Managing cats with cancer: An examination of ethical perspectives

Antony S Moore BVSc MVSc
Journal of Feline Medicine and Surgery 
(2011) 13, 661–67

Caring for cancer patients presents many ethical issues for veterinarians and other veterinary health workers. The issues that most veterinarians think of relate to management of the patient when the owners’ preferences for treatment do not appear to be in the animal’s best interest, as well as concerns about toxicities and about costs of veterinary services (advanced imaging, surgery, radiation therapy and chemotherapy). While not limited to the veterinary profession, we are more often faced with dilemmas about the appropriateness of palliative care and decisions about euthanasia than our medical colleagues. Equally important are the ethics of not treating patients, and the integration of unproven and alternative strategies into conventional care. A separate ethical issue arises from investigational therapies and research. Less often considered, but nonetheless relevant, are the ethics of suboptimal evaluation (staging) of patients prior to treatment, or of not informing owners about all the options available

Causes of pancytopenia y dogs and cats

Shawn Ann Kearns, DVM 
Patty Ewing, DVM, MS, DACVP
Compendium 
February 2006

Pancytopenia (i.e., a decrease in all circulating hematologic cell lines) can result from peripheral destruction of cells or a primary insult to the bone marrow. Many infectious, immunemediated, and neoplastic conditions have been associated with pancytopenia in dogs and cats. Bone marrow aspirates and/or core biopsy samples are generally required to fully characterize the marrow disease, especially in cases of decreased hematopoietic cell production. Understanding the mechanisms by which various disorders alter circulating blood or marrow cells may aid in developing a diagnostic and/or treatment plan.The prognosis in pancytopenic patients is variable and depends on the underlying cause.

Flea control in flea allergic dogs and cats

Marie-Christine Cadiergues
EJCAP - Vol. 19 - Issue 3 
December 2009

Flea allergy dermatitis (FAD) remains the most common allergic skin disease of dogs and cats, although its frequency varies according to geographical location. Despite the availability of safe, effective products, treating FAD remains a challenge. This challenge should be more readily overcome once both practitioner and owner(s) are entirely convinced of the diagnosis. The main diffi culties and pitfalls facing the practitioner are described. Treatment requires appropriate knowledge of the fl ea life cycle and fl ea-related biology, and understanding of the mode of action of the relevant fl ea control products. An integrated approach to treatment should be adopted, involving all the players in the fl ea life cycle - the FAD patient, all in-contact pets, and the environment. Each case must be customised, with effective fl ea control products used in combination with cleaning measures such as steaming, vacuuming and regular grooming.

Canine Pyometra

Jennifer Roberts, DVM
Marc R. Raffe, DVM, MS, DACVA, DACVECC
Steven L. Marks, BVSc, MS, MRCVS, DACVIM
STANDARDS of CARE: EMERGENCY AND CRITICAL CARE MEDICINE. 

MAY 2003

The cystic endometrial hyperplasia (CEH)/pyometra complex may present as either an acute or chronic disease that occurs as a result of chronic and repeated exposure of the endometrium to progesterone. The underlying uterine pathology is CEH, which predisposes the uterus to an ascending bacterial infection causing pyometra. Generally, the diagnosis of open-cervix pyometra is based on physical examination findings of enlarged uterine structures and the presence of a purulent vaginal discharge. Closed-cervix pyometra is more insidious, with early clinical signs of general malaise that may escalate to clinical signs compatible with a lifethreatening disease in later stages. Rapid recognition and intervention in fulminant cases of pyometra is important because these patients may be profoundly dehydrated and demonstrating signs of septicemia or shock secondary to systemic infection.

Acute pancreatitis in dogs: a review article

I. Kalli, K. Adamama-Moraitou, T. S. Rallis
EJCAP - Vol. 19 - Issue 2 
October 2009

Canine acute pancreatitis is a relatively common disease, but it is often misdiagnosed. The most common causes of acute pancreatitis in dogs include malnutrition, drug administration, infection, trauma, refl ux of duodenum contents into the pancreatic duct and ischaemia. Idiopathic causes have also been encountered. The clinical signs of the disease are not specifi c and are often associated with a number of life-threatening, severe systemic complications. Despite the continuing new knowledge of pancreatic pathophysiology, the aetiopathogenesis of canine pancreatitis is still unclear and subsequently treatment is supportive.

The Kidney in Critically ill Small Animals

Katharine F. Lunn, BVMS, MS, PhD, MRCVS
Vet Clin Small Anim 41 (2011) 727–744

This article discusses kidney disease in critically ill small animal patients. Critically ill patients may present to the clinician with kidney disease as the primary complaint, or kidney damage or dysfunction may arise as a complication or consequence of other illness. In the latter scenario, the clinician must carefully monitor parameters that assess renal function and be prepared to intervene to prevent irreversible injury.

