. administered especially slowly to avoid
Generally, when a critical avian patient is in leakage (minimal with careful technique)
need of fluid therapy, the subcutaneous and pain (significant with high pressure).
route will not restore circulatory fluid
volume as effectively as intravenous or Intravenous
intraosseous techniques. Subcutaneous
Fluids can also be administered
fluids can be administered in the
directly intravenously as in other species.
prepatagium (wing web), dorsally between
Birds as small as 15 grams can be
the wings, or in the inguinal fold.
administered fluids with single boluses
Intraosseous given via the jugular. The basilic and medial
metatarsal veins may be used in larger
Because of the difficulty in birds. In some cases one or two boluses
stabilizing a standard I.V. catheter and the provide such improvement that further I.V.
small size of many patients, the administration is unnecessary.
intraosseous catheter has become popular
among avian veterinarians. Two primary Use of the basilic vein usually results in the
sites are used: the distal ulna and the formation of a large hematoma at the
proximal tibiatarsus. The technique simply administration site. This can be minimized
involves installing a spinal needle through by removing the needle from the vein but
the end of the bone and into the marrow not the skin following fluid administration
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

and injecting a large volume of fluids Basilic

subcutaneously. The fluid compression
A small diameter Teflon catheter
then lessens vascular leakage.
can be placed in the basilic vein of larger
Jugular birds as it crosses the medial aspect of the
elbow. A section of tongue depressor may
Installation of a jugular intravenous
be taped alongside the catheter to provide
catheter is easily accomplished in many
stability. After the catheter is installed the
species of birds. Jugular catheters have
wing should be placed in a figure “8”
routinely been installed by the author in the
bandage to prevent dislodging.
jugulars of patients as small as 75 grams.
The more prominent right jugular and often Maintaining Proficiency of Technique
the left jugular are readily accessible on the
Regular and frequent performance
ventrolateral sides of the neck. A standard
of routine mechanical techniques on avian
I.V. catheter of appropriate size and length
patients establishes skill and competence in
is installed into the jugular in a cardiac
the avian practitioner. Two tremendous
direction. It is important to place the
benefits are subsequently realized:
catheter as near the thoracic inlet as
increased clinical success and improved
possible to avoid kinking when the neck is in
client confidence. In many situations the
normal flexion. Use of a more rigid
owner of a sick bird will be more impressed
polypropylene catheter also minimizes the
by the clinician’s mechanical skills than by
possibility of kinking. The catheter can be
his knowledge; the mechanical skills are
sutured in place or enclosed in a tape collar
more visible. A competent avian clinician
following installation. The tape collar
has both the knowledge of what to provide
actually increases the catheter’s stability
and the skill to provide it. The avian
but should be applied loosely to avoid
practitioner owes it to the patient, the
constricting the crop and esophagus.
client, and himself to develop his skills in
handling avian patients.

Figure 11
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Avian Diagnostic Testing

INTRODUCTION: Clinical pathology holds the key to unravelling much of the mystery surrounding
the avian patient. Although many avian diseases present with identical clinical signs, laboratory
data can often distinguish between infectious and metabolic disease, bacterial versus fungal,
renal versus hepatic, etc. In a clinical situation, an appropriately broad selection of laboratory
tests offers the best odds of quickly determining the nature of the patient’s problem.

COMPLETE BLOOD COUNT (CBC) • white blood cell types parallel

mammalian cells except that the heterophil
is present in avian blood instead of the
The complete blood count (CBC) is one of neutrophil; and
the most important components of an avian
• thrombocytes are present in avian
diagnostic panel. For analytical purposes
blood instead of platelets.
the CBC may be divided into components
describing: the volume and character of the
red blood cells; the numbers, percentages,
Unlike dogs and cats, cell counts of birds
and characteristics of the white blood cells;
may vary widely among members of a given
the concentration of solids in the plasma;
species. To determine normal cell count for
the relative number of thrombocytes; and
an individual, baseline data must be
the presence or absence of blood-borne
collected during periods of apparent good
parasites. While many other tests provide
health. Reference values for various species
information not demonstrated by the CBC,
have been published, but these tables
no other single test provides such a broad
should only be used as rough guidelines.
range of information. Differences exist
Published ranges will typically be wide,
between avian and mammalian blood but,
therefore subtle patient variations may not
once these differences are recognized, the
be apparent.
similarity in functions of the various
components becomes evident.

The primary differences between Beyond these differences, the functions of

mammalian and avian blood are that: the various cellular components in avian
blood are roughly comparable to those of
mammals. Infections, non-infectious
• normal mature avian red blood cells inflammation, necrosis, neoplasia, etc may
are nucleated, and regenerative anemia is cause a leucocytosis. A moderate
therefore demonstrated by polychromasia heterophilia often indicates the presence of
among the red cells in a stained smear; bacterial infections or cellular necrosis, and
(basophilia of cytoplasm, increased nucleus extremely high heterophil counts often
to cytoplasmic ratio, and more spherical accompany pansystemic illness such as
shape to the nucleus and cell). chlamydiosis, aspergillosis, or tuberculosis.
These changes are usually characterized by
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varying degrees of toxic changes in the Basophils are uncommon findings in normal
white cells. Subtle-to-moderate avian haemograms. Conditions that cause
heterophilias, without toxic changes in the their appearance include respiratory
white cells, may reflect stress leucograms. infections, resolution of tissue damage,
parasitism, and some chlamydial infections.

An overwhelming bacterial infection, sepsis,

or a severe viral infection may result in a Electrophoresis (EPH, SPE)
leucopenia with a heteropenia or
occasionally a lymphopenia. The leucopenia
may be due to decreased production or The fractionation of plasma proteins via
increased consumption of the cell line. protein electrophoresis is analogous to the
Increased consumption is evidenced by the separation and identification of white blood
presence of immature and toxic cells, cells in the differential cell count. Just as
findings not present with decreased different families of white cells are
production. separately quantitated, so the relative
percentages of the plasma proteins are
measured. It should be realized that the
In some avian species, the relative technique of performing an electrophoresis
lymphocyte count may be higher than in does not produce absolute values of each
others. An absolute lymphocytosis may protein fraction; rather, it reveals the
suggest a viral infection or certain stages of percentage of each as part of the
chlamydiosis. premeasured total protein. The absolute
values must be calculated after the total
protein has been determined through
A lymphopenia may occur in severe viral another method. The electrophoresis then
infections, such as avian circovirus in young yields information regarding a variety of
African grey parrots. (This presentation, in physiologic and immunologic states of the
fact, usually demonstrates a pancytopenia.) patient. The primary categorization of avian
plasma proteins includes pre-albumin,
albumin and globulin components.
A monocytosis implies the presence of Globulins are then divided (and sometimes
chronic infection, granulomatous disease, subdivided) into alpha, beta, and gamma
or extensive necrosis in which a large fractions.
amount of phagocytosis is occurring. Classic
examples of this include chronic forms of
aspergillosis, tuberculosis, and One aspect of protein determinations that
chlamydiosis. should always be observed is the
albumin:globulin (A:G) ratio. More
important than the patient’s total plasma
Eosinophil functions have not been clearly protein are the relative quantities of pre-
defined. Intestinal parasitism may produce albumin, albumin, and globulin. The ratio is
an eosinophilia, but not consistently. calculated using the formula (pre-albumin +
Peripheral eosinophilia does not appear to albumin)/globulins, and the normal A:G
occur in allergic conditions. ratio ranges from 1.6–4.5. The importance
of this ratio is illustrated by the following
example. Snowflake and Peaches each have
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total plasma proteins of 4.0. At first glance, globulin fractions contains proteins active in
according to published data, each patient’s different physiologic and
proteins appear to be normal. Snowflake’s pathophysiological conditions.
albumin is 3.0 and his globulin is 1.0,
resulting in an A:G ratio of 3.0, normal.
Peaches, however, has an albumin of 1.0 Alpha globulins: Alpha globulins consist of 2
with a globulin of 3.0. Peaches’ A:G ratio is principal fractions: 1 and 2. Contained
0.33, grossly abnormal. Peaches’ albumin is within this group of globulins are acute
very low and her globulins are very high–an phase inflammatory proteins such as -
indication of a potentially serious condition. lipoprotein, 1-antitrypsin, 2-macroglobin,
Peaches is losing or failing to produce and haptoglobin. The 2-macroglobin
albumin, while at the same time some sometimes migrates into the range. One
portion of the globulins is being produced at condition associated with elevated
an accelerated rate. globulin levels in birds is parasitism. Other
consistent correlations have yet to be
identified. Elevations in alpha globulins are
Pre-albumin and albumin fractions somewhat uncommon.

The significance of the pre-albumin fraction

of the serum protein in birds is uncertain. It
Beta globulins: Beta globulins constitute
may function as a transport protein, similar
other acute phase inflammatory proteins,
to albumin. There does not appear to be a
including 2-macro-globulin, fibronectin,
comparable component in mammalian
transferrin, and -lipoprotein. In some
blood. In avian samples, it may comprise as
species, namely the African grey parrot, the
much as 40 per cent of the total serum
component of the EPH consists of 2
protein. In some species, it appears that low
primary components: 1 and 2. Elevated
pre-albumin values may have the same
beta globulin levels may be indicative of
significance as low albumin.
chronic liver or kidney disease, or chronic
inflammatory diseases such as aspergillosis
or chlamydiosis. The most common reason
The albumin fraction typically comprises
for elevated beta globulins in birds, which is
45%–70% of avian serum protein in species
attributable to the transferrin component,
that have high pre-albumin values, and
is egg production. A significantly elevated
tends to be lower in species with low pre-
beta globulin level, combined with a 1.5- to
albumin values. Albumin functions primarily
2-fold increase in the blood calcium level, in
as an osmotic pressure regulator and a
birds of unknown sex, is almost 100%
transport protein, as it does in mammalian
suggestive that the bird is an ovulating
species.
female.

GLOBULIN FRACTION
Gamma globulins: In mammals, gamma
The globulin fraction has alpha ( ), beta ( ), globulins appear as 2 primary fractions: 1
and gamma ( ) components, and high- and 2. In avian species, only one fraction is
resolution electrophoresis will divide the demonstrated. The primary components of
globulins into the protein components the gamma globulins are antibodies,
listed under the , , and subgroups complement, and complement degradation
discussed below. Each of the 3 primary products. Elevated gamma globulins are a
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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common finding in birds suffering from elevations from variable sources cause AP
acute Chlamydia infection. to be of almost no value in avian
diagnostics. Disruption of bone probably
Serum Biochemistries
causes elevations of AP more than other
Alanine aminotransferase (ALT, SGPT) sources.

Alanine aminotransferase is an enzyme

found in the cells of many avian tissues. In
Aspartate aminotransferase (AST, SGOT)
other animals, elevations have been shown
to be associated with hepatocellular The intracellular enzyme most useful for
disruption, but no such association has been diagnosing hepatocellular disruption in
consistently demonstrated in birds. Little avian species is aspartate aminotransferase.
clinical significance can therefore be applied Although present in liver, skeletal muscle,
to ALT values in avian patients. kidney, heart, and brain, elevations are
frequently associated with liver disease or
muscle damage. Whenever an elevation in
Albumin AST is detected, the creatine kinase (CK)
level should be reviewed. An elevated AST
The function of albumin is discussed above. without a concurrent elevation in CK is
It should be noted here that an accurate highly suggestive of hepatocellular
albumin determination is best calculated disruption. It should be emphasized that
through electrophoresis. Because of the this does not confirm liver disease; nor does
linear range of most laboratory a normal AST positively rule out liver
instrumentation, currently utilized disease. As with all diagnostics, the AST
chemistry assays often do not provide provides evidence towards a diagnosis but
accurate avian albumin measurements. does not in itself determine the diagnosis.
Also, the AST in no way indicates the
functional capacity of the liver. The bile
Amylase acids test, discussed shortly, is more
In birds, the pancreas, liver, and small appropriately used to evaluate hepatic
intestine produce amylase. Elevations have function.
been associated with acute pancreatitis and
enteritis. Because more than one source of
amylase exists, an elevation is not in itself Bile acids
diagnostic. Bile acids are produced by the liver to aid in
the digestion of fats. After excretion into
the intestinal tract, bile acids are
Alkaline phosphatase (AP, SAP) reabsorbed and returned to the liver via the
Alkaline phosphatase is found in bone, portal circulation. The liver then extracts
kidneys, intestine, and liver. The hepatic the bile acids from the blood for recycling.
fraction composes only a very small Elevation of bile acids in the general
proportion of the total reported in routine circulation implies decreased ability of the
testing. Because changes in the hepatic liver to extract the bile acids from the portal
fraction have little and inconsistent circulation, and therefore suggests
influence on the overall value, no impaired liver function.
correlation can be made between liver
disease and AP levels. The inconsistent
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Confusion arises when it is noted that the Bilirubin

liver is the organ of bile acid synthesis. It
Since biliverdin is the major avian bile
would seem logical that hepatic
pigment, bilirubin is uncommonly observed
insufficiency would result in decreased
in avian serum samples. In occasional cases
production of bile acids, and therefore in
of severe liver disease, significant bilirubin
decreased circulating levels. However,
levels are present; therefore, hepatic
hepatic extraction of bile acids from the
pathology may be suspected in patients
portal circulation is apparently more
demonstrating elevated bilirubin levels.
dependent on efficient liver function than is
the synthesis of bile acids. It is reasonable to
presume (and it does appear to happen)
that at some point the production of bile Calcium
acids does diminish and values fall. As with Calcium levels are profoundly influenced by
aspartate aminotransferase, a normal bile a number of normal as well as pathological
acid level does not absolutely rule out conditions, and great care should be
hepatic disease. exercised in the interpretation of abnormal
findings. Almost all pathological changes
are secondary to conditions not associated
It is important to distinguish between the with dietary levels. Because of the
information provided by the AST and bile effectiveness of the parathyroid gland,
acids. Aspartate aminotransferase is a dietary deficiencies of calcium will rarely
leakage enzyme, and therefore an inverse cause obvious subnormal blood levels.
indicator of hepatocellular integrity, while Blood calcium levels are also directly linked
the bile acids is an inverse indicator of liver to albumin levels. Hypoalbuminaemia will
function. One is not necessarily dependent result in artifactual depression of measured
on the other. For example, a patient may calcium levels. Other causes of lowered
exhibit a normal AST but elevated bile acids. blood calcium levels include
This would imply impaired liver function, hypoparathyroidism in African grey parrots,
even though the cells are intact; such glucocorticoid administration, and
conditions include hepatic lipidosis, chronic insufficient exposure to full spectrum
fibrosis, etc. Conversely, many diseases lighting.
such as salmonellosis or acute chlamydiosis
may cause hepatocellular damage without
being extensive enough to impaire overall Dehydration will sometimes elevate
liver function. Marked elevations in the AST albumin, and therefore blood calcium. Two-
may be observed without concurrent fold or greater elevations typically occur
elevations in bile acids. Again, normal with ovulation. Elevated levels of calcium
values of either or both do not rule out have been associated with vitamin D3
hepatic disease. A totally fibrotic end-stage toxicity, osteolytic bone tumours, renal
liver lacks enough functional hepatocytes to adenocarcinoma, and dehydration.
produce measurable AST or bile acids.
Finally, a significantly elevated AST along
with a significantly elevated bile acids Cholesterol
presents a worse-case scenario in terms of
liver disease. Cholesterol levels in birds may accompany
various physiological or pathological
conditions, but there is inconsistency and a
lack of specificity associated with abnormal
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findings. Generally, elevations are and non-hepatic causes of elevated

associated with liver disease, aspartate aminotransferase (AST). Any
hypothyroidism, high fat diets, and elevation in AST should be compared with
starvation, especially in obese birds. the patient’s CK level. If the CK is normal, it
Subnormal levels are rarely significant but is relatively safe to conclude that the liver is
may be observed with endotoxaemia, the source of the elevated AST. If the CK is
aflatoxicosis, spirochaetosis, and low elevated along with the AST, muscle should
dietary fat. Unfortunately, there are no be considered a possible source of the
clear indicators to determine whether or elevated AST. Other possibilities for the dual
not an abnormal cholesterol level is elevations would, of course, be concurrent
associated with a particular condition. For liver and muscle or liver and neurological
example, if an obese bird were to display disease. Lastly, an elevated CK in the
elevated cholesterol, it would be unclear absence of other biochemical pathology is
whether the elevation was a result of often the result of significant neurologic
hypothyroidism, excessive dietary fat, disease.
hepatic lipidosis, or mobilization of body
stores during anorexia. Other tests and
observations usually provide evidence of Glucose
these conditions, with or without the
support of the cholesterol level. Again, Pathological changes in avian blood glucose
normal values do not rule out the levels principally involve elevations.
aforementioned conditions. Hypoglycemia is extremely rare in birds and,
when present, is almost never associated
with starvation. The primary cause of
hypoglycemia in pet birds is septicemia.
Creatinine

Creatinine levels in avian serum samples

typically fall below a measurable range, and Hyperglycemia occurs commonly due to
are rarely useful in avian clinical pathology. stress or recent intake and, occasionally,
Also, certain technical factors contribute to from diabetes mellitus. Because of the
a high incidence of artifactual changes. frequency with which hyperglycemia is
Elevations have been associated with caused by stress, a diagnosis of diabetes
kidney disease, but creatine is not mellitus should be considered carefully and
considered to be a reliable indicator of renal only if other evidence supports it. A visibly
function. Many commercial labs include normal hyperglycemic patient displaying no
creatine in an avian profile, but its polydipsia, no polyuria, and no weight loss,
significance should be regarded with etc should not automatically be considered
suspicion. diabetic. Repeat testing, other investigative
tests and observation are necessary to
confirm a diagnosis.
Creatine kinase (CK)

The primary sources of creatine kinase

Glutamate dehydrogenase (GLDH)
include skeletal muscle, cardiac muscle, and
nervous tissue, and elevations are Sources of GLDH in birds include the liver
associated with significant disruptions of and, to a lessor degree, the kidney.
these tissues. The primary usefulness of this Although not widely available, the GLDH
enzyme is in distinguishing between hepatic level can provide significant information in
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the investigation of hepatic disease. GLDH is usually life-threatening clinical situation.

a leakage enzyme, so elevations are Hyperkalemia develops with advanced
observed when significant cellular kidney disease, adrenal disease, muscle
destruction occurs. If the assay for GLDH damage, and during episodes of acidosis.
could be refined, the GLDH could replace Hypokalemia may result from loss through
the paired AST and CK as an indicator of diarrhea, and during states of alkalosis.
hepatocelluladisrption.
Sodium

Changes in sodium values usually reflect

Lactate dehydrogenase (LDH) serious conditions. Elevated levels occur
with salt poisoning, water deprivation, and
LDH is found in skeletal and cardiac muscle,
dehydration. Decreased levels occur due to
liver, kidney, bone, and erythrocytes.
sodium loss in kidney disease or diarrhea.
Elevations can be observed with disruption
of any of these tissues or in haemolysis, and Total protein (TP)
are therefore extremely non-specific. One
A total serum protein level must be
benefit of measuring LDH levels may be in
evaluated in light of its components,
following the progress of liver disease, in
albumin, and globulin. The total value is
which LDH levels apparently change more
influenced by various factors but, as
quickly than AST levels; lowering LDH values
discussed previously, a normal value does
may imply improvement even though AST
not rule out abnormalities of the individual
levels remain elevated.
protein components. Overall, dehydration
Lipase and immune stimulation may cause a
hyperproteinemia. Hypoproteinemia may
Serum lipase levels may be elevated in cases
be caused by overhydration, protein loss in
of acute pancreatitis. Currently, the only
kidney disease, starvation, liver disease, or
reliable antemortem confirmation of
intestinal disease. As stated earlier, the
pancreatitis is by pancreatic biopsy.
protein should never be considered normal
Phosphorus until the A:G ratio is known to be normal.

