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EDUCATION

EDUCATION. Education is learning what you didn’t even know you didn’t know. - Daniel J. Boorstin. DISEASES OF THE PARATHYROID GLANDS. HYPERPARATHYROIDISM HYPOPARATHYROIDISM. Thyroid/Parathyroid glands. 2 glands for each thyroid lobe. 1=normal thyroid gland

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EDUCATION

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

  2. DISEASES OF THE PARATHYROID GLANDS HYPERPARATHYROIDISM HYPOPARATHYROIDISM

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

  4. Parathyroid gland • Secretion: Parathyroid hormone (PTH, Parathormone) • Function: ↑ plasma Ca2+ concentration • 1. ↑ osteoclast activity • 2. ↑ Ca++ absorption from GI tract • 3. ↑ Ca++ reabsorption from kidney tubules • Hyperparathyroidism → ________________ • Hypoparathyroidism → __________________

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

  6. Signalment: 7-11 yrs; Keeshoondren

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

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

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

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

  11. Hypercalcemia • Tests • Elevated serum calcium levels • Low to low-normal phosphorus concentrations

  12. Hypercalcemia • Treatment • Fluids: 0.9% NaCl • No Ca2+ containing fluids • Diuretics (furosemide): dilute urine • Steroids • Complications • Irreversible renal failure • Soft tissue calcifications

  13. Hypocalcemia Causes: • Parathyroid disease • Inadvertent removal of ____________________ during thyroidectomy (most common cause • 1º Hypoparathyroidism (uncommon in animals) • Chronic renal failure— • may cause ↑ serum P, which can result in ↓ serum Ca (Ca:P __________________) • Vit D normally activated in kidney • Protein-losing nephropathy results in loss of albumin-bound Ca • Puerperal Tetany (Eclampsia)—late gestation thru post-partum period • Improper prenatal ______________________________________ • Heavy lactation • Inappropriate Ca++ supplementation • Post-partum and late gestaion http://www.thepetcenter.com/gen/eclampsia.html#The_video

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

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

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

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

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

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

  20. Pancreas

  21. Pancreas: beta cells

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

  23. Insulin/Glucagon Balance

  24. Endocrine Pancreas • Hyperglycemia • Definition: Excessively high blood glucose levels • Normal in dogs: _________________ mg/dl • Normal in cats: __________________ mg/dl

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

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

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

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

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

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

  31. Diabetes in Cats:Plantigrade posture Plantigrade posture Diabetic neuropathy

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

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

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

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

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

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

  38. DM Rx: INSULIN AND DIET!!! Table 1. Traditional insulin outline.

  39. Diabetes: Insulin therapy

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

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

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

  43. Diabetes Mellitus: Monitoring Find an ear vein Prick the ear to get Place drop of blood blood sample on green tip; readout in a few seconds

  44. Diabetes Rx: Urine glucose

  45. Diabetes monitoring: Urine glucose

  46. DM: monitoring

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

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

  49. Insulin Shock Causes: • Insulin overdose (____________ syringe) • Too much exercise • Anorexia Signs: Weakness, incoordination,_______________, coma

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