Diagnosis of Urolithiasis

Cathy Langston, DVM,DACVIM, Kelly Gisselman, DVM
Douglas Palma, DVM, John McCue, DVM
Compendium
August 2008. 

Diagnostic imaging is usually required to determine the presence of urolithiasis. Double-contrast cystography is more accurate than survey radiography and approximately as accurate as ultrasonography. Knowledge of the mineral composition of calculi helps direct appropriate management of urolithiasis, and signalment can help predict composition with about 70% accuracy. In cats, about half of cystic calculi are struvite and half are calcium oxalate; most nephroliths and ureteroliths are calcium oxalate. In female dogs, struvite uroliths are the predominant type found in the bladder. In male dogs, breed plays a strong role in prediction of bladder urolith type. It is difficult to predict the composition of nephroliths and ureteroliths based on signalment alone in dogs. Urinalysis and imaging findings can help in predicting urolith composition, although chemical analysis is necessary for definitive diagnosis.

Causes of otitis externa in the dog

Jane Coatesworth MA VetMB CertVD MRCVS
Companion Animal Vol 16 
July 2011

Otitis externa can involve a number of interlinked factors. These factors may directly induce inflammation, 

greatly assist us in successfully unravelling and treating an individual case. 

has resolved. This article discusses how the recognition of specific primary, predisposing and perpetuating factors can 

may increase the likelihood of inflammation occurring, or may maintain inflammation even when the primary factor

Pathophysiology of diarrhoea

Theresa McCann BVSc CertSAM MRCVS
James W Simpson BVM&S MPhil MRCVS, RCVS 
UK Vet - Vol 11 No 5 
June 2006

Diarrhoea is one of the commonest presenting complaints seen in small animal practice and is associated with a large number of differential diagnoses. This paper will review the underlying pathophysiology of diarrhoea, an understanding of which will assist the clinician when investigating individual cases and their subsequent treatment.

A Review of the Pathophysiology, Classification, and Analysis of Canine and Feline Cavitary Effusions

Suzanne M. Dempsey, DVM, Patty J. Ewing, DVM, MS, Diplomate ACVP
Am Anim Hosp Assoc 201147:1–11. DOI 10.5326/JAAHA-MS-5558.

Effusion is the abnormal accumulation of fluid within a body cavity that can result from a variety of disease processes. This article reviews the normal production and resorption of body cavity fluid and the pathophysiology of abnormal fluid accumulation. In addition, classification schemes, differential diagnoses, and currently available diagnostic tests for evaluation of effusions are reviewed.

Blastomycosis

Alison Werner, DVM, Frank Norton, DVM, MS, DACVIM 
Compendium: Continuing Education for Veterinarians
(Vol 33, No 8)
August 2011

For more than 100 years, blastomycosis has been recognized as causing significant morbidity and mortality in people and dogs. The disease is rare in cats. Isolation of the organism is difficult, and novel methods to culture environmental samples are forthcoming. The most significant clinical dilemma is the inability to make a timely diagnosis when multiple cytologic samples are unrewarding. This article reviews the literature on advances in epidemiology and serology, clinical presentations, new antifungal drugs, and progress in formulating a vaccine.

 (Vol 33, No 8)

The use of intravenous lipid emulsion as an antidote in veterinary toxicology

Alberto L. Fernandez, Justine A. Lee, Louisa Rahilly,

Lynn Hovda, Ahna G. Brutlag and Kristin Engebretsen

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE
Volume 21, Issue 4, August 2011, Pages: 309–320,
Article first published online:30 JUN 2011.

The use of ILE appears to be a safe therapy for the poisoned animal patient, but is warranted only with certain toxicoses. Adverse events associated with ILE in veterinary medicine are rare and anecdotal. Standard resuscitation protocols should be exhausted before considering this therapy and the potential side effects should be evaluated before administration of ILE as a potential antidote in cases of lipophilic drug toxicoses. Further research is waranted

Pneumothorax - A Review

Danielle R. Pawloski, Kristyn D. Broaddus
J Am Anim Hosp Assoc 
46:385-397.

2010

Pneumothorax is a pathological condition in which air accumulates within the thoracic cavity.Pneumothorax affects animals without sex or age predilections; however, it has been suggested that the Siberian husky breed of dog has a predisposition for spontaneous pneumothorax. Pneumothorax occurs as the result of trauma or underlying disease and can present a clinical challenge with regard to diagnostic and therapeutic techniques. Topics reviewed include normal lung physiology; the pathogenesis, diagnosis, treatment, complications, and prognosis of pneumothorax; and current techniques in animals and humans..

Iron Homeostasis and Disorders in Dogs and Cats - A Review

Jennifer L. McCown, DVM*, Andrew J. Specht, DVM, DACVIM
J Am Anim Hosp Assoc; 
47:151–160. DOI 10.5326. 