Elevated serum phosphorus is frequently Urea

observed in advanced renal failure. An
Because of the low level of urea (blood urea
elevated phosphorus level resulting from
nitrogen—BUN) in avian blood, its
renal disease suggests chronicity and
usefulness is limited. Also, the avian kidney
presents a guarded prognosis. Elevations
appears able to excrete most urea as long as
are also observed in hypoparathyroidism
the patient’s hydration is adequate.
and nutritional secondary
Therefore, blood urea may be a better
hyperparathyroidism. Hemolysis may
indicator of hydration than renal function.
artifactually elevate serum levels.
Malabsorption and vitamin D deficiencies
may cause lowered blood phosphorus
Uric acid
levels.
The blood uric acid level is the primary
indicator of renal function in birds. An
Potassium elevated uric acid (UA) level is a reliable
indicator that kidney function is impaired.
As with sodium, pathological changes in
With many tests, substantial elevations are
potassium levels indicate a serious and
necessary before there is reason for
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concern; however, even a subtle elevation Gram staining

in the uric acid warrants suspicion of renal
At one time, the Gram stain was the most
disease. Conversely, serial determinations
commonly utilized test in avian medicine.
should be made after adequately hydrating
Much controversy now surrounds its
the patient before concluding a diagnosis of
significance in assessing avian health.
renal disease. While it has been argued that
dehydration has little effect on uric acid The Gram sain itself will always be a useful
levels in birds, this is not the author’s test; the problem lies not in the test but in
experience. Many patients with profoundly its interpretation. Many birds are
elevated UA levels have reverted to erroneously diagnosed with gram-negative
complete normalcy after fundamental bacterial infections due to artifact from
rehydration. An artifactual elevation of UA poor staining techniques. The findings of a
often occurs if blood is collected via nail trim correctly performed test are often
due to contamination of the nail with the misinterpreted as abnormal when in fact,
patient’s droppings. they may be acceptable. An understanding
of avian bacteriology is a prerequisite for
accurate interpretation of avian Gram
Fecal examinations for parasites stains. The Gram stain may then be used to
suggest the major flora in a given fecal
Gastrointestinal parasites, while rare in pet
sample. Usually, abnormal findings should
birds, are occasionally significant causes of
be validated through bacterial/fungal
avian illness and sometimes even death.
cultures.
Suspect cases should be examined through
the use of direct saline smears, flotation
techniques, and certain specialized assays.
Summary
Giardia species are parasites for which there
Laboratory testing is an essential
are a variety of diagnostic techniques
component of avian medicine. When
available. Direct saline smears are
examining avian patients, both routinely
occasionally revealing, although the
and in the face of illness, it is necessary to
organisms may be more clearly visible when
utilize an appropriate assortment of tests in
stained with Lugol’s iodine. Trichrome
order to obtain a reasonably complete
staining will sometimes display the
profile of the patient. Knowing how to
organisms more readily. An ELISA test is
interpret the findings is as important as
now available that shows great promise in
knowing which tests to utilize. By employing
identifying difficult cases. Molecular
the right tests, and correctly interpreting
diagnostic assays are also readily available
the meaning behind the findings, avian
to the avian practitioner.
patients can be diagnosed and treated with
maximal accuracy and effectiveness.
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MEDICINA DE
RUMIANTES
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1. Medicina rumeantes

Índice
CHRISTINE NAVARRE
DVM, MS, DACVIM School of Animal Sciences
Louisiana State University Agricultural Center, Baton Rouge, LA

2.1.1. Maximizing Health Of Calves..................................................................................... 227

2.1.2. Field Diagnostics And Therapeutics For Cattle And Small Ruminants ...................... 232
2.1.3. Practical Fluid Therapy For The Field: Cattle And Small Ruminants ......................... 240
2.1.4. Basic Steps To Building Herd/Flock Health: Part I And Ii ........................................... 249
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Maximizing Health Of Calves

INTRODUCTION: Maximizing calf survivability is crucial to economic success of beef producers.

Having healthy calves starts many months before calving season. Proper herd nutrition impacts
calf survivability more than any other factor. Proper environment/facilities are also important.
If these two factors are under control, herd outbreaks of calf diseases will be minimized.

Calf losses are greatest in the first week of life, and most of these are a direct result of dystocia.
Some causes of dystocia, such as fetal malpositioning, are impossible to control. However, other
causes of dystocia, such as poor nutrition (under or overfeeding), and poor heifer and bull
selection, can be minimized with proper management.

PREVENTION levels in the diet. For example, if a cow isn't

taking in enough protein to maintain her
body condition, she can't make antibodies.
Nutrition Therefore, vaccinating cows to protect
calves through colostral transfer of
Underfeeding late gestation cows can have immunity will only work with proper cow
a major impact on calf survivability. First, nutrition.
stillbirths will increase, probably due to
failure of the cow to go into labor, or due to Historically, focus has been placed on the
prolonged labor. Second, birth weights of influence of nutrition in the third trimester
calves may decrease, as will calf vigor. The on calf health. A newer focus is the
producer may not notice this unless records influence of nutrition in early gestation and
are maintained of cow body condition its impact on placental weight (and
scores and calf birth weights and survival. subsequent fetal growth), neonatal weight
This slight decrease in calf birth weight and and conformation, and body fat makeup
vigor increases failure of passive transfer, and metabolism. Subsequent growth later
increases cold stress and hypoglycemia, and in life and long term reproductive health of
decreases disease resistance, all of which calves may be impacted by nutrition in
decrease calf survivability. these early stages of gestation in their
dams. More recently, evidence suggests
Although overfeeding is less common, it can that supplementation of protein in beef
be as damaging as underfeeding. Excess fat brood cows effects the growth and
in the vaginal cavity can cause dystocia. reproductive efficiency of the female
Overfeeding of heifers can increase fat in offspring of these cows.
the udder, and impact milk production later
in life.

Nutrition also impacts vaccine response due Failure of Passive Transfer

to its impact on the immune system (both
Many immune system defense mechanisms
humoral and cell-mediated immunity).
are lacking or deficient in the neonatal calf.
Cows can only respond to vaccines if they
Therefore, intake of high quality colostrum
have proper energy, protein and mineral
to provide adequate passive transfer of
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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immunity is an important factor in are not great substitutes for real colostrum,
protecting calves from disease. Besides and do not warrant the purchase cost.
providing circulating immunoglobulins, Colostrum replacers are better, but should
colostrum provides local immunity in the not be considered a substitute for good
gut, WBC's that also contribute to local hygiene and management. They may be a
immunity and stimulate cell-mediated better option if the source of outside
immunity (if fresh), and nutritional colostrum is of unknown disease status.
elements. Calves that receive colostrum
Prevention of FPT on a herd basis involves
have higher growth rates than calves that
providing adequate nutrition, providing an
don't receive colostrum, even if those calves
environment that allows the calves to stand
don't become ill. This increase in growth
and nurse without difficulty, minimizing
rate carries over even into the feedlot.
dystocia, and culling cows with poor udder
Several factors can contribute to failure of and teat conformation. It's important to
passive transfer (FPT). Low immunoglobulin remember that FPT is not a death sentence.
concentrations in colostrum of beef cows is On any one farm, there are going to be a few
usually a result of poor nutrition. Weak calves that have FPT, even if these farms are
calves and poor udder conformation or a well managed. Disease outbreaks in the calf
poor environment can all interfere with the herd start to arise when the numbers of FPT
calf's ability to ingest colostrum. And, even calves increases (usually poor nutrition).
if calves ingest adequate amounts of good The more FPT calves on a farm, the more
quality colostrum at the appropriate time, likely a calf will become sick with a
sometimes they do not absorb the proper contagious disease (ex. infectious calf
amounts of immunoglobulins. Dystocia diarrhea). Calves are amplifiers of disease
leading to hypoxia and acidosis is probably because they shed more organisms than the
most commonly associated with poor adults, even if not clinically ill. So one sick
absorption. Other causes that are calf can be the start of a vicious cycle of
implicated but difficult to prove are disease transmission that spreads
placental insufficiency due to fetal oversize throughout the herd.
and/or poor nutrition in early gestation.
If a specific infectious organism is identified
Prevention of FPT in an individual calf in a calf disease outbreak, vaccination of the
involves ensuring at least 100 grams of cow a month prepartum to passively
immunoglobulins is ingested. Two liters of protect the calf can be considered. But,
beef or four liters of high quality dairy since outbreaks are more common at the
colostrum is recommended. Many times end of the calving season, vaccination rarely
two liters is hard to get from a beef cow. helps prevent disease in the current year,
Feed whatever can be safely obtained. I but may help prevent cases the following
usually only try to milk beef cows if I have year.
had to intervene to deliver a calf and I am
worried the calf will not nurse in time or at
all. Sanitation
High quality dairy colostrum is hard to find, It’s very important to remember that an
and biosecurity issues should be adequate passive transfer status of the herd
considered. Fresh colostrum is better than can be overwhelmed by a dirty,
frozen. But frozen colostrum is far superior contaminated environment. Feed troughs
to colostral supplements or replacers. The and hay racks should be moved periodically,
colostral supplements available at this time and placed away from waterers and shelter
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

to discourage congregation of cattle in one their own herd as recipients. An alternative

area, and subsequently concentration of is to lease proven cows from other
pathogens. If a disease outbreak occurs in producers. Cows should be leased from
the calves, move pregnant animals to a farms with BVD and Johne’s control
clean pen and leave sick animals in the programs in place, as well as other
already contaminated pen. Healthy calves biosecurity measures. Embryo recipients
should not move with pregnant cows, since are more likely to have large, overdue
they may be incubating the disease and risk calves, so close observation during calving is
contaminating another pen. If possible very important.
move healthy calves to a third pen. On large
Feeding at night, or even in the afternoon
operations, cattle should be segregated in
increases the likelihood of daytime calving.
groups according to calf age, so that young
On farm lay help and veterinary services are
calves are not exposed to older calves.
more likely to be available during the day,
so dystocia problems and weak calves are
more easily handled and treated more
Other Preventive Strategies
promptly.
Umbilical infections can be a problem in
some herds, especially during wet years.
Dipping navels with 7% tincture of iodine at TREATMENT
birth, as well as controlling cattle
movement and congregation as discussed
earlier will help decrease the number of First hours of Life
umbilical infections in a herd. Umbilical
infections, even mild ones that go
unnoticed, can lead to weakening of the The earlier "at risk" neonates are identified
body wall and umbilical hernias later. and treated, the better the prognosis for a
Sometimes “outbreak” of umbilical hernias healthy and productive life. Any calf that is
suspected to be genetic in origin are born following a dystocia, even if it appears
actually from previous umbilical infections. normal, should be considered at risk. Many
Proper heifer development and selection, of these calves will look normal for a few
and bull selection are beyond the scope of hours, but deteriorate quickly, so will need
this article, but are extremely important in to be watched closely. Immediately
decreasing dystocia, weak calves, and FPT. following the dystocia, while the cow is still
Heifers should be bred to calve early in the restrained, the cow should be milked (if
calving season so they can be observed possible) and the calf bottle or tube fed.
more closely for dystocia. In some years, This ensures colostrum intake and
early weaning of calves born to heifers (and precludes having to restrain the pair later if
cows if necessary) may make maintaining the calf has not nursed. It also helps
proper body condition in these heifers prevent hypothermia and hypoglycemia.
easier as they continue to grow. Calves born following dystocia can be
If embryo transfer is employed, selection of depressed due to hypoxia, metabolic
good embryo recipients is crucial. Heifers acidosis, and/or hypothermia. Calves with
should be avoided, as should cull diary mild depression can be warmed and given
cattle (mastitis, Johne's disease, poor udder intravenous sodium bicarbonate
conformation, etc.). Producers should be inexpensively, and this can greatly improve
encouraged to select proven dams from the chances of survival of these calves. If
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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only mildly hypothermic, heat lamps and the 50% dextrose will cause a rebound
hot water bottles may work. However, if hypoglycemia if dextrose isn't continued.
severely hypothermic, peripheral perfusion Calves should be weaned form 5% dextrose
is poor and external warming is not very slowly.
effective. Therefore these calves need to be
warmed from the inside. Warm oral and
intravenous fluids (balanced electrolyte Failure of Passive Transfer
solution with 1.5% dextrose) are best, along
with external sources of heat. Correcting In an individual calf with failure of passive
for a base deficit of 10 is usually safe. transfer (FPT), the most important
Concentrated sodium bicarbonate (5-8%) problems are decreased growth rates and
can be administered undiluted at a rapid septicemia. Diagnosis of failure of passive
rate through a needle if a catheter for other transfer can be made at 24 hours up to
fluids is not needed. Calves with more about one week of age. One of the
severe depression may require oxygen cheapest tests is serum protein, which
therapy, which will increase the cost of should be > 6.0 g/dl in beef calves.
treatment. However, many times a small If the value of the calf warrants it, the only
amount of supportive care early prevents specific treatment for FPT is a plasma
having to do more extensive, prolonged transfusion, or more practically, a whole
care later. blood transfusion. Plasma is of
questionable benefit in healthy calves for
prophylaxis because even with high
Hypoglycemia volumes, immunoglobulin levels don't
reach those of calves that received
Hypoglycemia is less of a problem in the first
colostrums. This is further magnified if
hours of life, and more of a problem later
whole blood is given because of volume
secondary to inadequate nutritional intake,
limits. However, there are other benefits of
diarrhea, septicemia, etc. If severe,
plasma or whole blood administration,
hypoglycemia can mimic meningitis with
especially in sick calves. The increase in
signs such as miotic pupils, ophisthotonus,
protein levels helps prevent
seizures, etc. Glucose levels can be low with
hypoproteinemia if IV fluids have to be
both conditions. If other causes of
given, and if fresh whole blood is given,
weakness and neurologic signs have been
benefits of cellular immunity, interferon,
eliminated (hypothermia, acidosis, severe
and other circulating non-specific immune
dehydration), a slow infusion of 0.5 mls/10
factors may benefit the calf. Treatment
lbs body weight of 50% dextrose IV can be
with antibiotics prophylactically in healthy
administered without the need of a
calves is controversial, and should be
catheter. If calves have simple
considered on a case by case basis.
hypoglycemia, they will usually respond to
the dextrose by improving. If they do not
respond, a CSF tap can be easily performed.
If the fluid is grossly abnormal, the Neonatal Septicemia
prognosis is poor, and the owner can factor A potential sequella to failure of passive
this into treatment decisions. If the fluid transfer is septicemia. Calves under 7 days
looks grossly normal, the calf may still have of age are at greatest risk. The source of the
meningitis, but the prognosis is good with bacteria can be the umbilicus, the GI tract,
treatment. If treatment is continued, these or the respiratory tract. Any organ system
calves must have IV 2.5- 5% dextrose, since can be secondarily infected, but the
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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neurologic, musculoskeletal and although they are common problems in

ophthalmic systems are most likely. calves with FPT.
General clinical signs of septicemia are
depression and reluctance or inability to
stand. Anorexia, poor suckle reflex, Umbilical Infections
+/- fever (more often hypothermia) are
other general signs. Hypoglycemia may be If an umbilicus becomes infected, and the
present. Neurologic signs due to secondary calf is systemically ill or has poor growth,
meningitis are ophisthotonus, seizures, stiff the umbilicus should usually be
extremities, nystagmus, and/or miotic immediately removed surgically. Systemic
pupils. Hypopyon, uveitis, synechia, and antibiotics rarely work, and the longer the
conjunctivitis may occur but are not life infected umbilicus stays, the higher the risk
threatening, only a sign of serious problems. of the infection spreading to the joints,
Single or multiple swollen joints, edema nervous system, etc. Unlike simple hernia
around the joints and osteomyelitis may repair, which can be done under sedation
occur. Musculoskeletal infections carry a and local anesthesia, removal of an infected
poor prognosis unless caught early. umbilicus can be more complicated, and
Lameness in neonatal calves should be general anesthesia is recommended. The
treated as an emergency. Infectious surgeon should be prepared to resect
arthritis from septicemia is a more likely infected or abscessed umbilical veins and
cause of lameness than injury/trauma. arteries, and the urachus.
Diarrhea and pneumonia are not a common
sequella to septicemia in beef calves,
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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Field Diagnostics And Therapeutics For

Cattle And Small Ruminants

DIAGNOSTICS

Once fluid is collected, it can be analyzed for

color; odor; pH; protozoal species and
There is no substitute for a thorough
motility; methylene blue reduction time
physical examination when trying to
(MBR); gram staining characteristics; and
determine what body systems are involved
chloride levels. Anorexia may cause the
in making an animal sick. However, ancillary
fluid to look darker, the pH to increase, and
diagnostic procedures con often times help
the number and motility of protozoa to
to more clearly characterize diseases.
decrease. A grey color, low pH, and dead or
no protozoa are seen with rumen acidosis
from grain overload. The MBR will be
Rumen Fluid Analalysis prolonged with any type of indigestion.
Analysis of rumen fluid can help Large numbers of gram positive rods
differentiate diseases of the forestomachs. (Lactobacilli spp.) may also be seen with
An appropriate size orogastric tube can be rumen acidosis. Elevated rumen chloride
can be passed via the oral cavity for fluid indicates an abomasal or proximal small
collection. Care must be taken to properly intestinal obstruction (either functional or
restrain the animal. Use of a mouth mechanical).
speculum is needed to prevent chewing of
the tube, which if not prevented can lead to
roughening of the tube surface and damage Abdominocentesis
to the esophagus. Excessive chewing can
Abdominocentisis is useful in discerning the
also lead to a broken tube that can be
causes of fluid distension in the abdomen.
swallowed. Rumen fluid can also be
Two techniques can be utilized. The first
collected via percutaneous
technique is useful in ruling out a ruptured
rumenocentesis. A 16 guage needle can be
bladder as the cause of general ascites, and
inserted in the rumen through the
involves tapping the abdomen at the lowest
abdominal wall caudal to the xyphoid and to
point and slightly to the right of midline.
the left of midline. Fluid is then aspirated
Care should be taken to avoid the prepuce
with a syringe. Local anesthesia and
in males. The second technique is useful if
sedation of the animal may be needed. This
peritonitis is suspected. Since localized
technique avoids saliva contamination that
peritonitis is more common than
can occur from collection with an orogastric
generalized peritonitis, four sites are
tube and it appears to be less stressful.
tapped. The two cranial sites are slightly
There is a slight risk of causing peritonitis
caudal to the xyphoid and medial to the milk
with rumenocentesis, which can be
veins on the left and right sides. The two
minimized with proper restraint.
caudal sites are slightly cranial to the
Percutaneous rumenocentesisis should not
mammary gland and to the left and right of
be performed in pregnant females.
midline. For either technique, manual
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

restraint with sedation is recommended, glass vial or tube); histopathology (in

and the use of real time ultrasonography formalin at a 10:1 ratio of formalin:tissue);
may help locate fluid pockets. A twenty- and/or mineral analysis (in a plastic tube).
gauge needle or teat cannula can be used When performing a liver biopsy for mineral
for fluid collection. Sterile preparation of analysis, the biopsy site should be rinsed
the site is needed, and local anesthesia is with distilled and deionized water following
necessary when a teat cannula is employed. sterile preparation to minimize
Fluid should be collected into a small EDTA contamination of the sample. Samples for
tube for analysis, and a sterile tube for mineral analysis should not be placed in
culture. Fluid can be difficult to obtain, and formalin.
is usually in small amounts. Care should be
taken to minimize the ratio of EDTA to fluid,
since EDTA can falsely elevate protein CSF Tap
levels. Use of EDTA tubes made for small
animals, or shaking excess EDTA out of large A 20 gauge-1½ inch needle is used for
tubes will resolve this problem. Fluid can neonates, an 18 gauge -1½ inch needle for
also be collected for culture. Normal values adults. Ambulatory patients can be tapped
are similar to those for cattle (clear, standing. Non-ambulatory patients should
colorless to slightly yellow, 1-5 gm/dl be placed in lateral recumbency or in sternal
protein, < 10,000 cells). Cytologic recumbency in a "dog-sitting" position with
examination is needed to characterize the the rear legs forward on either side of the
cell population, and look for the presence of animal. The pelvis needs to be straight and
phagocytized bacteria. level. The lumbosacral area should be
clipped and surgically prepared. Wearing
sterile gloves, the indention of the
lumbosacral junction should be palpated. A
Liver Biopsy
needle is inserted into the deepest part of
Liver biopsy in small ruminants is performed the indention, directly on midline. Keep the
using the same technique and instruments needle perpendicular to the spine from the
as in cattle. However, sedation and side view, and straight up and down from
ultrasound guidance are recommended. the rear view. If bone is encountered,
The biopsy can be performed in the 9th to redirect the needle slightly cranial or caudal
10th intercostal space slightly above an until the needle drops into the lumbosacral
imaginary line from the tuber coxae to the space. Advance the needle slowly until a
point of the elbow. Local anesthesia with slight "pop" is felt. The animal usually
lidocaine hydrochloride at the site should jumps slightly when the needle punctures
be performed following sterile preparation. the dura mater. CSF should flow from the
A small scalpel blade is used to make a stab needle or can be gently aspirated with a
incision through the skin. A 14 gauge liver syringe. If the needle is in the lumbosacral
biopsy instrument is inserted through the space and advanced until bone is
stab incision and intercostal muscles and encountered again, back the needle out 1-
into the liver. The biopsy instrument should 2mm and try to aspirate. Place the fluid in
be directed towards the opposite elbow in an EDTA tube for fluid analysis and a plain
most cases, but utrasonography will help tube if cultures are desired. Normal, non-
determine the direction and depth needed. traumatically obtained fluid should be
Vessels along the caudal border of the ribs perfectly clear with no discoloration,
should be avoided. Samples can be sediment or turbidity. It is best to have the
submitted for culture (in a sterile plastic or sample analyzed locally as soon as possible
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

(within one hour). If this is not possible, acid-fast staining or place the sample in
place half of the sample in an equal volume formalin for histopathology.
of 40% ethanol to preserve the cells (inform
Caution: Only go in wrist deep, staying in the
the laboratory that this has been done), or
retroperitoneal area to prevent a full
centrifuge half the sample to concentrate
thickness biopsy and peritonitis.
the cells and prepare slides to be sent with
the rest of the fluid.

