Small Animal Internal Medicine for Veterinary Technicians and Nurses

Linda Merrill, LVT, VTS (Small Animal Internal Medicine, Clinical Practice) is the executive director and founding chair of the Academy of Internal Medicine for Veterinary Technicians and organizing committee member of the Academy of Veterinary Technicians in Clinical Practice. She is also a former president of NAVTA and has nearly 30 years of practice experience in small animal, cardiology, oncology, and internal medicine.

Contributors xiii

Preface xv

Chapter 1 Physical Examination 1

Charting 1

Goals of the consultation appointment 2

Conclusion 9

Chapter 2 Endocrinology 11

Section 1 Pituitary Gland 11

Growth hormone disorders 11

Diabetes insipidus 13

Section 2 Thyroid Glands 14

Canine hypothyroidism 14

Feline hyperthyroidism 16

Canine thyroid tumors 20

Section 3 Parathyroid Glands 22

Hypoparathyroidism 22

Hyperparathyroidism 23

Section 4 Adrenal Glands 25

Hypoadrenocorticism: Addison’s disease 25

Hyperadrenocorticism: Cushing’s disease 26

Pheochromocytoma 29

Section 5 Pancreas 31

Feline diabetes mellitus 31

Canine diabetes mellitus 37

Canine diabetic ketoacidosis 40

Insulinomas 41

Glucagonoma 45

Section 6 Miscellaneous Hormones, Glands, and Disease 47

Calcitriol 47

Erythropoietin 48

Gastrin 50

Gastrinoma 51

The kinins 52

Melatonin 53

Natriuretic peptides 55

Renin 57

Somatostatin 59

Other rare neuroendocrine tumors 60

Bibliography 62

Chapter 3 Musculoskeletal 69

Section 1 Anatomy and Physiology 69

The skeletal system 69

The muscular system 71

Section 2 Selected Diagnostics in Musculoskeletal Disease 72

Arthrocentesis 72

Muscle biopsy 73

Section 3 Diseases of the Musculoskeletal System 73

Inflammatory joint disease 73

Noninflammatory joint disease 76

Neuromuscular diseases 77

Inflammatory myopathies 78

Hepatozoonosis 79

Neoplasia 80

Section 4 General Musculoskeletal Examination 81

Section 5 Musculoskeletal Therapy 82

Veterinary rehabilitation therapy 82

Palliative radiation therapy 88

Section 6 Musculoskeletal Nutrition 89

Nutrients 90

Antioxidants 91

Energy and growth 91

Osteoarthritis 92

Body condition scoring 92

Body condition score uses 92

Muscle condition scoring 93

Bibliography 96

Chapter 4 The Neurological Examination 99

Clinical signs and the relevant anatomy 99

Seizures 102

Encephalopathies 103

Cerebral neoplasia 105

Inflammatory/infectious etiologies: encephalitis 105

Meningitis 107

Cranial nerve syndromes 107

Spinal diseases 109

Neuromuscular diseases 113

Diagnostic testing 114

Pharmacology 119

Nursing considerations 121

Neurological glossary 122

Suggested readings 124

Chapter 5 Thrombotic Disorders in Small Animal Medicine 127

Physiology 127

Thrombotic disorders 129

Diagnosis 130

Therapy 132

Client education 134

Suggested readings 134

Chapter 6 Respiratory 137

Section 1 Upper Airway Disease 137

Anatomy and physiology 137

Diseases of the upper airway 137

Nutritional considerations 140

Anesthetic and analgesic considerations 140