Fecal Smear:
Four-Point Nerve Block: Indications: Diagnosis of Johne's Disease or
Cryptosporidiosis.
Indications: Localization of lameness to the
foot, anesthesia for surgery/therapy of the Materials: Acid-fast stain, slides
foot.
Procedure: Smear a small amount of feces
Materials: 20 gauge-1½ inch needles, on a slide. Heat fix the slide for Johne's and
lidocaine. let it air dry for Cryptosporidiosis. Under
40x or 100x, look for small, acid-fast bacilli
Procedure: 1. Insert the needle into the
in clumps (Mycobacterium
dorsal aspect of the pastern, in the groove
paratuberculosis), or round, refractile, acid-
between the proximal phalanges, just distal
fast protozoa (Cryptosporidium).
to the fetlock. Administer 5cc of lidocaine
deep, and 5cc while pulling the needle out.
2. Repeat the previous block from the
palmar/plantar aspect of the pastern, just Lung Aspirate:
distal to the dewclaws. 3. Palpate the nerve Indications: Obtaining fluid for culture in a
over the lateral aspect of the fetlock, patient with respiratory disease.
approximately 2cm dorsal and proximal to
the dewclaw. Administer 5cc of lidocaine Materials: 18 gauge-1½(calves) or
over the nerve. 4. Repeat the previous 3½(adults) inch needle, syringe.
block on the medial side. Procedure: Insert the needle through an
intercostal space over an area where
abnormal lung sounds are auscultated.
Rectal Mucosal Biopsy: Aspirate fluid and place on culturette of into
blood culture bottle.

Indications: Cytology or histopathology for Caution: Stay close to the cranial border of
diagnosis of Johne's Disease. the ribs and beware of the heart. Fatal
hemorrhage from hitting a major vessel can
Materials: Rectal biopsy instrument, occur.
sharpened needle cap, or bottle cap.

Procedure: Place hand wrist deep into the

rectum. Secure a fold of mucosa between THERAPEUTICS
two fingers and pinch off a piece of the
mucosa with the biopsy instrument inserted
with the opposite hand. Alternatively, pinch Hoof Block
off a piece of mucosa between thumb and
needle cap. Make impression smears for
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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A wooden, plastic or rubber hoof block, the block immediately and reevaluate the
placed on the normal claw removes the problem. The hoof block may be causing
source of pain by preventing weight bearing the lameness. Also, the heat produced
on the affected claw and allows the animal during the hardening process can cause
to ambulate comfortably while healing thermal necrosis of soft tissues under the
takes place. This is an affective for hoof wall. Use sparingly on the hooves of
treatment of P3 fractures, and is essential young calves and small ruminants.
for treatment of sole ulcers and serious
hoof cracks. Blocks 1-2 inches thick, cut to
fit the shape of the claw, with grooves on Other Uses of Acrylic
both sides, are glued to the hoof with some
type of bonding material. The wooden hoof Acrylic can be used alone or in combination
blocks and Technovit® acrylic can be with wire to repair hoof wall defects.
obtained from Jorgensen Laboratories. However, the hoof defect must be clean,
Bovi-Bond® is a newer product by Vettec dry, and free of infection before the acrylic
that is very easy to use. The same company can be placed over it. Hoof cracks are very
makes 1 inch plastic or rubber blocks that common in beef cattle. Many times they
can be glued together if a taller block is are found during routine foot trimming.
needed. The black plastic blocks are the The author does not recommend any
widest and fit beef bulls the best. Although treatment of hoof cracks unless they are
Cow Slips® are used routinely in dairy cattle, causing lameness, especially if the patient is
they don’t always fit beef cattle, especially a bull receiving a hoof trim immediately
bulls. All products can be found at Animart prior to breeding season and is not lame.
(www.animart.com or 800-255-1181). Many times in paring out hoof cracks with a
knife or rotary tool, sensitive lamina is
encountered and the animal becomes
temporarily lame. Many animals have hoof
Preparation of the claw is crucial for
cracks for years with no lameness
preventing the blocks from falling off too
associated with them. If the hoof crack is
soon. The claw should be clean, dry and
causing lameness, then it must be treated.
level. Shallow grooves can be made in the
sole with a hoof knife but are not necessary
in my opinion. The Bovi-Bond® sets up
quicker than the Technovit®, so everything Local Intravenous Anesthesia
should be ready. In cold, wet weather, a Local intravenous anesthesia is the
hair dryer helps to quicken setup. When preferred technique for surgical procedures
applying the acrylic, pay particular attention of the foot and pastern. Although clipping
to the axial surface, making sure it’s smooth is not necessary, a surgical scrub should be
and will not irritate the interdigital space or performed prior to injection. A tourniquet
the axial surface of the opposite claw. Do is placed proximal to the fetlock
not spread the acrylic onto the coronary immediately prior to injection (vein will be
band or up on the soft part of the heel. distended best immediately after the
Make sure the block is positioned so that tourniquet is placed). Two sites of injection
the animal does not rock back on its heel, are available. One vein runs down the
and the toe doesn’t tip up. Caution: If the center of the dorsal aspect of the pastern
lameness worsens with the hoof block on or and the other runs approximately 2cm
if the animal develops a lameness after dorsal to the dewclaw, on both the lateral
wearing the block for several days, , remove and medial sides of the foot. A 20 gauge
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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needle or butterfly catheter is inserted into there are radiographic changes in the bone
the vein and 15-20cc of lidocaine or surrounding the joint, two options exist.
carbocaine is administered. It is only One is claw amputation and one is joint
necessary to administer an anesthetic into arthrodesis. Joint arthrodesis is preferable
one of these veins to provide anesthesia to in valuable breeding animals, especially
the entire area distal to the tourniquet. The bulls, because it saves the claw. Although
tourniquet can be safely left on for up to 1 the procedure is easy to perform and
hour to provide hemostasis during surgical relatively inexpensive, the aftercare
procedures. (flushing wound, bandage changes, keeping
a hoof block on and toes wired together,
In feet with severe cellulitis, local
and/or cast application) can be prolonged
intravenous anesthesia can be difficult. In
(1-2 months), which increases the cost over
these cases, a four point nerve block or a
amputation. Also, if significant cellulitis is
simple ring block will also work. The two
present, or there is radiographic evidence of
interdigital injections performed in the four
osteomyelitis proximal to the joint being
point block can be used for removal of an
athrodesed, the success rate of arthrodesis
interdigital fibroma.
is poor, and amputation should be
considered. The procedure is performed
under local anesthesia, and only requires a
Joint Injection and Lavage shop drill and 1/4 and ½ inch drill bits
Septic arthritis is a serious condition that (sterilized). There are several techniques
requires immediate treatment. Although it described. Contact the author for
is tempting to try systemic antibiotics alone references describing the details of the
first, the chances of this working are low, procedure. The owners should be aware
and if systemic antibiotics fail, the disease that time to breeding soundness in bulls can
may have progressed to the point that the be several months, even once the actual
joint can’t be saved. For joint lavage to be infection is cleared. The fetlock joint can
successful, it needs to be performed very also be successfully arthrodesed, although a
early (first few days) in the course of the splint or cast is needed for 6-8 weeks for
disease. Since veterinarians rarely see support during healing.
these cases early, this is not a common
technique used for treatment of the coffin,
pastern or fetlock joint in adult cattle. The Pregnancy Toxemia
coffin joint is especially difficult to tap in
Pregnancy toxemia (twin lamb disease,
cattle. If a needle can be placed in the joint
lambing or kidding sickness) is most
space, isotonic fluids can be administered
common does with triplets, and/or are
under pressure to distend the joint. A
either thin or obese. Much of the
second needle is then placed in the joint
abdominal space is occupied with multiple
space and a through and through lavage is
feti in the uterus during late gestation. Fat
performed, preferably with about 500-1000
accumulation in the abdomen in obese
mls. The larger the needle (14 to 16 gauge)
animals also occupies space. Because of
the better the lavage.
lack of space for the rumen, these females
have difficulty consuming enough
feedstuffs to satisfy their requirements. In
Joint Arthrodesis/Facilitated Ankylosis late gestation, nutritional requirements
When septic arthritis of the coffin or increase to 150% of maintenance with a
pastern joint has advanced to the point that single fetus and 200% with twins. Late
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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gestation is usually during the winter also be given orally. Rumen transfaunation,
months, when less pasture is available, and vitamin B complex (including B12, biotin, and
as a general rule, poorer quality feeds are niacin) are also recommended treatments.
available. Pregnancy toxemia is also seen
following anorexia secondary to other
diseases (ex. foot rot, ovine progressive Once females show neurologic signs or
pneumonia, caprine arthritis encephalitis become recumbent, treatment must be
virus), or with stresses such as bad weather, very aggressive. IV glucose, calcium
transporting, etc. There is also a genetic borogluconate, and bicarbonate may be
predisposition in some individual animals. needed.
Very early signs of pregnancy toxemia are Glucocorticoids (15–20 mg
mild depression, anorexia and possibly limb dexamethasone) can help by causing
edema. If left untreated, goats become gluconeogenesis, increasing appetite and
anorexic and depressed, and soon become inducing abortion. Prostaglandin (PGF2α)
recumbent. Neurologic signs including should also be used (5-10 mg) for induction
blindness, circling, incoordination, star- of parturition in does. Flunixin meglumine
gazing, and tremors. Constipation and teeth (0.5-1 mg/lb) are indicated if endotoxemia
grinding can also occur Icreased respiratory is suspected from dead fetuses.
rate develops if acidosis occurs. If left
untreated, does become recumbent.
Removal of the fetuses is critical in these
severe cases. Assessment of fetal viability
Azotemia, both from dehydration and with ultrasound helps with the decision to
secondary renal disease, is a common induce parturition or perform a C-section.
finding. A urinalysis will be positive for both Since a breeding date is rarely known, age
ketones and protein. Ketoacidosis is of the fetuses is hard to determine. If the
common in small ruminants. Hypocalcemia fetuses are alive, induction of parturition
and hypokalemia may be present due to can be an option. However, if the fetuses
anorexia. They are not always are already dead, or the condition of the
hypoglycemic. Liver enzymes are usually doe is severe, an immediate C-section is
found to be within normal limits, but warranted. Fluid support during and after
occasionally may be increased. surgery is critical. Low birth weights of
lambs, kids and calves at the beginning of
the birthing season can indicate potential
Diagnosis is based on clinical signs, the risk of pregnancy toxemia.
presence of multiple fetuses, and typical
clinicopathologic findings. Differential
diagnoses include listeriosis, hypocalcemia, Prevention of this disease is through proper
polioencephalomalacia, hypomagnesemia, nutrition. Maintaining animals in proper
and meningeal worm infestation. body condition throughout the year, and
making sure energy and protein levels are
In small ruminants, very early cases (prior to
adequate in late gestation are important.
recumbency) may be treated with oral
For does in late gestation, hay should have
glucose or glucose precursors. 60-100 mls
protein content of at least 10%, and 1-2 lbs
of propylene glycol orally twice a day, or
of concentrate should be fed per head per
oral corn syrup or glycerol can be tried. Oral
day. During periods of stress, particularly
high energy calf electrolytes with bicarb can
cold wet weather, concentrate may need to
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

be increased to 2-3 lbs/head/day (divided in caudal epidural may facilitate

two feedings). Parasite control, disease exteriorization of the penis. Acepromazine
prevention and decreasing stress are is the sedative of choice as it may also have
important. antispasmodic effects on the urethra.
Xylazine should be avoided due to its
Ultrasonography can help determine which
diuretic effects. Urethral catheterization is
females have multiple fetuses, and these
difficult to perform and should be
animals separated into groups and fed
performed with extreme caution to prevent
accordingly. Addition of an ionophore in a
rupture of the urethra. A mixture of 1 part
feed or mineral mixture will enhance the
2% lidocaine and 3 parts saline may relieve
formation of the glucose precursor
some urethral spasms and facilitate
propionic acid, and improve effeciency of
flushing.
feed utilization.
A more acceptable alternative to urethral
catheterization if removing the urethral
Urolithiasis process fails to relieve the obstruction or
the obstruction recurs is chemical
Obstructive urolithiasis should be treated as dissolution of the calculi. Under general
an emergency. Immediate slaughter should anesthesia, the bladder is located with
be considered in feedlot or grade animals if ultrasound, and an 18 gauge 4 inch needle
rupture of the bladder or urethra has not is inserted into the trigone of the bladder.
occurred. If surgery is indicated, it should Urine is aspirated until the bladder is small,
not be delayed. Dehydration and and 30-60 mls of Walpole’s solution is
electrolyte abnormalities should be placed in the bladder and removed again
corrected with isotonic sodium chloride until the turbidity of the urine is decreased.
during surgery. If hyperkalemia is severe, Then another 30 to 50 mls of Walpole’s
adding dextrose or sodium bicarbonate to solution is infused into the bladder and the
fluids may help decrease potassium. needle removed. Urine flow is usually seen
Calcium may also be needed. Nonsteroidal in 24-36 hours, and is normal in 3-5 days. A
anti-inflammatory drugs are an important second infusion of Walpole’s may be
part of therapy. Not only do they help with needed in some cases.
pain, shock, and urethral swelling in the
acute stages of the disease, they may also Several surgical procedures are available for
help decrease the amount of urethral urethral obstruction. If the animal is
stricture formation chronically. Broad- destined for slaughter, temporary measures
spectrum antibiotics should be such as perineal or ischial urethrostomy or
administered prophylactically. penile amputation can be performed.
Urethrostomy can be difficult to perform in
In cases of urethral obstruction, if the penis small ruminants, and stricture formation
can be exteriorized, the urethral process with obstruction at the surgical sight usually
can be removed with sharp scissors or a occurs in a few weeks to a few months. If
scalpel blade if it has not already necrosed the stones can be palpated in the urethra, a
off. Antibiotic and/or steroid cream can be urethrotomy can be performed at this sight.
applied to the penis. Removal of the However, stricture formation and
urethral process may relieve the reobstruction can still occur. For cases in
obstruction initially, but obstruction at the which breeding is important, or in pets in
sigmoid flexure commonly occurs which long term survival is important, a
secondarily, so careful monitoring for
recurrence is necessary. Sedation and/or
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

tube cystostomy or bladder choice trace mineralized salt is the source of

marsupialization is recommended. minerals, intake of these may drop when
salt is added to the ration. Therefore,
If the tube cystostomy fails (estimated to
adequate minerals should be added to the
fail in about 20% of cases), or the animal is
ration. Clean water should be provided at
a pet and breeding is not desired, the
all times. In winter, warm water can be
bladder can be marsupialized. A stoma is
provided to pet animals to keep intake up.
made lateral to the prepuce and as cranial
as the bladder will allow. Note that this Pet small ruminants not used for breeding
surgery can be difficult to perform following tend toward obesity, and can usually be
a failed tube cystostomy due to intra- maintained on good quality grass hay.
abdominal adhesions. Although breeding Concentrate supplements should be
success rates following marsupialization reserved for breeding or feedlot animals.
have not been reported, the author is aware The concentrate in the diet should be
of one animal that successfully bred females limited to 25% of the ration (feedlot rations
following bladder marsupialization. may be the exception). A 1.5 to 2:1 Ca:P
ratio should be maintained in the entire
The prognosis for urethral rupture is poor
diet. The total recommended amounts of
compared to simple obstruction or bladder
calcium and phosphorus should not be
rupture if these are treated appropriately.
exceeded, and magnesium should not be in
With urethral rupture, urine still needs an
excess. Adequate vitamin A should be
outlet, so a urethrostomy or penile
included in the ration, especially if dry
amputation should be performed. Tube
forages are the majority of the ration.
cystostomy or bladder marsupialization
Legume hay should be avoided, or limited to
may not be able to be performed due to the
only what is needed if certain production
severe ventral accumulation of urine, and
systems require them.
tissue necrosis. Multiple incisions in the
skin to allow drainage, and debridement of Acidification of the urine can be
necrotic tissue is necessary. Severe accomplished several ways. For large
adhesions of the prepuce and penis may numbers of animals, an anionic ration
interfere with subsequent breeding. similar to that fed to dairy cattle to prevent
hypocalcemia can be fed. Also, ammonium
chloride can be added at 0.5% to 1% of the
Prevention total ration, or 2% of the concentrate. For
individual animals 5-10 grams/head/day
Because preventive measures are should maintain the urine pH at
dependent on the type of stone present, approximately 6.5. This can be checked
which is difficult to predict in small weekly by the owner with pH paper.
ruminants, it is important to have calculi Ammonium chloride is highly unpalatable,
analyzed. A thorough dietary history is and should be mixed with syrup or put in
necessary to determine any predisposing gelcaps for administration (avoid molasses
dietary factors. Castration of pet animals since it is high in cations). Vitamin C has to
should be delayed as long as possible, be administered several times per day in
preferably until the preputial attachment to ruminants to be effective so is impractical.
the penis has broken down.