Section 2 Mediastinal Disease 141

Anatomy and physiology 141

Mediastinitis 141

Pneumomediastinum 141

Mediastinal masses 141

Section 3 Lower Airway Disease 142

Anatomy and physiology 142

Clinical signs 142

Diagnostic testing 142

Specific airway diseases and treatment 143

Anesthetic and analgesic considerations 146

Section 4 Pulmonary Parenchymal Disease 146

Anatomy and physiology 146

Clinical signs 146

Diagnostic testing 147

Treatment 148

Diseases 148

Nutritional considerations 151

Anesthetic and analgesic considerations 151

Section 5 Pleural Disease 152

Anatomy and physiology 152

Clinical signs 152

Diagnostic testing 152

Treatment 154

Nutritional considerations 156

Anesthetic and analgesic considerations 156

Section 6 Anesthesic and Analgesic Considerations in Respiratory Disease 156

Premedication 156

Induction 157

Maintenance anesthesia 157

Monitoring 157

Recovery 157

Section 7 Feeding Considerations for Respiratory Disease 157

Bibliography 158

Chapter 7 Hematology 161

Section 1 Anatomy and Physiology 161

The circulatory system 161

The lymphatic system 162

The spleen 162

The coagulation system 163

Section 2 Red Blood Cell Disorders 163

Anemia 163

Polycythemia 167

Transfusion medicine 167

Immune-mediated hemolytic anemia 171

Section 3 Leukocyte Disorders 174

Methods for determining the leukogram 174

Disorders of neutrophils 175

Disorders of eosinophils 180

Disorders of basophils 180

Disorders of monocytes 180

Disorders of lymphocytes 181

Section 4 Platelet, Coagulation, and Inherited Disorders 182

Diseases of coagulation 182

Disorders of platelets 184

Breed-related disorders 188

Bibliography 189

Chapter 8 Gastrointestinal 193

Section 1 Clinical Signs and Examination of the GI Patient 193

Patient history 193

Physical examination 194

Clinical signs of gastrointestinal disorders 194

Conclusion 197

Section 2 Selected Diagnostics in Gastrointestinal Disease 197

Laboratory evaluation 198

Microscopic fecal evaluation 198

Bacteriologic examination 199

Virologic examination 199

Occult blood 199

Alpha1-protease inhibitor 200

Imaging 200

Special tests 201

Conclusion 201

Section 3 Gastrointestinal Disease 201

Oral disease 201

Esophageal disorders 204

Gastric disease 207

Alimentary tract parasites 213

Diseases of the small intestine 216

Diseases of the large intestine 235

Section 4 Pharmacology 238

Antacids 238

Antiemetics 239

Anti-inflammatory and immunosuppressive drugs 240

Antibiotics 241

Gastromucosal protectants 241

Digestive enzymes 241

Laxatives 241

Section 5 Feeding Tubes 242

Feeding tubes 242

Esophagostomy tube placement 243

Gastrostomy tube placement 244

Jejunostomy tube placement 247

Conclusion 247

Feeding tube management and complications 247

Section 6 Food Intolerance and Food Allergy 251

Clinical signs 251

Causes 251

Diagnostics 251

Treatment 251

Elimination diets 252

Proteins 252

Carbohydrates 252

Prebiotics and probiotics 253

Section 7 Anesthesia and Analgesia Considerations in Gastrointestinal Disease 255