Increased water intake is indicated with any

type of stone. This can be accomplished by
adding salt to the diet at 4% to 5%. If free
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Practical Fluid Therapy For The Field:

Cattle And Small Ruminants

DIAGNOSTICS peritonitis with rumenocentesis, which can

be minimized with proper restraint.
Percutaneous rumenocentesisis should not
There is no substitute for a thorough be performed in pregnant females.
physical examination when trying to
determine what body systems are involved
in making an animal sick. However, Once fluid is collected, it can be analyzed
ancillary diagnostic procedures con often for color; odor; pH; protozoal species and
times help to more clearly characterize motility; methylene blue reduction time
diseases. (MBR); gram staining characteristics; and
chloride levels. Anorexia may cause the
fluid to look darker, the pH to increase, and
Rumen Fluid Analalysis the number and motility of protozoa to
decrease. A grey color, low pH, and dead
or no protozoa are seen with rumen
Analysis of rumen fluid can help acidosis from grain overload. The MBR will
differentiate diseases of the forestomachs. be prolonged with any type of indigestion.
An appropriate size orogastric tube can be Large numbers of gram positive rods
can be passed via the oral cavity for fluid (Lactobacilli spp.) may also be seen with
collection. Care must be taken to properly rumen acidosis. Elevated rumen chloride
restrain the animal. Use of a mouth indicates an abomasal or proximal small
speculum is needed to prevent chewing of intestinal obstruction (either functional or
the tube, which if not prevented can lead mechanical).
to roughening of the tube surface and
damage to the esophagus. Excessive
chewing can also lead to a broken tube Abdominocentesis
that can be swallowed. Rumen fluid can
also be collected via percutaneous
rumenocentesis. A 16 guage needle can be Abdominocentisis is useful in discerning
inserted in the rumen through the the causes of fluid distension in the
abdominal wall caudal to the xyphoid and abdomen. Two techniques can be
to the left of midline. Fluid is then utilized. The first technique is useful in
aspirated with a syringe. Local anesthesia ruling out a ruptured bladder as the cause
and sedation of the animal may be needed. of general ascites, and involves tapping the
This technique avoids saliva contamination abdomen at the lowest point and slightly
that can occur from collection with an to the right of midline. Care should be
orogastric tube and it appears to be less taken to avoid the prepuce in males. The
stressful. There is a slight risk of causing second technique is useful if peritonitis is
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

suspected. Since localized peritonitis is incision through the skin. A 14 gauge liver
more common than generalized peritonitis, biopsy instrument is inserted through the
four sites are tapped. The two cranial sites stab incision and intercostal muscles and
are slightly caudal to the xyphoid and into the liver. The biopsy instrument
medial to the milk veins on the left and should be directed towards the opposite
right sides. The two caudal sites are elbow in most cases, but utrasonography
slightly cranial to the mammary gland and will help determine the direction and
to the left and right of midline. For either depth needed. Vessels along the caudal
technique, manual restraint with sedation border of the ribs should be avoided.
is recommended, and the use of real time Samples can be submitted for culture (in a
ultrasonography may help locate fluid sterile plastic or glass vial or tube);
pockets. A twenty-gauge needle or teat histopathology (in formalin at a 10:1 ratio
cannula can be used for fluid collection. of formalin:tissue); and/or mineral analysis
Sterile preparation of the site is needed, (in a plastic tube). When performing a liver
and local anesthesia is necessary when a biopsy for mineral analysis, the biopsy site
teat cannula is employed. Fluid should be should be rinsed with distilled and
collected into a small EDTA tube for deionized water following sterile
analysis, and a sterile tube for culture. preparation to minimize contamination of
Fluid can be difficult to obtain, and is the sample. Samples for mineral analysis
usually in small amounts. Care should be should not be placed in formalin.
taken to minimize the ratio of EDTA to
fluid, since EDTA can falsely elevate protein
levels. Use of EDTA tubes made for small CSF Tap
animals, or shaking excess EDTA out of
large tubes will resolve this problem. Fluid A 20 gauge-1½ inch needle is used for
can also be collected for culture. Normal neonates, an 18 gauge -1½ inch needle for
values are similar to those for cattle (clear, adults. Ambulatory patients can be tapped
colorless to slightly yellow, 1-5 gm/dl standing. Non-ambulatory patients should
protein, < 10,000 cells). Cytologic be placed in lateral recumbency or in
examination is needed to characterize the sternal recumbency in a "dog-sitting"
cell population, and look for the presence position with the rear legs forward on
of phagocytized bacteria. either side of the animal. The pelvis needs
to be straight and level. The lumbosacral
area should be clipped and surgically
prepared. Wearing sterile gloves, the
Liver Biopsy
indention of the lumbosacral junction
Liver biopsy in small ruminants is should be palpated. A needle is inserted
performed using the same technique and into the deepest part of the indention,
instruments as in cattle. However, directly on midline. Keep the needle
sedation and ultrasound guidance are perpendicular to the spine from the side
recommended. The biopsy can be view, and straight up and down from the
performed in the 9th to 10th intercostal rear view. If bone is encountered, redirect
space slightly above an imaginary line from the needle slightly cranial or caudal until
the tuber coxae to the point of the elbow. the needle drops into the lumbosacral
Local anesthesia with lidocaine space. Advance the needle slowly until a
hydrochloride at the site should be slight "pop" is felt. The animal usually
performed following sterile preparation. A jumps slightly when the needle punctures
small scalpel blade is used to make a stab the dura mater. CSF should flow from the
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

needle or can be gently aspirated with a Materials: Rectal biopsy instrument,

syringe. If the needle is in the lumbosacral sharpened needle cap, or bottle cap.
space and advanced until bone is
Procedure: Place hand wrist deep into the
encountered again, back the needle out 1-
rectum. Secure a fold of mucosa between
2mm and try to aspirate. Place the fluid in
two fingers and pinch off a piece of the
an EDTA tube for fluid analysis and a plain
mucosa with the biopsy instrument
tube if cultures are desired. Normal, non-
inserted with the opposite hand.
traumatically obtained fluid should be
Alternatively, pinch off a piece of mucosa
perfectly clear with no discoloration,
between thumb and needle cap. Make
sediment or turbidity. It is best to have the
impression smears for acid-fast staining or
sample analyzed locally as soon as possible
place the sample in formalin for
(within one hour). If this is not possible,
histopathology.
place half of the sample in an equal volume
of 40% ethanol to preserve the cells Caution: Only go in wrist deep, staying in
(inform the laboratory that this has been the retroperitoneal area to prevent a full
done), or centrifuge half the sample to thickness biopsy and peritonitis.
concentrate the cells and prepare slides to
be sent with the rest of the fluid.
Fecal Smear:

Four-Point Nerve Block Indications: Diagnosis of Johne's Disease or

Cryptosporidiosis.
Indications: Localization of lameness to the
foot, anesthesia for surgery/therapy of the Materials: Acid-fast stain, slides
foot. Procedure: Smear a small amount of feces
Materials: 20 gauge-1½ inch needles, on a slide. Heat fix the slide for Johne's
lidocaine. and let it air dry for Cryptosporidiosis.
Under 40x or 100x, look for small, acid-fast
Procedure: 1. Insert the needle into the bacilli in clumps (Mycobacterium
dorsal aspect of the pastern, in the groove paratuberculosis), or round, refractile, acd-
between the proximal phalanges, just distal fast protozoa (Cryptosporidium).
to the fetlock. Administer 5cc of lidocaine
deep, and 5cc while pulling the needle out.
2. Repeat the previous block from the Lung Aspirate:
palmar/plantar aspect of the pastern, just
distal to the dewclaws. 3. Palpate the Indications: Obtaining fluid for culture in a
nerve over the lateral aspect of the fetlock, patient with respiratory disease.
approximately 2cm dorsal and proximal to Materials: 18 gauge-1½(calves) or
the dewclaw. Administer 5cc of lidocaine 3½(adults) inch needle, syringe.
over the nerve. 4. Repeat the previous
block on the medial side. Procedure: Insert the needle through an
intercostal space over an area where
abnormal lung sounds are auscultated.
Rectal Mucosal Biopsy: Aspirate fluid and place on culturette of
into blood culture bottle.

Caution: Stay close to the cranial border of

Indications: Cytology or histopathology for the ribs and beware of the heart. Fatal
diagnosis of Johne's Disease.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

hemorrhage from hitting a major vessel surface of the opposite claw. Do not
can occur. spread the acrylic onto the coronary band
or up on the soft part of the heel. Make
sure the block is positioned so that the
THERAPEUTICS animal does not rock back on its heel, and
the toe doesn’t tip up. Caution: If the
Hoof Block lameness worsens with the hoof block on
or if the animal develops a lameness after
wearing the block for several days, ,
A wooden, plastic or rubber hoof block, remove the block immediately and
placed on the normal claw removes the reevaluate the problem. The hoof block
source of pain by preventing weight may be causing the lameness. Also, the
bearing on the affected claw and allows heat produced during the hardening
the animal to ambulate comfortably while process can cause thermal necrosis of soft
healing takes place. This is an affective for tissues under the hoof wall. Use sparingly
treatment of P3 fractures, and is essential on the hooves of young calves and small
for treatment of sole ulcers and serious ruminants.
hoof cracks. Blocks 1-2 inches thick, cut to
fit the shape of the claw, with grooves on Other Uses of Acrylic
both sides, are glued to the hoof with some Acrylic can be used alone or in combination
type of bonding material. The wooden with wire to repair hoof wall defects.
hoof blocks and Technovit® acrylic can be However, the hoof defect must be clean,
obtained from Jorgensen Laboratories. dry, and free of infection before the acrylic
Bovi-Bond® is a newer product by Vettec can be placed over it. Hoof cracks are very
that is very easy to use. The same common in beef cattle. Many times they
company makes 1 inch plastic or rubber are found during routine foot trimming.
blocks that can be glued together if a taller The author does not recommend any
block is needed. The black plastic blocks treatment of hoof cracks unless they are
are the widest and fit beef bulls the best. causing lameness, especially if the patient
Although Cow Slips® are used routinely in is a bull receiving a hoof trim immediately
dairy cattle, they don’t always fit beef prior to breeding season and is not lame.
cattle, especially bulls. All products can be Many times in paring out hoof cracks with
found at Animart (www.animart.com or a knife or rotary tool, sensitive lamina is
800-255-1181). encountered and the animal becomes
Preparation of the claw is crucial for temporarily lame. Many animals have hoof
preventing the blocks from falling off too cracks for years with no lameness
soon. The claw should be clean, dry and associated with them. If the hoof crack is
level. Shallow grooves can be made in the causing lameness, then it must be treated.
sole with a hoof knife but are not
necessary in my opinion. The Bovi-Bond®
sets up quicker than the Technovit®, so Local Intravenous Anesthesia
everything should be ready. In cold, wet
weather, a hair dryer helps to quicken
setup. When applying the acrylic, pay Local intravenous anesthesia is the
particular attention to the axial surface, preferred technique for surgical
making sure it’s smooth and will not procedures of the foot and pastern.
irritate the interdigital space or the axial Although clipping is not necessary, a
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

surgical scrub should be performed prior to coffin joint is especially difficult to tap in
injection. A tourniquet is placed proximal cattle. If a needle can be placed in the
to the fetlock immediately prior to joint space, isotonic fluids can be
injection (vein will be distended best administered under pressure to distend the
immediately after the tourniquet is joint. A second needle is then placed in the
placed). Two sites of injection are joint space and a through and through
available. One vein runs down the center lavage is performed, preferably with about
of the dorsal aspect of the pastern and the 500-1000 mls. The larger the needle (14 to
other runs approximately 2cm dorsal to the 16 gauge) the better the lavage.
dewclaw, on both the lateral and medial
sides of the foot. A 20 gauge needle or
butterfly catheter is inserted into the vein Joint Arthrodesis/Facilitated Ankylosis
and 15-20cc of lidocaine or carbocaine is
administered. It is only necessary to
administer an anesthetic into one of these When septic arthritis of the coffin or
veins to provide anesthesia to the entire pastern joint has advanced to the point
area distal to the tourniquet. The that there are radiographic changes in the
tourniquet can be safely left on for up to 1 bone surrounding the joint, two options
hour to provide hemostasis during surgical exist. One is claw amputation and one is
procedures. joint arthrodesis. Joint arthrodesis is
preferable in valuable breeding animals,
especially bulls, because it saves the claw.
In feet with severe cellulitis, local Although the procedure is easy to perform
intravenous anesthesia can be difficult. In and relatively inexpensive, the aftercare
these cases, a four point nerve block or a (flushing wound, bandage changes,
simple ring block will also work. The two keeping a hoof block on and toes wired
interdigital injections performed in the four together, and/or cast application) can be
point block can be used for removal of an prolonged (1-2 months), which increases
interdigital fibroma. the cost over amputation. Also, if
significant cellulitis is present, or there is
radiographic evidence of osteomyelitis
Joint Injection and Lavage proximal to the joint being athrodesed, the
success rate of arthrodesis is poor, and
amputation should be considered. The
Septic arthritis is a serious condition that procedure is performed under local
requires immediate treatment. Although it anesthesia, and only requires a shop drill
is tempting to try systemic antibiotics alone and 1/4 and ½ inch drill bits (sterilized).
first, the chances of this working are low, There are several techniques described.
and if systemic antibiotics fail, the disease Contact the author for references
may have progressed to the point that the describing the details of the procedure.
joint can’t be saved. For joint lavage to be The owners should be aware that time to
successful, it needs to be performed very breeding soundness in bulls can be several
early (first few days) in the course of the months, even once the actual infection is
disease. Since veterinarians rarely see cleared. The fetlock joint can also be
these cases early, this is not a common successfully arthrodesed, although a splint
technique used for treatment of the coffin, or cast is needed for 6-8 weeks for support
pastern or fetlock joint in adult cattle. The during healing.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

both ketones and protein. Ketoacidosis is

common in small ruminants. Hypocalcemia
Pregnancy Toxemia
and hypokalemia may be present due to
anorexia. They are not always
hypoglycemic. Liver enzymes are usually
Pregnancy toxemia (twin lamb disease, found to be within normal limits, but
lambing or kidding sickness) is most occasionally may be increased.
common does with triplets, and/or are
either thin or obese. Much of the
abdominal space is occupied with multiple
Diagnosis is based on clinical signs, the
feti in the uterus during late gestation. Fat
presence of multiple fetuses, and typical
accumulation in the abdomen in obese
clinicopathologic findings. Differential
animals also occupies space. Because of
diagnoses include listeriosis, hypocalcemia,
lack of space for the rumen, these females
polioencephalomalacia, hypomagnesemia,
have difficulty consuming enough
and meningeal worm infestation.
feedstuffs to satisfy their requirements. In
late gestation, nutritional requirements
increase to 150% of maintenance with a
In small ruminants, very early cases (prior
single fetus and 200% with twins. Late
to recumbency) may be treated with oral
gestation is usually during the winter
glucose or glucose precursors. 60-100 mls
months, when less pasture is available, and
of propylene glycol orally twice a day, or
as a general rule, poorer quality feeds are
oral corn syrup or glycerol can be tried.
available. Pregnancy toxemia is also seen
Oral high energy calf electrolytes with
following anorexia secondary to other
bicarb can also be given orally. Rumen
diseases (ex. foot rot, ovine progressive
transfaunation, vitamin B complex
pneumonia, caprine arthritis encephalitis
(including B12, biotin, and niacin) are also
virus), or with stresses such as bad
recommended treatments.
weather, transporting, etc. There is also a
genetic predisposition in some individual
animals.
Once females show neurologic signs or
become recumbent, treatment must be
very aggressive. IV glucose, calcium
Very early signs of pregnancy toxemia are
borogluconate, and bicarbonate may be
mild depression, anorexia and possibly
needed.
limb edema. If left untreated, goats
become anorexic and depressed, and soon
become recumbent. Neurologic signs
including blindness, circling, Glucocorticoids (15–20 mg
incoordination, star-gazing, and tremors. dexamethasone) can help by causing
Constipation and teeth grinding can also gluconeogenesis, increasing appetite and
occur Icreased respiratory rate develops if inducing abortion. Prostaglandin (PGF2α)
acidosis occurs. If left untreated, does should also be used (5-10 mg) for induction
become recumbent. of parturition in does. Flunixin meglumine
(0.5-1 mg/lb) are indicated if endotoxemia
is suspected from dead fetuses.
Azotemia, both from dehydration and
secondary renal disease, is a common
finding. A urinalysis will be positive for
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Removal of the fetuses is critical in these Obstructive urolithiasis should be treated

severe cases. Assessment of fetal viability as an emergency. Immediate slaughter
with ultrasound helps with the decision to should be considered in feedlot or grade
induce parturition or perform a C-section. animals if rupture of the bladder or urethra
Since a breeding date is rarely known, age has not occurred. If surgery is indicated, it
of the fetuses is hard to determine. If the should not be delayed. Dehydration and
fetuses are alive, induction of parturition electrolyte abnormalities should be
can be an option. However, if the fetuses corrected with isotonic sodium chloride
are already dead, or the condition of the during surgery. If hyperkalemia is severe,
doe is severe, an immediate C-section is adding dextrose or sodium bicarbonate to
warranted. Fluid support during and after fluids may help decrease potassium.
surgery is critical. Low birth weights of Calcium may also be needed. Nonsteroidal
lambs, kids and calves at the beginning of anti-inflammatory drugs are an important
the birthing season can indicate potential part of therapy. Not only do they help with
risk of pregnancy toxemia. pain, shock, and urethral swelling in the
acute stages of the disease, they may also
help decrease the amount of urethral
Prevention of this disease is through stricture formation chronically. Broad-
proper nutrition. Maintaining animals in spectrum antibiotics should be
proper body condition throughout the administered prophylactically.
year, and making sure energy and protein
levels are adequate in late gestation are
important. For does in late gestation, hay In cases of urethral obstruction, if the penis
should have protein content of at least can be exteriorized, the urethral process
10%, and 1-2 lbs of concentrate should be can be removed with sharp scissors or a
fed per head per day. During periods of scalpel blade if it has not already necrosed
stress, particularly cold wet weather, off. Antibiotic and/or steroid cream can be
concentrate may need to be increased to applied to the penis. Removal of the
2-3 lbs/head/day (divided in two feedings). urethral process may relieve the
Parasite control, disease prevention and obstruction initially, but obstruction at the
decreasing stress are important. sigmoid flexure commonly occurs
secondarily, so careful monitoring for
recurrence is necessary. Sedation and/or
Ultrasonography can help determine which caudal epidural may facilitate
females have multiple fetuses, and these exteriorization of the penis. Acepromazine
animals separated into groups and fed is the sedative of choice as it may also have
accordingly. Addition of an ionophore in a antispasmodic effects on the urethra.
feed or mineral mixture will enhance the Xylazine should be avoided due to its
formation of the glucose precursor diuretic effects. Urethral catheterization is
propionic acid, and improve effeciency of difficult to perform and should be
feed utilization. performed with extreme caution to
prevent rupture of the urethra. A mixture
of 1 part 2% lidocaine and 3 parts saline
Urolithiasis may relieve some urethral spasms and
facilitate flushing.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

A more acceptable alternative to urethral intra-abdominal adhesions. Although

catheterization if removing the urethral breeding success rates following
process fails to relieve the obstruction or marsupialization have not been reported,
the obstruction recurs is chemical the author is aware of one animal that
dissolution of the calculi. Under general successfully bred females following bladder
anesthesia, the bladder is located with marsupialization.
ultrasound, and an 18 gauge 4 inch needle
is inserted into the trigone of the bladder.
Urine is aspirated until the bladder is small, The prognosis for urethral rupture is poor
and 30-60 mls of Walpole’s solution is compared to simple obstruction or bladder
placed in the bladder and removed again rupture if these are treated appropriately.
until the turbidity of the urine is decreased. With urethral rupture, urine still needs an
Then another 30 to 50 mls of Walpole’s outlet, so a urethrostomy or penile
solution is infused into the bladder and the amputation should be performed. Tube
needle removed. Urine flow is usually seen cystostomy or bladder marsupialization
in 24-36 hours, and is normal in 3-5 days. may not be able to be performed due to
A second infusion of Walpole’s may be the severe ventral accumulation of urine,
needed in some cases. and tissue necrosis. Multiple incisions in
the skin to allow drainage, and
debridement of necrotic tissue is
Several surgical procedures are available necessary. Severe adhesions of the
for urethral obstruction. If the animal is prepuce and penis may interfere with
destined for slaughter, temporary subsequent breeding.
measures such as perineal or ischial
urethrostomy or penile amputation can be
performed. Urethrostomy can be difficult Prevention
to perform in small ruminants, and
stricture formation with obstruction at the
surgical sight usually occurs in a few weeks Because preventive measures are
to a few months. If the stones can be dependent on the type of stone present,
palpated in the urethra, a urethrotomy can which is difficult to predict in small
be performed at this sight. However, ruminants, it is important to have calculi
stricture formation and reobstruction can analyzed. A thorough dietary history is
still occur. For cases in which breeding is necessary to determine any predisposing
important, or in pets in which long term dietary factors. Castration of pet animals
survival is important, a tube cystostomy or should be delayed as long as possible,
bladder marsupialization is recommended. preferably until the preputial attachment
to the penis has broken down.

If the tube cystostomy fails (estimated to

fail in about 20% of cases), or the animal is Increased water intake is indicated with
a pet and breeding is not desired, the any type of stone. This can be
bladder can be marsupialized. A stoma is accomplished by adding salt to the diet at
made lateral to the prepuce and as cranial 4% to 5%. If free choice trace mineralized
as the bladder will allow. Note that this salt is the source of minerals, intake of
surgery can be difficult to perform these may drop when salt is added to the
following a failed tube cystostomy due to ration. Therefore, adequate minerals
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should be added to the ration. Clean water to only what is needed if certain
should be provided at all times. In winter, production systems require them.
warm water can be provided to pet
animals to keep intake up.
Acidification of the urine can be
accomplished several ways. For large
Pet small ruminants not used for breeding numbers of animals, an anionic ration
tend toward obesity, and can usually be similar to that fed to dairy cattle to prevent
maintained on good quality grass hay. hypocalcemia can be fed. Also, ammonium
Concentrate supplements should be chloride can be added at 0.5% to 1% of the
reserved for breeding or feedlot animals. total ration, or 2% of the concentrate. For
The concentrate in the diet should be individual animals 5-10 grams/head/day
limited to 25% of the ration (feedlot rations should maintain the urine pH at
may be the exception). A 1.5 to 2:1 Ca:P approximately 6.5. This can be checked
ratio should be maintained in the entire weekly by the owner with pH paper.
diet. The total recommended amounts of Ammonium chloride is highly unpalatable,
calcium and phosphorus should not be and should be mixed with syrup or put in
exceeded, and magnesium should not be in gelcaps for administration (avoid molasses
excess. Adequate vitamin A should be since it is high in cations). Vitamin C has to
included in the ration, especially if dry be administered several times per day in
forages are the majority of the ration. ruminants to be effective so is impractical.
Legume hay should be avoided, or limited
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Basic Steps To Building Herd/Flock Health:

Part I And II

INTRODUCTION: The term “Herd Health” means different things to different people: both
producers and veterinarians. Many times producers equate a herd health program with a
vaccination program. However, much more that goes into preventive herd health programs
than just a good vaccination program.