Premedication 255

Induction 255

Maintenance anesthesia 256

Monitoring 256

Recovery 256

Bibliography 256

Chapter 9 Liver 263

Section 1 Hepatic Disease 263

Acute hepatitis 263

Chronic hepatitis 265

Copper-associated chronic hepatitis 266

Hepatic lipidosis 268

Toxic hepatopathy 270

Hepatocutaneous syndrome 272

Congenital vascular anomaly 274

Liver neoplasia 275

Section 2 Posthepatic Disease 276

Feline cholangitis complex 276

Biliary cysts 278

Extrahepatic biliary obstruction 279

Gallbladder mucocoeles 280

Section 3 Nutrition in Liver Disease 282

Protein 283

Fats 283

Carbohydrates 283

Fiber 283

Vitamins and minerals 284

Feeding plan 284

Section 4 Anesthesia and Analgesia Considerations in Hepatic Disease 284

Premedication 284

Induction 284

Maintenance anesthesia 285

Monitoring 285

Recovery 286

Bibliography 286

Chapter 10 Urinary and Renal Diseases 289

Section 1 Urinary Anatomy and Physiology 289

Section 2 Clinical Signs 291

Section 3 Urinary Diseases 292

Chronic kidney disease 292

Acute renal failure 293

Urinary tract infections 294

Pyelonephritis 295

Urolithiasis 295

Prostatic diseases 298

Lower urinary tract disease in cats 299

Ectopic ureters 299

Urethral sphincter mechanism incompetence 300

Protein-losing nephropathy 301

Urinary neoplasia 301

Section 4 Urinary Diagnostics and Therapeutic Implications 302

Urinalysis 302

Complete blood count and serum biochemistry profile 306

Proteinuria 309

Blood pressure 311

Urine culture 313

Section 5 Urinary Tract Biopsy Techniques 315

Aspiration biopsy 315

Biopsy 316

Sample handling 319

Postbiopsy nursing care 319

Section 6 Urinary Imaging 319

Radiology 319

Ultrasound 321

Cystoscopy and vaginoscopy 323

Computed tomography 323

Section 7 Renal and Urinary Disease Pharmacology 324

Fluid therapy and correction of electrolyte imbalances 327

Section 8 Anesthetic and Analgesic Considerations 335

Anesthesia 335

Pain management 336

Section 9 Nutritional Considerations 336

Chronic kidney disease 336

Urolithiasis 338

Feline idiopathic cystitis 341

Bibliography 341

Chapter 11 Infectious Diseases 349

Section 1 Infectious Bacterial Diseases 349

Bartonella 349

Lyme borreliosis 350

Canine brucellosis 352

Ehrlichiosis 353

Helicobacter-associated disease 355

Leptospirosis 357

Methicillin-resistant Staphylococcus aureus 360

Mycobacterial disease 361

Mycoplasmal diseases 363

Plague 365

Section 2 Fungal Diseases 366

Histoplasmosis 366

Aspergillosis 368

Coccidioidomycosis 368

Cryptococcosis 369

Blastomycosis 370

Section 3 Protozoal Diseases 374

Amebiasis 374

Babesiosis 374

Giardia 375

Trichomoniasis 375

Leishmaniasis 376

Toxoplasmosis 376

Neosporosis 377

Cytauxzoonosis 378

Hepatozoonosis 379

Section 4 Infectious Viral Diseases 381

Canine and feline herpesvirus 381

Influenza 383

Papillomas 384

Section 5 Infectious Disease Testing 385

Disease prevention and control in the small animal hospital 395

Bibliography 400

Chapter 12 Vaccine, Vaccination, and Immunology 403

Section 1 The Immune Response and Cancer Immunotherapy 403

Innate and adaptive immune response 403

Humoral and cell-mediated immunity 404

Immunomodulation 404

Cancer vaccines 404

Cytokine immunotherapy 405

Summary 405

Section 2 Laboratory Diagnostics in Immunology 405

Serology 405

Biopsy techniques 407

Section 3 Immunosuppressive Medications 409

Corticosteroids 409

Immunosuppresives 411

Less commonly used immunosuppressives 412

Novel immunosuppressive medications 412

Immunomodulating medications 413

Conclusion 413

Section 4 Vaccines and Vaccination 413

Vaccination strategies 413

Canine vaccines 416

Feline vaccines 422

Vaccinations and adverse reactions 427

Bibliography 429

Chapter 13 Pain and Its Management 433

Veterinary technician as pain management team leader 433

What is pain? 434

Pathophysiology of pain 434

Types of pain 435

Causes of pain 436

General approach to pain control 436

General rules of thumb in managing pain 436

Questions to consider 437

How to be an analgesic advocate for your patient 437

Clinical signs and means of detection 438

Pain scoring systems 439

Analgesics 439

Nursing care as analgesic 446

Clinical examples 447

Conclusion 448

Bibliography 448

Chapter 14 Nursing 449

Section 1 Occupational Health and Safety 449

Making the work place safe 449

Health and safety committees 449

Hazards in the workplace 450

Chemotherapy safety 452

Conclusion 453

Section 2 Pharmacological Implications in Internal Medicine 453

Drug calculations, compatibilities, dosing, and administration 453

Constant rate infusion 453

Drug compatibilities 454

Drug dosage adjustments in patients with heart, renal, and hepatic insufficiency or failure 454

Oxygen therapy 460

Drug calculations 461

Client education 462

Section 3 Nutritional Support 463

Nutritional support 463

Energy balance: weight loss versus weight gain 468

Refeeding syndrome 471

Section 4 Diagnostic Procedures 474

Cystocentesis 474

Abdominocentesis 475

Thoracocentesis 478

Urinary catheters 480

Bone marrow collection 484

Section 5 Endoscopy 487

Flexible endoscope 487

Videoendoscope 489

Instrumentation 489

Rigid endoscopes 490

Reprocessing 492

Patient and equipment preparation 495

Section 6 Selected Nursing Considerations of Internal Medicine Patients 495

Thermoregulation 495

Fever or hyperthermia? 495

Hypothermia 498

The sepsis syndrome 499

Bibliography 504

Appendix Accredited State Veterinary Diagnostic Laboratories 509

Abbreviations 515

Index 521