It is most cost effective to personalize each program. Many ranches don’t need every vaccine
available, and in some cases recommendations don’t fit the business model of the ranch. I
stress to producers that they should not use “cookbook” programs found on the internet. They
should consult their veterinarian to tailor the program to their ranch.

Good record keeping is extremely important. Herd records along with management changes
and new information will allow the herd health program to be fine-tuned each year.

A key point for producers to understand is that health problems are not usually from a primary
disease issue. Management issues (nutrition, biosecurity, genetic selection, etc.) usually allow
a disease to take hold. It is futile to chase a disease problem if the underlying management
issues are not also addressed.

Herd health programs can be divided into six parts: nutrition; parasite control; biosecurity;
vaccinations; stress and genetics. .

NUTRITION more likely to die of cold stress and have

poor colostrum intake. Cows that cannot
If nutrition is optimized, health and
maintain their body condition also produce
production will be also. If it is not
poor quality colostrum, further
optimized, diseases and production losses
compounding failure of passive transfer
will be a problem. Poor nutrition (protein,
problems. Failure of passive transfer leads
energy, vitamins, minerals) depresses
to more disease and death in calves. Any
immunity to diseases and interferes with
calf that gets sick, even if it recovers, will
response to vaccination. Disease problems
not ever perform to its genetic potential.
my be subclinical, but they will be there.
Calves that have failure of passive transfer
For cow-calf ranches, nutrition in the brood but remain healthy still have decreased
cow has a major impact on calf health and performance. Cows that calve thin will
performance and ultimately the either not rebreed or will breed late. And
profitability of the ranch. One year of poor heifers born to thin cows, even when
nutrition can have impacts for multiple managed with appropriate nutrition, will
years. When cows cannot maintain have decreased reproductive performance
adequate body condition, dystocia when compared to heifers born to cows in
problems increase. Thin cows have trouble good condition. This all adds up to fewer
pushing with enough force to have calves pounds of calf weaned per cow for multiple
in a timely manner. This leads to more years and decreased productivity of feeder
stillborn and weak calves. Weak calves are calves and heifers beyond weaning.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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of concern (BVD, Trichomoniasis, etc.);

quarantine new arrivals and any animals
PARASITE CONTROL
that are returning from shows or sales;
avoid fence line contact with neighboring
herds; and purchase breeding stock and
Good parasite control is essential for good embryo recipients from as few sources as
health and productivity, especially in young possible.
animals. Controlling parasites increases
weaning weights, milk production, and
conception rates. Parasites are also
VACCINATIONS
immunosuppressive, so overall disease
resistance and response to vaccines is
decreased in parasitized animals.
As mentioned before, there is no
generic/cookbook vaccination program.
Many programs are similar, but each
BIOSECURITY
should be tailored to the ranch.
Management issues such as disease risk,
breeding season, disease history, locale,
I do not know who to credit with this etc. must all be taken into consideration. A
quote, but it is one of my favorites: “Most “generic” vaccination program would have
disease is bought and paid for”. A good to cover all known diseases and be safe to
biosecurity program will protect a herd recommend for all herds. The result would
from diseases in which there is not a good be a more costly but less effective
vaccine available or what’s available is very vaccination program.
expensive. It is futile to try to eliminate a
disease problem if you are not going to
prevent it from coming back into the herd.
GENETICS
Biosecurity plans can be challenging and
time consuming to develop initially, but
they are the cheapest and most effective
Genetically selecting animals that are more
means of disease control. No disease
resistant to diseases would be attractive.
prevention program will work without
This is an area of much interest and
biosecurity. There are different levels of
research is currently ongoing to investigate
risk and therefore biosecurity needs with
the genetics of disease resistance for
different management/business models. It
problems such as respiratory disease and
is up to the veterinarian to discuss the risks
parasites.
of certain management practices and
business models and help producers
develop practical biosecurity plans that fit
each ranch. Fetal programming and epigenetics are
also areas of ongoing research. Fetal (or
developmental) programming is the
concept that a maternal stimulus or insult
Biosecurity plans do not have to be
at a critical period in fetal development has
complicated. Since beef breeding animals
long term impacts on offspring. For
are usually housed outdoors, the elements
example, nutritional stress in the 1st and
help with disease control. Some simple
2nd trimesters of pregnancy can lead to
biosecurity recommendations are a good
problems with fetal organ development
start: test purchased animals for diseases
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and vascularization/placental Much recent research emphasis is being

development. Epigenetics is the study of placed on genetic selection of “high
heritable changes in gene expression or immune responders”-animals that
cellular phenotype caused by mechanisms genetically are less likely to be diseased.
other than changes in the underlying DNA Some progress is being made that has the
sequence. The resulting adverse long- potential to really improve animal health
term effects reflect a mismatch between and welfare.
fetal environmental conditions and the
conditions that the individual will confront
later in life. For example, when calves are DECREASE STRESS
born to thin cows, they may later have
health and performance issues when
placed on full feed in the feedyard. Other stressors such as castration,
Knowing the implications of our dehorning, weaning, commingling,
management practices could lead to handling should be minimized. Stress
recommendations on matching cows to depresses the immune system making
their ideal environment and managing animals more susceptible to disease. It
feeder and breeding cattle for better also interferes with vaccine response.
performance.
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Índice
CARLOS PINTO
Carlos R. F. Pinto, MedVet, PhD, DACT
Professor of Theriogenology, School of Veterinary Medicine
Louisiana State University, Baton Rouge, Louisiana

2.2.1 Update On Reproductive Physiology And Pharmacology ................................... 252

2.2.2 Clinical Management Of Ovarian And Uterine Disorders.................................... 255
2.2.3 Clinical Management Of Accidents Of Gestation In Cattle ................................. 258
2.2.4 Principles And Applications Of Reproductive Ultrasonography .......................... 264
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Update On Reproductive Physiology And

Pharmacology

INTRODUCTION: Knowledge of basic reproductive physiology is essential to understand

reproductive phenomena in health and disease. This knowledge is useful in designing or
modifying estrus synchronization protocols or therapeutic plans of common reproductive disease
that can be treated with hormones.

ESTROUS CYCLES synchronization. At the end of diestrus, if an

embryo is not present in the uterus to
The entire estrous cycle averages 21 days
provide a pregnancy signal, the uterus
long, but it can be as short as 18 days and as
releases prostaglandin that lyses the corpus
long as 24 days. Estrus lasts 18 to 20 hours
luteum, resulting in a decline of
but may be shorter in hot, humid weather
progesterone and the cow returns to
because of heat stress. Estrus can be
proestrus, which is a stage of the cycle that
particularly shorter in Bos indicus cows.
lasts 2 or 3 days until the cow becomes
Ovulation (Day 0) occurs 12 to 18 hours
sexually receptive again (estrus).
after the end of estrus. Estrus is followed by
metestrus (days 1 to 3), which is the time of
luteal development noted by rising
FOLLICLE DYNAMICS (‘WAVES’)
concentrations of blood progesterone. A
bloody discharge from the vulva may be Ovarian follicles develop and grown
noticed in nearly half of all cows and heifers in a continuum characterized by periodic
1 or 2 days after they are in estrus. The and constant appearance of tertiary
blood originates from diapedesis of follicles. This gradual and repeated growth
erythrocytes leaking from caruncular of follicles occurs in cycles known as follicle
capillaries in response to estrogen waves. Most cattle have 2 or 3 follicle
withdrawal. During metestrus, a corpus waves during an estrous cycle. A follicle
hemorrhagicum (CH) is formed at the site of wave is comprised of three distinct stages:
ovulation. This structure will develop into a recruitment, selection and dominance. A
corpus luteum over the next few days. key factor for the success of estrus
During metestrus the CL is not susceptible synchronization resides on the ability of
to the luteolytic action of a single veterinarians to pharmacologically induce a
administration of prostaglandin. The next new follicle wave, so that an “young” and
phase is called diestrus (Days 4 to 18) is the “fresh” oocyte is available for fertilization.
time that the mature corpus luteum is This same concept is extremely important
functional and secretes progesterone. when one is attempting to superovulate
During diestrus there are waves of follicular cows in embryo transfer programs:
growth that are important in understanding treatment with superovulatory doses of FSH
a cow's response to estrous cycle
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must be initiated at the time of emergence FSH secretion for ~ 48 hours

of a new follicle wave. following estradiol administration,
followed by a resurgence of FSH
HOW TO INITIATE OR INDUCE A NEW
concentrations by Day 2 to 3
FOLLICLE WAVE?
following the estradiol treatment
 One practical way to induce the that results in the emergence of a
emergence of a follicle wave is to new follicle wave by day 4. It is
use treatments of GnRH in estrus important to check with the
synchronization programs. A new regulatory agencies in your country
follicle wave starts in ~ 2 days to verify whether or not the use of
estrogen in food-producing animals
o Refer to the estrus synchronization is approved.
discussion
 DRF refers to dominant follicle
 Injections of estradiol (17-beta, removal. The use of transvaginal
benzoate or valerate) can ultrasonography to aspirate the
successfully induce a follicle wave in preovulatory follicle or any follicle
~ 4 days. This apparently protracted larger than 5 mm (follicle ablation)
time from the treatment results is very efficient in inducing a new
from an initial down regulation of follicle wave in ~ 1.5 days.
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Table 1. Common drugs utilized in bovine reproductive management

Bovine Drugs & Route Dose Regimen

dosage form
hCG I.V.; 1,000-2,500 IU
I.M.
Induction of 1,000 IU / ml Single dose
ovulation
GnRH 50mcg/ml I.V.; 100 mcg
I.M.
Bioidentical PGF2α I.M. 25 mg
(Dinoprost tromethamine;
Lutalyse®, 5mg/ ml; or
HighCon 12.5 mg/mL
Double injection
Synthetic PGF2α 500 mcg
11 or 14 days
(cloprostenol; or
Estrus Estrumate®, 250 mcg/ml)
150 mcg
synchronization
d-cloprostenol; 75
mcg/mL
Controlled Internal Drug vaginal One implant Leave for 5 or 7
Release (CIDR; 1.9 g days; PGF2α
progesterone) upon removal
Melengestrol acetate Oral 0.5 mg/cow/day Risk reduced
fertility
treat for 14 days
*Estradiol benzoate I.M. 2.5 mg Induce follicle
if approved in your country wave
Natural PGF2α (Dinoprost I.M. 25 mg
tromethamine;
Single dose until
Lutalyse®, 5mg/ ml 100 days of
Synthetic PGF2α 500 mcg gestation and
I.M. between 7
(cloprostenol;
months until term
Elective Estrumate®,
termination of
250 mcg/ml)
pregnancy
Dexamethasone 25-35 mg Single dose 4
I.M. months until
(Azium®, 2mg/ml)
term; may add
PGF2α
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Clinical Management Of Ovarian And

Uterine Disorders

FOLLICULAR CYSTS (CYSTIC OVARIAN •nymphomania

DISEASE)
•decreased milk production
BACKGROUND
– Predominant progesterone
Bovine ovarian cysts are anovulatory production
structures persisting for varying periods of
•prolonged interestrus interval
time that continue to be a significant source
of financial loss in dairy cattle, and to a •anestrus
lesser extent in beef cattle. Cystic ovaries
may affect cows for longer periods of time, TREATMENT
causing a greater loss to individual herds – GnRH (gonadotropin-releasing
and producers. The occurrence of COD hormone); 100 mcg; IM
continues to have significant economic
impact in the bovine industry. – hCG (human chorionic
gonadotropin)
PATHOGENESIS AND CLINICAL SIGNS
•2,000 to 3,000 IU IV or IM
Current considerations: Normal
preovulatory follicles measure on average – May associate with CIDR
15 to 20 mm in diameter. Follicular cysts (progesterone)
have been traditionally defined as follicular •7-10 days
structures that remain anovulatory for at
least 7-10 days, measure > 20-25 mm – Finish treatment with PGF2alpha at
diameter 7-10 days following GnRH/hCG treatment

•May have corpus luteum present CONSIDERATIONS

•Non-steroidogenic cysts may allow •Most commonly seen in dairy cows during
follicular waves to resume the first 2 months post partum

•Pathogenesis – Good response to treatment

– Actually some resolve
– Abnormal LH release spontaneously
– Decreased circulating levels of •What about beef cows?
estrogen, progesterone in high-producing
dairy cows owing to high metabolic – Some become chronically cystic
clearance
•Unresponsive to treatment
•Overall, largely unknown
•Our approach for chronic conditions:
CLINICAL SIGNS OF STEROIDOGENIC
ACTIVE CYSTS – hCG then 24 hours transvaginal
follicle aspiration + CIDR for 14 days
– Predominant estrogen production
followed by recheck and PGF2alpha
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Luteal Cyst – PGF2alpha

•Typically an old follicular cyst that

becomes partially luteinized
Mucometra
•Diagnosis by palpation/ultrasonography
•May or not be associate with CLs
•Treatment
•Often secondary to tubal, uterine or
– Often responsive to PGF2alpha cervical pathology
– I recommend to treat luteal cyst as
– Salpingits
describe above for follicular cysts followed
– Endometritis
by PGF2alpha in 7-10 days
– Cervical obstruction
•Use of CIDRs may be optional
•Treatment

– Difficult because underlying

Cystic Corpus Luteum primary reason may be chronic

•Not luteal cyst (pathologic) •Poor prognosis due to endometrial

atrophy
•Suggestion for new terminology

– “corpus luteum with a cavity”

– Also known as “hollow CL” Endometritis
– Physiologically normal; no
•May be subclinical
treatment required
– Diagnosis by •“repeat breeder”
ultrasonography
GRANULOSA-THECA CELL TUMORS •Diagnosis

•Most common ovarian tumors; somewhat – Ultrasonography

rare in the bovine – Low volume lavage
•Culture
•Benign
•Endometrial cytology
•Treatment: surgical removal; contralateral
ovary enables reproductive potential •Often performed to rule out uterine
problems as cause of apparent infertility
UTERINE DISEASES
Uterine abscess
Pyometra
•Relatively uncommon
•Associated with the presence of a
functional corpus luteum •Secondary to severe endometritis or
iatrogenic (AI, ET flushes, etc)
– Closed cervix
•Treatment difficult
– Accumulation of pus in uterine
horns •Poor prognosis

•Clinical signs Fetal mummification

– Pseudopregnancy •It occurs after formation of the placenta

– Anestrus and fetal ossification (~ 70 d gestation)
•Treatment
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– Between the 3rd and 8th months of – Laparotomy or colpotomy (not for
gestation large fetuses)
– Functional corpus luteum •Our recommendation
– Closed cervix
– Treat with PGF2alpha for a couple
•Causes are difficult to confirm
of days
•Infectious: bovine viral diarrhea (BVD),
– Recheck in 3 to 5 days
leptospirosis, fungus,
•Dilate cervix with PGE2 (1000-1500 mcg
•Mechanical: compression or torsion of the
misoprostol) if needed or dealing with
umbilical cord
“large” mummies
– Uterine torsion
– Defective placentation – Avoid injections of estradiol to
•Genetic anomalies, chromosomal dilate cervix
abnormalities

•Diagnosis
Fetal maceration
– Transrectal palpation and
ultrasonography •Fetal death and retention
•appearance of a compact, firm, and – Complete or partial following
immobile mass without placental fluid or abortion with incomplete cervical dilation
placentomes. (less common)
– Often normal physical exam; Except – Bacterial contamination of uterine
rare decrease in milk production and a loss contents
of weight •Fetid vaginal discharge; crepitation, fluid,
•Treatment fetal bones
– PGF2alpha: I recommend 2 or 3 •Treatment
doses given once daily
– Not rewarding
– Efficacious; safe expulsion of fetus – Hysterotomy
•If treatment with PGF2alpha fails… •Extensive endometrial damage invariably
(uncommon) leads to infertility; culling often
recommended
– Surgical removal
– Oocyte aspiration for IVF is an
option for extremely valuable animals
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Clinical Management Of Accidents Of

Gestation In Cattle

FETAL MUMMIFICATION persistent corpus luteum that not only

keeps the cervix closed but also prevents
Background
signs of estrus, thus, mummified fetuses
The overall incidence of fetal may be retained indefinitely. Spontaneous
mummification varies from 0.43 to 1.8% of expulsion of mummified fetuses seldom
pregnancies but it can be as high as 3-4% in occurs; affected cows typically have a
feedlot heifers due to incomplete history of failing to calve on time.
regression of corpus luteum following
Treatment
induced abortion. Mummification of the
fetus can only occur after calcification of The treatment of choice is PGF2alpha (25
the fetal skeleton, therefore, fetal death mg dinoprost i.m); expulsion of mummified
followed by mummification may occur fetus is expected in 2 to 4 days. The
anywhere from 3rd to 8th month of breeding prognosis good; cows typically
gestation; most cases occur during 4-6 conceive in 1 to 3 months following
months. Causes may include torsion of the expulsion of fetus. Surgical removal is
umbilical cord, Campylobacter fetus, fungal indicated if fetus is not expelled after
infection, leptospirosis, Infectious Bovine therapy with PGF2alpha.
Rhinotracheitis and Bovine Viral Diarrhea,
FETAL MACERATION
etc. These infectious agents have in
common the fact they do not induce Background and Pathogenesis
placentitis and endometrial release of
prostaglandin F2alpha; and are not The incidence of fetal maceration is 0.09%
pyogenic. Fetal mummification may be of pregnancies. Fetal death followed by
seen in ewes that become infected with maceration may occur at any stage of
toxoplasmosis during early gestation. gestation. If it occurs prior to calcification,
the fetus will decompose in fetal tissue
debris contained in a purulent liquid
material. If fetal demise occurs after fetal
Pathogenesis and Clinical Signs
calcification, and bacteria from the caudal
In mummification, fetal death occurs reproductive tract gain access to the
without luteolysis and adequate cervical uterus, it will result in bacterial
dilation. It results in autolysis and fluid decomposition of autolyzing fetus and
resorption in a non-pyogenic environment; membranes. Clinically, there will be a
fetus & membranes become dehydrated, compact mass of bones in a collection of
resulting in a dark brown, leathery fetus purulent material. For these reasons, fetal
with shrunken dried skin and bones. There maceration with a closed cervix and a
is no odor or exudate present. Cows functional corpus luteum is rare.
affected with mummified fetuses do not
Clinical Signs
show signs of estrus because there is a
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Usually a chronic, fetid reddish-gray watery saliva and secretions of the nasopharynx
or mucopurulent discharge from the vulva from fetus.
is seen over a period of several weeks to
Hydramnios is a relatively uncommon
months. In some cases, there may be toxic
condition caused by autosomal recessive
metritis early but systemic illness is
genes characterized by an abnormal
typically absent in later stages. Cows with
accumulation of amniotic fluid.
macerated fetus may experience gradual
Pathologically the amount of amniotic fluid
weight loss and decline in milk production.
greatly increases up to 8-10 times (25-150
Treatment liters in cows).Its incidence is only 5-10% of
uterine dropsy cases. The condition is
No satisfactory treatment is available. Poor
associated with a genetic or congenitally
breeding prognosis due to severe
defective fetus that has impaired
endometrial damage. Surgical removal can
swallowing. The increase of amniotic fluid
be attempted if warranted by the animal’s
is gradual. Hydramnios is seen most
value but it is often a frustratingly
commonly in cattle, and occasionally in
unrewarding effort.
sheep.
FETAL EMPHYSEMA
Clinical Signs and Prognosis
Similar to fetal maceration in that
Hydramnios is characterized by a gradual
putrefactive bacteria invade the uterus
enlargement or filling of the amniotic
through an open cervix.It is often detected
cavity over several months during latter
in later term pregnant animals. Fetal death
half of gestation. The gradual abdominal
may be associated with dystocia or
enlargement lasts leads to a pear-shaped
incomplete abortion in late gestation.
abdomen when the cow is seen from her
Gross fetal changes include putrefaction,
rear. It is often not noticed until
distension with fetid gases, crepitation, dry
parturition, when a large volume syrupy,
hair and coat secondary to extensive fluid
viscous, meconium stained fluid is released
loss and fetal dehydration. Dystocia
during calving. In examining cows
involving a fetal emphysema is a
suspected to having hydrops, it would be
complicated and grave condition that is
important to differentiate hydrops of the
commonly fatal to the dam. In ewes,
amnion or the allantois compartment. In
Clostridium chauvoei may be involved;
cows affected with hydramnions, the
usually poor prognosis.
placentomes, and often fetus can be
HYDRAMNIOS (HYDROPS OF THE palpated because the chorioallantois,
AMNION) amnion and placentomes are normal.
Dystocia is common due to uterine inertia
Background and Pathogenesis and defective/abnormal fetus. Retention of
Normal amnion: The amniotic fluid is clear, placenta is a common sequela; milk
colorless, and mucoid in nature. Under production in subsequent lactation is
normal conditions, the volume of the generally poor.
amniotic compartment is regulated by the
 The prognosis for future breeding
fetal swallowing. In early to mid-gestation life of the dam is good, but the
the amniotic fluid is watery; in late fetus is invariably defective and
gestation, the fetal bladder sphincter nonviable.
prevents urine outflow and the amniotic
fluid becomes more viscid. The HYDRALLANTOIS (HYDROPS OF THE
accentuated mucoid nature is owing to ALLANTOIS)
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Background and Pathogenesis abdominal distension leads to digestive

symptoms such as anorexia, decreased
Normal allantois: The allantois fluid is
ruminations and ultimately constipation.
clear, watery, and amber colored. There is
Hydrallantois can be misdiagnosed as
only a small amount of allantois fluid
indigestion, bloat, or traumatic gastritis.
produced from the allantois epithelium
The pulse is elevated (90-140/min),
prior to functional fetal kidneys. The
accompanied by expiratory grunt.
allantois cavity stores fetal urine delivered
through the umbilical cord via urachus. In Reproductive examination: the excessive
late gestation and under normal fluid cause the uterus to palpate greatly
conditions, the volume of fluid may reach 8 distended and tense; the distension in the
to 15 liters. allantois compartment precludes the
palpation of placentomes or fetus.
Hydrallantois is a much more common
Complications include uterine rupture,
hydrops condition than hydramnios (85-
rupture of pre-pubic tendon, and ventral
90% of hydrops conditions); both beef and
hernia. In mild cases, hydrallantois may not
dairy cattle are affected. In hydrallantois,
be diagnosed until term, when an excessive
fluid accumulation may reach 50 to 200
clear, watery, amber fluid with
liters. Excessive fluid has specific gravity
characteristics of transudate is passed
and characteristics of a transudate due to
during calving. A greatly enlarged and
vascular disturbance occurring in allantois.
atonic uterus may cause dystocia. Fetuses
It is generally characterized by a diseased
are usually slightly smaller than normal and
uterus with many non-functional caruncles
present with edema and ascites. Fetal
and some placentomes greatly enlarged.
membranes may be tough and difficult to
Adventitial placentation is common, with
rupture. The fetus is generally dead at birth
portions that are necrotic and edematous.
or dies soon after. Fetal membranes may
Cystic kidneys, hydronephrosis and
be heavy and edematous, and retained
dysfunction of the fetal tubules with
fetal membranes and septic metritis are
resultant polyuria are seldom involved in
common sequelae. These complications
pathogenesis of hydrallantois. It generally
account for the relative high morbidity and
affects cows > 3 years, unless heifers are
mortality of hydrallantois. The prognosis is
affected with congenital caruncle deficit. In
therefore guarded for life and fertility.
older cows caruncle deficit may reflect
Salvage by slaughter is the best option for
prior uterine infection or injudicious
most producers. Milk production in
removal of fetus and/or retained
subsequent lactation is generally poor.
membranes leading to a defective
endometrium and caruncles. TREATMENT OF HYDRAMNIOS AND
HYDRALLANTOIS
Clinical Signs and Prognosis
Varies with duration and severity
Occasionally develops as early as 5th month
of condition. In severe cases, an early
of gestation in severe cases. It usually
decision to salvage is best while affected
develops rapidly over 1 to 3 weeks during
cows are still in good physical condition.
late gestation; the distended uterus fills a
Alternately, prompt termination of
tense, barrel-shaped abdomen (bilateral
pregnancy is desirable and the best
abdominal distension). The resulting
approach. Induction of
marked abdominal enlargement leads
parturition/abortion in affected cows can
farmers to question breeding dates or
be achieved by administering 20 mg
suspicion of triplets! Eventually, the
dexamethasone and 30 mg of PGF2alpha
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that result in cervical dilation and abortion removal of large volume of fluid may
within 24 to 48hrs. Inducing abortion is induce shock. Appropriate fluid therapy in
more successful with hydramnios. Dystocia large volumes indicated before, during, and
can occur in association with defective after surgery. When terminating
fetus (hydramnios) and uterine inertia hydrallantois by Cesarean section, the
secondary to uterine distension uterus may continue to fill with transudate
(hydrallantois). Weak abdominal muscles for about 48 hours and it may require
and absence of strong abdominal pressure further draining. Retention of fetal
are common; cervical dilation are often membranes and secondary metritis is
incomplete. A trochar or plastic tube can common; treat early with local and
be used to draw fluid off slowly over 24 parenteral antibiotics and oxytocin to aid in
hours prior to Cesarean section. Rapid continuing evacuation of the uterus.

Table 1. Hydrallantois and hydramnios

Characteristic Hydrallantois Hydramnios

Prevalence 85–95% 5–15%

Rate of development Rapid (within 1 month) Slow over several months

Shape of abdomen (Bilaterally) round and (unilaterally) pear-shaped, not

tense tense

Palpation (per rectum) of Nonpalpable (tense uterus) Palpable

placentomes and fetus

Gross characteristics of fluid Watery, clear, amber- Viscid, may contain meconium
colored transudate

Fetus Small, normal Grossly abnormal

Placenta Adventitious Normal

Refilling after trocharization Rapid Does not occur

Occurrence of complications Common Uncommon

Outcome Abortion or maternal death Parturition at approximately full

common term

Adapted from: M. Drost. Complications during gestation in the cow. Theriogenology

2007;68:487-491;
S.J. Roberts. Veterinary obstetrics and genital diseases (theriogenology)
(3rd ed.) 1986:225;
V. Sloss, J.H. Dufty (Eds.), Handbook of bovine obstetrics, The Williams & Wilkins Co., Baltimore,
MD 1980:89 .
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UTERINE TORSION birth canal and initiate the cervical dilation

and contractions (Ferguson Reflex).
Background and Pathogenesis
Torsions or rotations of the uterus at 45 to
Uterine torsion is most common in 90º are often found during pregnancy and
dairy cows, but occasionally seen in beef generally correct themselves. Unusual
cows, sheep and goats. The etiology cases involve 180 to 360º torsions that
involves anatomy, manner of lying down, leads to obstruction of blood supply to
and maybe sudden falls or rolling. The uterus  congestion, edema, shock, and
lesser curvature of uterus in late gestation may be gangrene of uterus. Under these
is supported dorso-laterally by the broad conditions, fetal death is unavoidable.
ligament. The greater curvature lies free in
abdominal cavity resting on abdominal
floor, supported by rumen, the viscera, and Reproductive Examination: Diagnosis of
abdominal walls. In ruminants the gravid uterine torsion and its direction is done via
horn is in the shape of an arc or a U-shaped palpation per rectum. The amount of
loop with the vagina and ovary at the tension on the broad ligaments and
respective ends of the arc. The ovarian end arteries indicates severity of torsion.
of the gravid horn forms a narrow base Vaginal walls spiral and a stenosis of the
upon which the uterus rests. Torsion vagina is present but in pre-cervical
involves the rotation of this arc on its torsions there may be no vaginal
transverse axis, and involves both gravid involvement. In ~ 75% of the cases, the
and non-gravid uterine horns. Each time cranial portion of the vagina will show a
cow lies down or rises, the gravid uterus is characteristic twisting of the vaginal folds.
suspended in the abdominal cavity, and a Torsions may be clockwise or counter-
sudden slip or fall could cause torsion clockwise. Left torsions are more common
(down front first; up back first). An than right. A left torsion means that the
increased incidence is seen in cows right uterine (gravid) horn moved to the
subjected to stall confinement in the left side. In most cases, the position of the
winter. Torsion of the gravid uterus occurs fetus will be dorso-pubic in 180º torsions.
more frequent in pluriparous than Prognosis in torsions prior to term depends
primiparous animals; it generally occurs in upon duration and degree of torsion, and
advanced pregnancy. Most torsions occur severity of symptoms. If torsions > 180º
in late first stage or early second stage are diagnosed and treated early, prognosis
labor and may be associated with strong for dam and fetus are good. Prior to term,
movements of the fetus. Uterine torsions best methods of correction are rolling or
<180º may be present for days or weeks via laparotomy. Complications include
without clinical symptoms until labor uterine rupture and hemorrhage from
begins and dystocia results. ruptured vessels. Only rarely does torsion
recur in the subsequent pregnancy.

Clinical Signs and Prognosis

TREATMENT OF UTERINE TORSION
Usually history of prolonged 1st stage of
labor (i.e. restless, colic behavior);
abdominal straining is absent, or mild and
A. Rolling the Dam
intermittent as fetus cannot enter into
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 Disadvantage is manpower (3-6  Loop passed over one fetal limb

needed). and loop on other side of rod
 Caste cow in lateral recumbency passed over 2nd limb.
onto side of torsion.
 Aim to have loops just above
 Tie both hind limbs and both
fetlocks.
forelimbs together, leaving 8-10
foot of rope free for pulling.  Use short broom handle or large
 Hold head extended with halter. screw driver through eye in rod
 Rotate cow rapidly onto opposite and wrap chain tightly around it.
side  body overtakes the more
slowly rotating gravid uterus.
 If successful, the spiral folds and C. Laparotomy
stenosis of birth canal will have
disappeared. If cervix dilated, fetus  Useful earlier in gestation, or when
may be palpated with ease and cervix closed.
there may be a rush of fetal fluids.  Try rolling first if assistance
 May require 2 or 3 rapid rotations available.
to succeed.  Open on side of torsion and pass
 Schafer's method requires less hand down between uterus and
assistance as the cow is rolled abdominal wall and grasp fetal
slowly with a plank holding uterus limb. Rock up and down 
stationary. momentum  lift in direction
 Cow caste on side of torsion. opposite to torsion.
 One end of a 3-4 meters plank (20-
30 cm wide) placed over cow's D. Cesarean Section
para-lumbar fossa and assistant
stands on plank.  Indicated when other methods fail
or when the cervix not adequately
dilated.
B. Rotation of fetus and uterus per  In dystocia, cervix may have
vagina undergone constriction and
 Only possible if cow at term & has emphysematous fetus now
a partially dilated cervix. present.
 Must be able to introduce hand  Generally cervix only partially
into uterus to grasp fetus – access dilated due to atony of cervix and
depends on severity of twist. uterus(circulatory disturbance).
 Rupture membranes first to
release fluids  reduce size and E. Complications/Sequelae
weight of the uterus.
 Rock back and forth  momentum  Uterine rupture with peritonitis -
 vigorous twist in opposite Internal hemorrhage - Retained
direction to torsion. fetal membranes - Septic metritis.
 Detorsion rod – 1 cm steel rod, 80-
100 cm long with eye at either end.
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Principles And Applications Of

Reproductive Ultrasonography

INTRODUCTION: Although we are all familiar with reproductive ultrasonography today, it is valid
to remember that was not until a couple of decades ago that this extraordinary technology
revolutionized the knowledge of female bovine reproduction
o Increased knowledge of reproductive physiology
o Increased knowledge of reproductive pathology
 Potential applications
o Routine clinical applications
o Advanced clinical applications
o Research applications
 This presentation will concentrate on the value of ultrasonography for routine clinical
applications and examples of its use for advanced assisted reproduction in cows

ROUTINE CLINICAL APPLICATIONS  Hydrosalpinx

 Palpation per rectum allied with – Ovarian dynamic events

transrectal ultrasonography  Require serial examinations

– Powerful tool  Detection of follicle growth follicle

– Its routine use should be selection, confirmation of
implemented ovulation, etc
 Equipment
– Use in embryo transfer
– Portable units with linear-array  Evaluation of the response to
transducer (typically 5 to 7.5 MHz) superovulation protocols
designed for transrectal use
 Follicle development
– Choose 5 MHz transducers If only
one transducer is being purchased  Number of corpora lutea before
more versatile for general use embryo collection
 Ovarian structures
 Assessment of recipient’s corpus
– Follicles luteum
 Average size of preovulatory follicles:
15-18 mm  Uterus

– Corpora lutea – Invariably used for pregnancy

 It can be solid, uniformly echoic or diagnosis but bovine practitioners
with a cavity (7-10 mm) should develop an appreciation for
interpreting normal and abnormal
– Pathology uterine changes in the non-
pregnant cow
 Follicular cysts
– Pregnancy
 Luteal cysts  Adequate restraint
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 Easily adapted by experienced REASONS SUPPORTING THE ADOPTION

practitioners OF ULTRASONOGRAPHY

 High sensitivity and specificity  Professional

especially during early gestation
– Ultrasound technology is not yet
(between days 25 to 30)
widely used by bovine practitioners
 Diagnosis of twin pregnancies – Increased diagnostic power
 Assessing breeding efficiency
 Management?
 Trouble-shooting infertility
 Does not increase accuracy of
pregnancy diagnosis > 45 days – Use in combination with estrus
synchronization protocols
 Except for inexperienced “palpators”
– Veterinarians are the only group
 Detection of early embryonic loss that can perform ultrasound
examinations in most states in the
 Repeat breeders US
 Fetal sexing  Some farmers elect to purchase their
own ultrasound equipment

 But they generally lack knowledge

ADVANCED CLINICAL USE and adequate training to efficiently
use this technology
 Transvaginal ultrasound guided
procedures – Veterinarian and Client satisfaction
– Aspiration of chronic ovarian  Economics
follicular cysts – Viable investment
– Aspiration of follicles for oocyte  1-3 years to pay for cost of
collection equipment
 In vitro production of embryos
 Not including fetal sexing

 Example: 7-14 days earlier diagnosis

of non-pregnant animals
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Índice
POSTERS

3.1. Ana Maria Quessada ............................................................................ 268

3.2. Juan David Cordoba ............................................................................ 271

3.3. Maria grazia Tovar ............................................................................... 274

3.4. Maria Jose Gonzales ............................................................................ 276

3.5. Raquel Arellano Bastidas ..................................................................... 277

3.6. Raquel Watanabe ................................................................................ 278

3.7. Jose Luis Torreblanca Arana 280

3.8. Rachel Cristina Ruivo Carazzatto 287

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CASTRAÇÃO QUÍMICA EM CÃES COM ÓLEO

DE CRAVO DA ÍNDIA
Raquel Freire Feix1 , Bruna Gabriela Kaiser Côrrea, Mayara da Silva Trentim2 , Rita de
Cássia Lima Ribeiro, Ana Maria Quessada3 .

INTRODUÇÃO: Atualmente, o método mais efetivo para controlar a população de cães

errantes é a castração cirúrgica. No entanto, tal método apresenta limitações como necessidade
de anestesiar o paciente, equipamentos cirúrgicos, instalações adequadas e a presença de um
médico veterinário (CATHEY & MEMON 2010). Diante deste cenário, a castração química tem
sido sugerida como uma alternativa rápida e de custo baixo (OLIVEIRA et al 2011). Neste
procedimento são introduzidos agentes esclerosantes nos testículos (KUTZLER & WOOD, 2006).
No entanto, a injeção intra-testicular de substâncias esclerosantes pode provocar dor intensa,
mas a literatura é precária quanto à avaliação do processo inflamatório e da dor em animais
castrados quimicamente (ROSSETTO et al., 2012). Recentemente foram divulgados estudos
utilizando-se óleo essencial de cravo da índia em cães para realização de castração química
(ABSHENAS et al 2013, ABU-AHMED, 2015).

OBJETIVO: O presente artigo tem o objetivo de analisar a morfologia testicular de cães

submetidos à castração química com óleo essencial de cravo da índia, bem como mensurar a dor
nestes animais por meio de escalas.

figura 1. Cão, sem raça definida, 10 kg, entre os dois grupos. A consistência dos
submetido à castração química com óleo testículos foi considerada firme para os cães
essencial de cravo (Eugenia caryophyllus). dos dois grupos na palpação realizada antes
A: administração de lidocaína (4mg/kg) no dos procedimentos. Sete dias após, os
cordão espermático. B: Injeção intra- testículos dos cães do grupo tratado (óleo
testicular de óleo essencial de cravo da índia de cravo) apresentaram consistência rígida.
(0,5ml em cada testículo). Quarenta e cinco dias após a castração
química, a consistência testicular destes
cães estava normal. Nos cães do grupo onde
se injetou solução fisiológica a consistência
dos testículos foi considerada normal em
todas as avaliações. Os testículos dos
animais do grupo tratado (óleo de cravo)
apresentaram diferença estatística entre a
mensuração basal (antes do procedimento)
e sete dias após a aplicação do fármaco. No
entanto, não houve diferença
RESULTADOS estatisticamente significativa entre os
grupos em relação ao volume testicular ao
Os pacientes apresentaram apenas dor leve
longo do tempo. Os testículos dos cães em
nas duas escalas empregadas. Não se
que foi injetada solução fisiológica
obteve diferença estatística significativa
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apresentaram aspecto macroscópico Figura 3: Histopatologia de testículo de cão,

normal no corte longitudinal (Figura 2A). Os submetido à injeção intratesticular de
testículos em que foi administrado óleo de solução fisiológica (grupo controle) em
estudo sobre castração química. A: Túbulos
seminíferos sem alterações morfológicas
em objetiva de 4 x. Estão separados por um
delicado estroma de tecido conjuntivo
frouxo e células intersticiais (setas brancas).
cravo (grupo tratado) apresentaram B: Objetiva de 10 x, observando-se luz
coloração amarelada e evidente tubular (setas pretas). C e D:: Lâmina
degeneração testicular (Figura 2B). A própria tubular, apoiada na membrana
histopatologia dos testículos dos animais basal observando-se células de Sertoli
em que foi injetada solução fisiológica (setas amarelas) e no interstício células de
(grupo controle) demonstrou aspecto Leydig (seta azul). E: Ducto epididimário,
normal (Figura 3). Nos animais tratados com células que revestem o ducto são ciliadas na
óleo de cravo foram observadas severas luz do túbulo. Não há alterações
alterações degenerativas (Figura 4). morfológicas evidentes. Objetiva de 10x. F:
Ducto epididimário sem alterações
METODOLOGIA morfológicas evidentes. Objetiva de 40x.
Células que revestem o ducto são ciliadas na
Foram utilizados doze cães, divididos em
luz do túbulo (seta azul). É possível
dois grupos iguais (grupo controle e grupo
encontrar espermatozoides (seta preta).
tratado). Realizou-se anestesia local
infiltrativa (cordão espermático e Figura 4: Histopatologia de testículo de cão,
intratesticular) (Figura 1A). Quinze minutos submetido à injeção intratesticular de óleo
após a realização da anestesia foi de cravo (Eugenia cariophyllata) (grupo
introduzido óleo essencial de cravo da índia tratado) em estudo sobre castração
na dose de 0,5 ml em cada testículo para o química. A: Objetiva de 4x. Nota-se
grupo tratado (Figura 1B) e 0,5ml de solução alteração no tecido conjuntivo dos septos
fisiológica em cada testículo para o grupo testiculares que separam os lóbulos dos
controle. Os testículos de todos os cães túbulos seminíferos. Há uma proliferação
foram avaliados por palpação e foi realizada de fibroblastos cicatriciais, aumentando o
biometria do saco escrotal. A avaliação da espaço do septo. B e C: Objetiva de 10x.
consistência e as mensurações da bolsa Observa-se, necrose difusa nos túbulos e
escrotal foram repetidas sete dias após os interstício, não evidenciando as células que
procedimentos e aos quarenta e cinco dias. compõem as estruturas do túbulo
Antes e após a introdução dos fármacos nos seminífero. D: Objetiva de 40x. Encontra-se
testículos, os animais foram submetidos a moderado infiltrado inflamatório com
avaliações de intensidade da dor por meio predomínio de células mononucleares (seta
do emprego de duas diferentes escalas: amarela), apresentando distribuição
escala analógica visual e escala de Glasgow multifocal. E: Objetiva de 10x e F: Objetiva
modificada. Aos 45 dias de realização dos de 40x. Ducto epididimário com células de
procedimentos, os pacientes foram revestimento tubular, apresentando núcleo
submetidos à orquiectomia bilateral. Os preservado, porém o citoplasma
testículos foram colhidos e processados vacuolizado (setas pretas). Degeneração
histologicamente sendo corados por hidrópica das células ciliadas. Observa-se
hematoxilina-eosina. Os dados obtidos infiltrado inflamatório misto (setas
foram analisados estatisticamente. brancas).
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CONCLUSÃO

A administração de óleo essencial de

cravo (Eugenia caryophyllus) em testículo
de cão produz alterações morfológicas
macroscópicas e microscópicas, mas não
causa dor com o emprego do protocolo
analgésico proposto. Sendo assim, o óleo de
cravo torna-se uma alternativa preferencial
para ser usada em programas que utilizam a
castração química como ferramenta para
esterilização de cães.
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VARIACIÓN EN LA CONCENTRACIÓN DE
CORTISOL SÉRICO DE BOVINOS PRE Y POST
TRANSPORTE EN CUNDINAMARCA
González-Rozo LV1, Quiroga-Villarraga S1, Rodríguez-Rodríguez MA1, Córdoba-Parra JD2

INTRODUCCIÓN. Actualmente existe una creciente preocupación pública sobre el bienestar de

los animales en la mayoría de los países del mundo. Los estudios etológicos aplicados de la
motivación, la cognición y la complejidad del comportamiento social en animales han dado como
resultado el rápido desarrollo de la ciencia del bienestar animal (Broom, 2011). El embarque,
transporte y desembarque son momentos que generan altos niveles de estrés en el bovino,
provocando pérdidas económicas relacionadas con contusiones, mortalidad, bajo rendimiento
de la canal y alteración de las variables organolépticas de la carne, entre otros (Gallo y Tadich,
2005). Los parámetros utilizados para evaluar el estrés o el bienestar se basan comúnmente en
medidas simpato-adrenales, como la frecuencia cardíaca, hormonas plasmáticas, metabolitos e
indicadores inmunes (Jacobson y Cook, 1998).

OBJETIVO. Veterinario privado para procesarlas

mediante la técnica de ultrafiltración.
Evaluar la variación en la concentración
sérica de cortisol en bovinos pre y post RESULTADOS.
transporte desde Tabio a Facatativá,
La concentración de cortisol sérico en los
Cundinamarca.
animales antes del transporte van desde
MATERIALES Y MÉTODO. 10,4 ng/ml hasta 18,8 ng/ml y la
concentración de cortisol al momento de
Camión característico para la movilización
desembarque del transporte va desde 20,4
de bovinos en Colombia. Elementos de
hasta 42,5 ng/ml.
restricción física (brete, lazos); Fundas o
camisas de agujas de punción intravenosa- DISCUSIÓN.
vacutainer; Tubos de recolección de sangre
La concentración de cortisol total sérico en
sin anticoagulante; un camión, 12 bovinos
vacas en lactancia es de 4,5 ±0,7 ng/mL y de
de la raza Gyrolando de 12-24 meses (nueve
cortisol libre fue de 0,3 ng/mL (Shutt y Fell,
hembras, tres machos), equipo de
1985). En un estudio en Chile, en un
transporte de muestras. Se procede a
transporte de 63 horas en terneros de
recolectar la muestra en los animales en un
carne, las concentraciones de cortiol en
brete antes de embarcados,
sangre fueron significativamente más bajas
posteriormente son embarcados y
después de desembarcar los animales
transportados en un recorrido de 45
comparado con los resultados antes del
minutos desde Tabio hasta otra hacienda en
embarque (Werner et al., 2013). En este
Facatativá, Cundinamarca. Luego se
caso, las concentraciones de cortisol sérico
desembarcaron y se tomaron nuevamente
pre transporte fueron de 15,25 ± 2,4 ng/mL
muestras de sangre en un brete. Las
y post transporte de 32,65 ± 5,8, resultando
muestras se llevaron a un laboratorio
casi en el doble el incremento de sus
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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concentraciones comparando los dos animal welfare and meat quality.

momentos. Agro-Ciencia, 21(2):37-49.

Conclusión. El embarque y transporte  Jacobson LH, Cook CJ. (1998).

generan incremento en las concentraciones Partitioning Psychological and
séricas de cortisol en bovinos, incluso en Physical Sources of Transport-
trayectos cortos (45 minutos). related Stress in Young Cattle. The
VetelinauJournal, 155: 205-208

 Shutt DA, Fell LR.

REFERENCIAS.
 Werner, M, Hepp C, Soto C,
 Broom D. (2011). Animal welfare:
Gallardo P, Bustamante H, Gallo C.
concepts, study methods and
(2013). Effects of a long distance
indicators. RCCP, 24(3).
transport and subsequent recovery
 Gallo C, Tadich N. (2005). Transport in recently weaned crossbred beef
of cattle for slaughter: effects on calves in Southern Chile. Livestock
Science, 152(1): 42 - 46
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
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PREVALENCIA DE MASTITIS EN UNA

LECHERÍA EN CHIQUINQUIRÁ, BOYACÁ,
COLOMBIA.
Vanegas-Ramírez A1, Roa-García LA1, Rojas-Ballesteros LF1, Córdoba-Parra JD2

INTRODUCCIÓN. La mastitis es una enfermedad con una amplia distribución a nivel mundial,
que se define como la inflamación de la glándula mamaria que generalmente se presenta como
una respuesta a la invasión por microorganismos y se caracteriza por daños en el epitelio
glandular, seguido por una inflamación clínica o subclínica (Pinzón A. , 2007). Esta enfermedad
genera graves problemas económicos para la industria lechera, entre los cuales se encuentran
la disminución en la producción de leche y costos de tratamientos, entre otros. Puede clasificarse
como clínica o subclínica (Abebe, 2016). Una de las técnicas empleadas para evaluar la afección
de las glándula mamaria es el California Mastitis Test (CMT)®, esta prueba estima un conteo total
de células somáticas, por medio de un reactivo; es una prueba sencilla, de bajo costo, practica y
se pueden obtener resultados diagnósticos de forma inmediata (Ballón 2013; Anderson 2014).

OBJETIVO. La prevalencia de mastitis por vaca en este

estudio fue de 66%. Pinzón (2007), encontró
Determinar la prevalencia de mastitis en
una prevalencia de mastitis clínica y sub
una lechería en Chiquinquirá, Boyacá,
clínica mayor al 50%. Dentro de los factores
Colombia.
asociados se reporta el inadecuado manejo
MATERIALES Y MÉTODOS. en la rutina de ordeño, ya que favorece la
transmisión de microorganismos patógenos
Se realizó un chequeo de mastitis en de cuartos infectados a cuartos sanos
noviembre de 2017 con un producto a base (Abebe, 2016). De acuerdo a los hallazgos
de sulfato de sodio y raqueta para de la afección por cuartos en este estudio,
evaluación de mastitis por cuartos, en 24 no concuerda con lo reportado por Bonifaz
vacas en producción de leche raza Holstein. (2016), quien encontró que el cuarto más
El ordeño se lleva a cabo en la lechería con afectado es el posterior derecho, seguido
un equipo mecánico. La lechería está del cuarto posterior izquierdo.
ubicada en el municipio de Chiquinquirá,
Departamento Boyacá, Colombia. CONCLUSIONES.

RESULTADOS. Se encontró en el estudio una prevalencia

del 66% de mastitis en la lechería, lo cual
Se encontró una prevalencia por animal de evidencia un problema a nivel sanitario
66% (16 / 24 animales), de los cuales el 4% relacionado con la salud de la glándula
(una vaca) presentó mastitis clínica y las mamaria y posiblemente repercutiendo la
demás presentaron mastitis sub clínica. La calidad de la leche. La mastitis clínica fue de
prevalencia por cuartos fue de 47,9% (46 / 4% y la sub clínica de 62%, reperestando en
96 cuartos). El cuarto posterior izquierdo valores absolutos que de 16 vacas afectadas
fue el más afectado (50%), seguido por el con mastitis, una corresponde con el mayor
anterior izquierdo (45%), luego el anterior grado de severidad (clínica). Se recomienda
derecho (41%) y por último el posterior revisar los posibles factores que estén
derecho (37%). influenciando la alta prevalencia de mastitis
DISCUSIÓN.
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e impementar nuevas estrategias para los Andes peruanos. Veterinaria y

reducir este porcentaje. Zootecnía.

Bonifaz, N. y F. Conlago. (2016). Prevalencia

e incidencia de mastitis bovina mediante la
prueba de California Mastitis Test con
REFERENCIAS identificación del agente etiológico, en
Paquiestancia, Ecuador. La Granja: Revista
Abebe, R. (2016). Bovine mastitis: de Ciencias de la Vida. Vol. 24(2):43-52.
prevalence, risk factors and isolation of ISSN: 1390-3799.
Staphylococcus aureus in dairy herds at
Hawassa milk shed, South Ethiopia. BMC Pinzón, A. (2007). Efectos de la mastitis
Veterinary Research 12:270. subclínica en algunos hatos de la cuenca
lechera del alto Chicamocha (departamento
Anderson, K. (2014). Encyclopedia of de Boyacá). Retrieved from Universidad De
Agriculture and Food Systems: Detection La Salle:
and Causes of Bovine Mastitis with
Emphasis on Staphylococcus aureus.
Elsevier. http://repository.lasalle.edu.co/bitstream/
handle/10185/6031/14001088.pdf?sequen
Ballón, C. (2013). Prevalencia y factores ce=1
asociados a la mastitis subclínica bovina en
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

ESTUDIO PRELIMINAR DE TIPIFICACIÓN

SANGUÍNEA EN CANINOS EN CASOS DE
EMERGENCIA
Salgado Sergio1, Tovar María Grazia1*, Valdivia Ángel1

INTRODUCCIÓN: La transfusión sanguínea en medicina veterinaria es una práctica médica que

se ha desarrollado en los últimos años (1). En la actualidad, fuera de la transfusión de sangre
entera, se cuenta con la transfusión de hemoderivados como el concentrado de glóbulos rojos,
plasma fresco, concentrado de plaquetas, entre otros (1,2). También se han desarrollado
productos sintéticos que sirven para casos de emergencia como la oxyglobina (3). El sistema DEA
es la clasificación de tipos de sangre aceptada internacionalmente para caninos, la cual reconoce
12 grupos de sangre, incluyendo DEA 1, 3, 4, 5 y 7 y el nuevo grupo llamado DA l (4) El grupo DEA
1 contiene tres antígenos DEA1.1, DEA1.2 y DEA 1.3; siendo el DEA 1.1 el más común y más
antigénico en perros de diferentes países (45-64%)(4); sin embargo, el DEA 1.2, y según algunos
autores, el DEA 7 también se pueden considerar antigénicos(2). No se han identificado
aloanticuerpos naturales contra este antígeno por lo que reacciones inmunológicas en la primera
transfusión son raras. Sin embargo, si se trasfunde sangre DEA 1.1 a un paciente que es negativo
para este antígeno, se estimula una respuesta de anticuerpos. Frente a una segunda exposición
todos los glóbulos rojos trasfundidos serán destruidos en menos de 12 horas (1,2). Durante la
preñez y lactancia se pueden inducir aloanticuerpos para DEA 1.1 hasta en un 25% de los perros
(1,4).
Existen varios métodos para tipificación sanguínea (5,6). La tipificación en laboratorios de
referencia hace que sea poco práctico y oneroso. La presencia de kits comerciales simplifica este
proceso y se obtienen resultados rápidos y en la misma clínica (5,6). Los caninos con presencia de
antígeno DEA 1.1 son considerados receptores universales, mientras que los negativos para el
antígeno (DEA 1.1-) son considerados donadores universales; y el pasaje de sangre de un
paciente DEA 1.1 +, así sea en la primera transfusión, no está recomendado (5,6).

OBJETIVOS: sensorio, alteraciones del pulso, signos

eminentes de shock), con 6 unidades de
Identificar el tipo de sangre de los pacientes
sangre entera provistas por un banco de
caninos sometidos a una primera
sangre comercial, con códigos de
transfusión sanguínea en caso de
identificación diferentes, y 3 donadores
emergencia.
(requisito no haber tenido transfusión
METODOLOGÍA: previa). Previo a la transfusión se utilizó el
kit comercial de tipificación sanguínea en
Se trabajó con 9 pacientes que llegaron a la caninos (Alvedia® Blood typing DEA 1) tanto
clínica con un hematocrito menor a 20% y para las unidades de sangre como para las
signos de descompensación asociados a la muestras de sangre con EDTA de los
anemia o hipovolemia (membranas pacientes y donadores. La técnica de
mucosas pálidas, tiempo de llenado capilar tipificación es en base a
mayor a 2”, taquicardia, afección de inmunocromatografía utilizando
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

anticuerpos monoclonales específicos. Se aloanticuerpos naturales que puedan

coloca una gota de sangre del paciente y generar una reacción transfusional aguda
una del reactivo y se espera 2 minutos por importante; bajo ninguna recomendación
los resultados. La tinción de la banda de actual se sugiere, aún en la primera
control refiere que la prueba fue bien transfusión, el pasaje de sangre DEA 1.1+ a
realizada. La presencia de dos bandas en la un individuo DEA 1.1-, en base a que el
tira indica positivo para DEA 1.1+. Si la tiempo de sobrevida de glóbulos rojos es
tinción es débil se considera DEA 1.1+ débil menor y se sensibiliza la sangre para un
(DEA 1.2), si solo se pinta el control se futuro. Consecuentemente este paciente
considera DEA1.1-. Los resultados describen estará sensibilizado de por vida y ante el
si el paciente presenta antígeno DEA 1.1 ó marco de una segunda transfusión con
1.2 (DEA 1.1+) o no los presenta (DEA 1.1-). sangre DEA 1.1+ el riesgo de reacciones
Los resultados fueron tabulados y transfusionales agudas, y de la vida del
resumidos en frecuencia de tipo de sangre. paciente es muy alto. Asimismo, estos
También se realizó prueba crossmatch en anticuerpos van a ser trasladados por la
los casos en los que se contó con donador (3 leche materna (calostro) afectando la vida a
casos). futuro de los cachorros DEA 1.1-. Estudios
de casos han señalado que la transfusión de
RESULTADOS Y DISCUSIÓN:
DEA 1.1+ débil en individuos DEA 1.1- de
Se obtuvo un total de 8/18 (44.4%) igual manera genera una producción alta de
animales positivos para el DEA 1.1+, de los anticuerpos contra el antígeno DEA1.1+.
cuales 1/8 fue débil considerándose DEA
CONCLUSIONES:
1.1+débil (DEA1.2). Por otro lado, 10/18
(55.6%) fueron DEA 1.1-. Todos los 1) La tipificación sanguínea debe realizarse
receptores (100%) resultaron DEA1.1-; de como parte de un control sanitario en etapa
los donadores el 88.9% (8/9) fueron de cachorro.
positivos al antígeno DEA 1.1+ y 1/9 fue
2) La tipificación sanguínea debería ser
negativo para el mismo. Todas las pruebas
parte de un protocolo de primera
crossmatch resultaron sin evidencia de
transfusión.
aglutinación o hemólisis macro o
microscópica. La tendencia de los grupos 3) No se debe transfundir sangre DEA 1.1+ a
sanguíneos corresponde a la bibliografía un paciente DEA 1.1- bajo ninguna razón.
revisada. En los casos donde los donadores
fueron DEA 1.1+ y los receptores no, se 4) Se requiere realizar estudios con más
consideró la búsqueda de nuevas unidades pacientes para establecer porcentajes
de sangre. Si bien, los caninos no presentan estadísticos de los tipos de sangre en
caninos en nuestra población.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

CARACTERIZACIÓN DEL MANEJO DE

RESUCITACIÓN CARDIOPULMONAR (RCP)
EN CANINOS Y FELINOS EN CLÍNICAS
VETERINARIAS DE LIMA METROPOLITANA
Y CALLAO
Gonzales Vigil Maria Jose1, Salgado Sergio1, Grandez Ricardo1

Clínica Veterinaria Cayetano Heredia, horas, y más del 50% no contaban con las
Facultad de Medicina Veterinaria y medidas de preparación ni herramientas
Zootecnia de la Universidad Peruana adecuadas para atender un paro
Cayetano Heredia. cardiorrespiratorio. La intubación
endotraqueal, el acceso venoso y el uso de
La resucitación cardiopulmonar (RCP) es un
compresiones torácicas laterales son
protocolo organizado para proporcionar
técnicas frecuentemente utilizadas en una
soporte artificial a la ventilación y
RCP. Sin embargo, no siempre se siguen las
circulación de un individuo ante un parto
recomendaciones para la atención
cardiorrespiratorio (PCR), hasta que este
adecuada de una RCP. Se observó la
restaure la respiración y circulación
tendencia por optar por una frecuencia de
espontánea. La ejecución de esta técnica e
compresiones menor a 80cpm y una
un reto tanto para médicos humanos y
frecuencia respiratoria mayor a 16rpm,
médico veterinarios alrededor del mundo
contrastando con lo recomendado de
debido a una baja de supervivencia. Menos
100cpm y 10rpm. Más del 50% prefiere
del 6% de los perros y entre 2% a 10% de los
utilizar dosis alta de fluido terapia y
gatos que generan un PCR salieron de alta.
fármacos como epinefrina a dosis alta,
La Sociedad Veterinaria de Emergencias y
glucocorticoides y doxapram; terapéutica
Cuidados Críticos (VECCS) mediante la
no recomendada para el manejo de una
Campaña de Evaluación en Reanimación
RCP. No existe diferencia entre médicos
Veterinaria (RECOVER) presentó una serie
veterinarios que recibieron entrenamiento
de recomendaciones consensuadas para la
sobre RCP sobre aquellos que no. Se
aplicación y estandarización de la técnica de
concluyó que el manejo de RCP se realiza de
RCP en caninos y felinos. Debido a la falta de
manera heterogénea y sin protocolos. Esto
información de las técnicas utilizadas en
evidencia la falta de entrenamiento y
Lima metropolitana y la Provincia
capacitación profesional, reflejado un
constitucional del Callao, se realizaron
deficiente manejo del soporte vital tanto
encuestas con la finalidad de caracterizar el
básico como avanzado. Con el fin de
manejo de RCP en caninos y felinos en los
mejorar el desempeño de los médicos
centros veterinarios de estas áreas. De 100
veterinarios en el área de emergencias y
médicos veterinarios encuestados, el 52%
cuidados críticos, es necesaria la
fueron mujeres, predominando
implementación de estrategias de
profesionales menores de 35 años y con
capacitación continua.
menos de 10 años de tiempo de ejercicio
profesional. El 66% de profesionales no
laboraban en centros con atención las 24
 INDICADORES DEMOGRÁFICOS Y
ESTIMACIÓN DE LA POBLACIÓN DE CANES
Y FELINOS DOMÉSTICOS CON DUEÑO EN EL
DISTRITO DE SAN BORJA, LIMA-PERÚ, 2017
Raquel Arellano1, María del Carmen Napurí2,
Milagros Osorio2, Daphne León1, Néstor Falcón1

RESUMEN: El comportamiento de la tenencia de perros y gatos varía de acuerdo con el lugar

geográfico en el que se desarrolla la estimación. Su conocimiento es importante para el
desarrollo, promoción y planificación adecuada de los programas de salud preventiva,
educación sanitaria y tenencia responsable de animales de compañía. El objetivo del estudio
fue cuantificar los indicadores demográficos y estimar la población de canes y felinos
domésticos en el distrito de San Borja. Para esto, se diseñó un estudio observacional con base
en encuestas que consideraron como variables: tipo de viviendas, número de personas por
vivienda, tenencia y número de canes y felinos domésticos, características demográficas (sexo,
edad y raza), datos reproductivos y edad de fallecimiento del último can o felino. La recolección
de la información se hizo en viviendas, que se seleccionaron con base en un muestreo
estratificado aleatorio de manzanas o conjuntos habitacionales, encuestándose 10 viviendas en
cada caso. Se recolectaron 871 encuestas válidas, las que provinieron principalmente de casas
(57.7%) y departamentos (40.8%). Del total de las viviendas el 54.2% tenía perros y 11.6%
gatos. El promedio de animales por vivienda fue de 1.4 para los canes y 1.7 para los felinos. Se
obtuvo una relación persona: can de 5:1 y persona: felino de 19.5:1. El porcentaje de
supervivencia de las crías fue estimado en 88.6% en perros y 88.4% en gatos y la esperanza de
vida estimada fue de 9.44 y 7.38 años, para canes y felinos domésticos respectivamente, en el
mismo orden. El principal uso de los canes y felinos fue como mascota (97.9% y 100%
respectivamente). En canes predominó la tenencia de machos (57.2%), de raza pura (67.5%),
no esterilizados (70.4%), tamaño pequeño (45.6%) y con una edad promedio de 4.26 años. En
felinos, predominaron las hembras (55.3%), esterilizados (63.5%), raza cruzada (79.6%) y con
una edad promedio de 2.52 años. Estos valores aportan información demográfica relevante de
canes y felinos domésticos que habitan en San Borja, la cual servirá para mejorar la
planificación de programas de vacunación y tenencia responsable de estas poblaciones.

PALABRAS CLAVES: San Borja, perros, gatos, población, rabia.

 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

ESTUDIO COMPARATIVO DE LA
DETERMINACIÓN DE EDAD BOVINA POR
CRONOLOGÍA DENTARIA Y LONGITUD DEL
CARTÍLAGO DE LAS APÓFISIS ESPINOSAS
DE LAS VÉRTEBRAS TORÁCICAS
Carlos Medina Sparrow1,2,
Susana Lem Guerra1, Raquel Watanabe
Watanabe1, Jorge Vilela Velarde1

RESUMEN: La evaluación en pie de los animales de abasto es una estimación importante de las
características que presentan las carcasas. En el Perú, el sistema de clasificación y tipificación
cárnica se basa en la descripción de las características físicas de la res, principalmente, por el
patrón de erupción y desgaste dentarios. Aunque la estimación de la madurez por la dentición
(evaluación de los dientes incisivos permanentes) es el método más utilizado, la edad fisiológica
se puede estimar mejor por el grado de osificación de los cartílagos de las vértebras sacras,
lumbares o torácicas. La osificación cartilaginosa es progresiva en sentido caudocraneal
conforme el animal madura cronológicamente., iniciándose en la región sacra, continuando en
la región lumbar para, posteriormente, finalizar en la región torácica (botones) de la canal a los
6 años de edad en promedio. El objetivo del presente estudio fue comparar la determinación de
la edad por cronología dentaria con la longitud del cartílago de las apófisis espinosas de las
vértebras torácicas en bovinos de las razas Brown Swiss, Cebú y criollo mejorado. Se evaluaron
375 carcasas de bovinos machos de las razas Cebú, Brown Swiss y Criolla, divididos en 5 grupos
etarios acorde a la edad cronológica dentaria (dientes deciduos, dos, cuatro, seis y ocho dientes),
y se determinó las longitudes de los cartílagos de las apófisis espinosas de las vértebras torácicas
1-4. Se encontró diferencia significativa entre el peso de carcasa y la longitud de la apófisis
espinosa de la primera vértebra torácica de las razas Criolla y Brown Swiss (p<0.0001), y Criolla
y Cebú (p<0.0001), mas no entre Brown Swiss y Cebú (p=0.0855). La correlación entre el peso y
la longitud de las apófisis espinosas fue negativa y significativa (p<0.001). Asimismo, se observó
diferencia estadística significativa entre los cinco grupos evaluados en relación a la longitud de
los cartílagos de las apófisis espinosas de las primeras cuatro vértebras torácicas y la edad
dentaria, lo que sugiere que el método de determinación de la edad mediante la evaluación de
la madurez fisiológica del animal beneficiado es confiable.

PALABRAS CLAVE: bovinos, edad, dientes, apófisis espinosas, vértebras torácicas

 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

EVALUACIÓN TRANSCRIPTÓMICA DEL

PERFIL INMUNE CELULAR EN LA MUCOSA
INTESTINAL DE CRÍAS DE ALPACAS
(VICUGNA PACOS)
Raquel Watanabe Watanabe1,2,3, Alberto Manchego Sayán2

RESUMEN: El objetivo del estudio fue estimar cuantitativamente la expresión génica de los
factores transcripcionales (T-bet, STAT-1, STAT-4) y las citocinas (IL-2, IL-2, IFN-γ, TNF-α)
involucradas en la activación y desarrollo de linfocitos Th1 de la mucosa intestinal de crías de
alpacas de tres grupos etarios de 1-8, 10-21 y 22-47 días de edad, criadas en un sistema extensivo
en los Andes peruanos. Se obtuvo muestras intestinales de cuatro centímetros de la porción
media del yeyuno de las crías de alpaca de la Estación Experimental IVITA Maranganí (Cusco),
las que fueron almacenadas a -196°C y procesadas en la Facultad de Medicina Veterinaria de la
Universidad de San Marcos (Lima, Perú). Se extrajo los ARN totales y se realizó las RT-qPCR en
tiempo real. La expresión cuantitativa del ARNm fue estimada estimó comparando los perfiles
de expresión en el calibrador (feto) mediante el método 2-ΔΔCt usando GAPDH como control
endógeno. La expresión de STAT-1, T-bet, IL-2 y TNF-α se incrementó con la edad en el grupo de
mayor edad, mientras que la expresión de IFN-γ excedió en cien veces la del calibrador (p<0.05).
La expresión de STAT-4 e IL-12 no fue significativa. Las expresiones de ambos factores
transcripcionales activados por IFN-γ, T-bet (p<0.05) y STAT-1 (p> 0.05), aumentaron con la edad,
del mismo modo que las citocinas involucradas en la respuesta Th1. La expresión de IFN-γ superó
en más de 100 veces la del calibrador, lo que evidencia la activación de los linfocitos Th1. No
obstante, no puede descartarse la participación de células natural killer, LT CD8+ y LTγδ en la
producción de esta citoquina, así como el efecto de parásitos intracelulares y bacterias
comensales que promueven la estimulación de las células dendríticas a través de la activación
de TLRs y, en consecuencia, la producción de IFN-γ.

PALABRAS CLAVE: transcriptómica, respuesta inmune celular, mucosa intestinal, alpaca

1
Carrera de Medicina Veterinaria y Zootecnia, Facultad de Ciencias Veterinarias y Biológicas,
Universidad Científica del Sur (UCSUR)
2
Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos (UNMSM)
3
rwatanabe@cientifica.edu.pe
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

ESTENOSIS INTESTINAL EN YEYUNO POR

CUERPO EXTRAÑO EN CANINO SCHNAUZER
DE 8 AÑOS
Ureta Escobedo Alexander1,
Torreblanca Arana Jose Luis2,
García Chávez Allison Judith3

INTRODUCCION: La estenosis refiere a la constricción/estrechamiento de un orificio/conducto

corporal, congénito o adquirido. Puede ocurrir por cuerpos extraños, intususcepción y menos
comúnmente por adhesión. La ingestión de cuerpos extraños en caninos se atribuye a hábitos
alimenticios indiscriminados, dando como resultado desequilibrio de electrolitos, hipovolemia y
toxemia que también se suman a mala digestión y mala absorción de nutrientes (Stagnant loop
Syndrome o Síndrome de Asa Estancada).

OBJETIVOS RESULTADOS

Obtener casuística no muy común en Se programó al paciente para cirugía, previa

nuestro medio, para mejorar el diagnóstico transfusión de sangre completa. En la
de pacientes con procesos crónicos y así laparotomía se observó estenosis intestinal
seguir los casos posteriores de la mejor a nivel de yeyuno, se realizó enterectomía
manera posible. de la zona afectada, el resto de órganos no
presentaban alteraciones macroscópicos.
En la muestra retirada se encontró material
METODOLOGIA de textura dura y color negro insertado en
las paredes del intestino.
Presentación del caso: Paciente canino de
raza Schnauzer de 8 años de edad de
nombre George, con historial de anorexia,
CONCLUSIONES
emesis y diarrea intermitente además de
pérdida progresiva de peso de noviembre
de 2016 a Junio de 2017. Tiempo en el cual
Se concluye que muchas veces en el
se realizaron exámenes complementarios
diagnóstico de cuerpos extraños ninguna
como hemograma, coproparasitológico,
prueba es concluyente al 100%, debiendo
bioquímica sanguínea y examen completo
realizarse diferentes pruebas antes de llegar
de orina con resultados no concluyentes.
a un diagnóstico definitivo.

En junio de 2017 se realizó ecografía

BIBLIOGRAFÍA
abdominal donde lo más resaltante fue la
evidencia de líquido libre en abdomen y
presencia de líquido en asas intestinales,
además de congestión de las mismas y a la 1. Clark, W.T (1968) Foreign Bodies In The
par se realizó estudio radiográfico de Small Intestine Of The Dog, Veterinary
abdomen donde se evidencia gran cantidad Record 83, 115 – 119. 2. Spencer A.
de gases en asas intestinales. Johnston, Karen M. Tobias (2018)
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

Veterinary Surgery Small Animal Second Cats: A Retrospective Study Of 208 Cases.
Edition, 1749, 1750. 3. B. Chandra Prasad, 5. L.G Papazoglou, M.N. Patsikas, P.
M.M Rajesh, Ch. Mallikarjuna Rao (2010) Papadopoulou, I. Savas, T. Petanides, T.
Intestinal Obstruction In A Dog Due To Rallis (2003) Intestinal Foreign Bodies In
Saree Piece, India. 4. G. Hayes (2009) Dogs And Cats.
Gastrointestinal Foreign Bodies In Dog And
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

REPORTE DE 25 CASOS EMPLEANDO

TOMOGRAFIA COMPUTARIZADA COMO
PRUEBA DIAGNÓSTICA
Ureta Escobedo Alexander1,
Torreblanca Arana Jose Luis2,
Rosalinda Rubio Lezama3

INTRODUCCION : La tomografía computarizada es una técnica de diagnóstico por imagen no

invasiva, tecnología de exploración de rayos X que produce imágenes detalladas de cortes axiales
del cuerpo, cada vez más usada en medicina veterinaria. Es utilizada en patologías de cavidad
nasal y senos paranasales, medula espinal, fracturas y pacientes oncológicos.

OBJETIVO versatilidad, para poder definir con

precisión las situaciones y optimizar el
Mejorar el diagnóstico veterinario
tratamiento.
mediante el uso de pruebas
complementarias como es el diagnostico DESVENTAJAS
por tomografía en diferentes áreas del
1. Requiere que los pacientes permanezcan
organismo.
quietos, lo cual quiere decir que deben
METODOLOGIA permanecer sedados para la realización del
examen. 2. El riesgo que conlleva este
VENTAJAS
examen ya que, se ven relacionados con el
1. Mayor resolución de contraste siendo uso de radiaciones ionizantes. 3. Los medios
superior a la radiografía convencional, económicos con lo que se cuenta no son
mediante la toma de imágenes favorables.
transversales, evita la superposición de
El presente estudio se basa en el resultado
estructuras. 2. Permite el uso de medios de
de 25 pacientes caninos, de diferentes
contraste que servirán para aumentar la
edades, raza y sexo, logrando obtener
cantidad de información, mejorando la
resultados en el 99% de casos y solo un
calidad y aumentando la disponibilidad de
fracaso del 1%, siendo 3 de columna
información morfológica. 3. Método de
lumbosacra, 13 de columna lumbar, 4 de
diagnóstico de elección en medicina
columna dorso lumbar, 2 de abdomen
veterinaria, debido a su rapidez, fiabilidad y
completo, 2 de cráneo, 1 de tórax.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

RESULTADOS

CONCLUSIONES BIBLIOGRAFIA

1. Cada vez más se toma en consideración la 1. Nicholas J.H., Simon J.W., (2012),
tomografía como prueba diagnóstica no Trastornos vertebrales de pequeños
solo en afecciones de columna. animales, North Carolina State University:
Elsevier Science Health Science; Edición: 2
2. El elevado costo de una sola prueba, en
(11 de septiembre de 2006).
este caso la tomografía, no permite que
esté al alcance de todos. 2. Fernando Liste Burillo (2010). “Atlas
veterinario de Diagnóstico por Imagen”,
3. Hacen falta especialistas veterinarios en
España: Editorial Servet.
interpretación de imágenes tomográficas
en nuestro medio, siendo muy útil como 3. De Rycke,L.M., I.M., Van Bree, H.,
prueba diagnóstica. Simoens, P.J. Computed tomography of the
elbow joint in clinically normal dogs. Am J
Vet Res, 2002 Oct; 63(10):1400-7
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

TUMOR VENÉREO TRANSMISIBLE (TVT) EN

CAVIDAD NASAL DE CANINO SCHNAUZER
DE 3 AÑOS
Ureta Escobedo Alexander1,
Torreblanca Arana Jose Luis2,
Vásquez Torres Diana Sofia3

INTRODUCCIÓN: El tumor venéreo transmisible (TVT) es un tumor de células redondas de origen

histiocítico que afecta a perros y otros cánidos como el lobo y coyote. Con mayor frecuencia en
perros de 2 a 5 años sin raza o predisposición sexual. El tumor se transmite principalmente
mediante la inoculación de células neoplásicas intactas en la membrana mucosa lesionada o en
la piel durante el apareamiento, pero también se han reportado otras formas, morder, oler y
lamerse. La enfermedad generalmente se considera benigna con predilección por los genitales
externos (prepucio, pene y vagina), pero también hay informes de metástasis en otros órganos
del cuerpo (piel, cavidad oral y nasal, conjuntiva, recto e hígado).

OBJETIVOS masa en cavidad nasal unilateral derecha.

Se procedió a tratamiento endovenoso con
Identificar la signología poco común en
Vincristina, una dosis semanal con
nuestro medio, para poder compartir los
recuperación favorable en un mes de
alances y así seguir los casos posteriores
tratamiento (4 dosis).
mejorando la tánica diagnóstica en la clínica
particular. CONCLUSIONES

METODOLOGÍA La poca presencia de TVT canino en areas

poco comunes como cavidad nasal pueden
Presentación del caso: se presenta al
llevar al error diagnóstico, se debe obtener
Hospital de Mascotas para consulta y
la mayor y mejor información de una buena
segunda opinión un macho canina de raza
anamnesis y realizar los exámenes
Schnauzer de 3 años de edad, llamado Tato.
auxiliares necesarios para determinar la
Reporte de vacunas y desparasitación al día.
patología final. Bibliografía 1. Ogilvie, G. K.,
Al examen clínico presentó condición
& Moore, A. S. (2008). Manejo del Paciente
corporal 3/5, peso de 15 kg. Temperatura
Oncológico. Buenos Aires: Intermedica.
38.6ºC. Reporta secreción nasal unilateral
derecha hace 5 meses, durante los cuales 2. Rezeai, M., Azizi, S., Shahheidaripour, S.,
estuvo en tratamiento con distintos & Rostami, S. (2016). Primary oral and Nasal
antibióticos sin mayor éxito, además se Transmissible Venereal Tumor in a Mix-
observa inflamación en área afectada. Breed Dog. Asian Pacific Journal of Tropical
Biomedicine, VI(5), 443-445.
RESULTADOS
3. Singh, R. S., & Sood, N. K. (2016).
Se procedió a realizar una PAAF (punción
Management of Primary Transmissible
aspiración con aguja fina) del área afectada
Venereal Tumor in Nasal Cavity of a Dog.
y tomografía. El resultado final de la PAAF
Intas Polivet, XVII(2).
fue TVT canino y la tomografía evidencia
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

INTRAOCULAR PRESSURE IN CAPTIVE

MAGELLANIC PENGUINS (Spheniscus
magellanicus) MEASURED BY REBOUND
TONOMETRY
RCR Carazzatto1*, JOT Souza1,2,3, L Reisfeld4, CL Brunato1,5

INTRODUÇÃO: Intraocular pressure (IOP) values are key diagnostic tools for ocular pathologies,
and may differ between species of the same order, family or gender, these parameters may be
above or below by normal considered. Intrinsic and extrinsic variables were described as
influential for altering the ocular bulb and, consequently, the IOP of penguins, including:
inflammation, cataracts, ocular trauma, corneal pathology, corneal thickness, circadian rhythm,
body position and head, anatomical constriction, sedative and anesthetic drugs, and age. The
establishment of basic health data is important to maintain the health of animals on professional
care and to monitor the health of the wild population. However, there are no data described in
the literature refering to Magellanic Penguins (Spheniscus-Magellanicus) species.

PURPOSE: RESULTS:

The objective of this study is to describe the It was possible to determine:

IOP (intraocular pressure) range found in a
population of Magellanic Penguins
(Spheniscus-magellanicus), to help to
establish the normal range for the species.

METHODS:

A total of 9 animals (n=18 eyes) from the No statistical differences were found
São Paulo aquarium (SP-Brazil) were used. between the male and female range. No
They underwent an ophthalmic evaluation correlation was found between the
in order to exclude pathologies that IOP/Weight, nor the IOP/body length.
interfered with the results. During the
ophthalmic examination, the animals were
held upright and 3 consecutive IOP
measurements were performed using a
rebound tonometer (Tono-Vet®- ICARE)
without the use of topic anesthesia (figure 1
and figure 2). The measurements were
performed in the afternoon at a room CONCLUSIONS:
temperature of 25ºC and air humidity of
53%. The other data took into account body The data obtained in this work can be used
biometrics, weight, sex, and age. The as a range reference and help future
analyzes were performed using the ophthalmologic evaluations in the species in
statistical program GraphPad Prism 5. question.
 Conferencia Veterinaria Latinoamericana 2018, Perú, Lima
11 al 13 Abril 2018

OCULAR ECOBIOMETRY IN CAPTIVE

MAGELLANIC PENGUINS (Spheniscus
magellanicus)
RCR Carazzatto1*, JOT Souza1,2,3, L Reisfeld4, CL Brunato1,5

INTRODUÇÃO: Ocular ultrasonography or "ocular ultrasound" is indicated for opaque eyes,

especially when it is impossible for complete ophthalmic examination, including corneal
opacities, hyphema, cataract, hemorrhage and/or vitreous opacity, and in eyes with ocular
trauma or suspicion of orbital disease; for diagnosis of primary or secondary diseases,
anatomical location of intraocular or orbital wall anomalies, therefore, other indications involve
biometric measurements, intraocular and orbital structures to establish values of normality and
make the control and prevention of ocular diseases, possible. However, there are no data
described in the literature refering to Magellanic Penguins (Spheniscus-Magellanicus) species.

PURPOSE:

The present work aimed to describe the RESULTS:

normal ultrasound ocular biometrics in
captive Magellanic Penguin (Spheniscus
magellanicus), through the following
measures (distances) eye ecobiometrics of:
M1 (corneal endothelium until anterior lens
capsule); M2 (thickness of the lens); M3
(posterior lens capsule until vitreoretinal
interface); M4 (corneal epithelium until
vitreoretinal interface) (figure1).

METHODS:

A total of 9 animals (=18 eyes) from the São

Paulo aquarium (SP-Brazil) were used. They
underwent ophthalmic evaluation to
exclude pathologies that interfered in the
results. The animals were restrained in an
prone position and ocular biometry was
conducted Sonomed EscalonTM-
VuPADTM,,mode A-B 10 mHz without
topical anesthesia. The measurements were
performed in the afternoon at a room CONCLUSIONS:
temperature of 25ºC and air humidity of In our knowledge, this data are the first
53%. reported in that species and therefore
The other data is based on weight, gender serves as a reference for the ocular
and age. The data was analyzed using the ecobiometric evaluation of the species
statistical program GraphPad Prism 5 studied.