May 2011

Iron is an essential element for nearly all living organisms and disruption of iron homeostasis can lead to a number of clinical manifestations. Iron is used in the formation of both hemoglobin and myoglobin, as well as numerous enzyme systems of the body. Disorders of iron in the body include iron deficiency anemia, anemia of inflammatory disease, and iron overload. This article reviews normal iron metabolism, disease syndromes of iron imbalance, diagnostic testing, and treatment of either iron deficiency or excess. Recent advances in diagnosing iron deficiency using reticulocyte indices are reviewed.

Update on the diagnosis and management of Giardia spp infections in dogs and cats

Sahatchai Tangtrongsup, DVM, MSc, and
Valeria Scorza, DVM, PhD
Topics in Companion Animal Medicine
Volume 25, Number 3
August 2010.

Giardia spp are flagellates that are found in the intestinal tract of humans and domestic and wildlife animals, including birds and amphibians, worldwide. The genus Giardia contains multiple species, which are for the most part morphologically indistinguishable. Recognized species of this genus are G. duodenalis, G. agilis, G. muris, G. microti, G. ardeae, and G. psittaci. Giardia duodenalis (syn. G. intestinalis or G. lamblia) is the species that infects people, dogs, and cats and is considered a species complex

Heatstroke

Carl Gorman BVSc MRCVS
Companion Animal Vol 16
June 2011

Heatstroke is one of the genuine emergencies seen in practice. The recognition, assessment and initial treatment of the condition is vitally important to improve survival rates. Studies suggest that 25-50% of severe cases may not survive. Patients that survive the initial 24 hours, however, will usually go on to recover. This article summarises the risk factors and physiological processes involved in heatstroke, and recommends monitoring and therapy to improve survival rates

Small animal wound management: Options for wound closure

Kelly Bowlt BVM&S MRCVS 
Ed Friend BVetMed Cert SAS DECVS MRCVS
Companion Animal Vol 16 
June 2011.

This article looks at wound closure once a healthy wound bed has been achieved. It discusses simple techniques for the avoidance of skin tension and includes skin stretching and vacuum assisted wound closure. Finally, techniques and recommendations for free skin grafts and skin flaps are presented

Guidelines for Reducing Veterinary Hospital Pathogens: Hospital Design and Special Considerations

Joshua A. Portner, DVM, DACVECC, 

Justine A. Johnson, DVM, DACVECC

Compendium

May 2010 (Vol 32, No 5)

Prevention of nosocomial infection begins with the hospital layout and identification of special considerations for particular patients. The construction of a new hospital or renovation of an existing hospital requires careful planning and consideration of the needs of the expected patient population and hospital staff. This article discusses considerations for preventing cross-contamination of pathogens through hospital design, as well as special considerations for particular patients, specifically those in isolation areas and surgical suites.

Panniculitis in dogs and cats

Ariane Neuber DrMedVet CertVD DipECVD MRCVS
Companion Animal Vol 16 
June 2011. 

Panniculitis is uncommonly seen in both dogs and cats. Although a large number of organisms can cause infectious panniculitis, many of these are rarely seen in the UK. A variety of systemic diseases can also cause non-infectious panniculitis. Of the non-infectious cases, sterile nodular panniculitis is the most common type. Histopathology and deep tissue culture are indicated in most cases to reach a diagnosis. Infectious panniculitis must be treated with antimicrobial agents. Sterile nodular panniculitis usually responds well to glucocorticoid administration. This paper gives an overview of the different causes of panniculitis and how to approach suspected cases

A Practical Approach to Diagnosing and Managing Ear Disease in Dogs

Paul Bloom, DVM, DACVD, DAVBP
Compendium. May 
2009 (Vol 31, No 5)

Entire books have been written on the subject of canine ear disease. Rather than attempt to present all the available information here, I am providing an overview of how I diagnose and manage ear disease in dogs. It is critical to appreciate that ear disease is only a clinical problem (no more specific than pruritus) and that steps must be taken to prevent otitis externa from progressing to proliferative otitis.

Determining the optimal age for gonadectomy of dogs and cats

Margaret V. Root Kustritz
J Am Vet Med Assoc 2007;231:1665-1675. 

December 1, 2007.

Elective gonadectomy of dogs and cats, most commonly performed as an OHE of females and castration of males, is one of the most common veterinary  procedures performed in the United States. Increasingly, dog owners and members of the veterinary profession throughout the world have questioned the optimal age for performance of these surgeries or whether they  should even be performed as elective surgeries. The objective for the information reported here was to provide  a review of the scientific evidence, which could be used  by veterinarians to counsel clients appropriately on this issue

Clinical Case: Craniodorsal luxation of the left hip joint

What Is Your Diagnosis?

Journal of American Veterinary Medical Association

August 1, 2011

A 2-year-old castrated male Labrador Retriever was referred for evaluation of a left hind limb lameness of 3 weeks’ duration. The dog had been struck by a car 3 weeks earlier, and craniodorsal luxation of its left hip joint was diagnosed on the basis  of physical examination and radiographic findings (Figure 1). Luxation of the hip joint was treated by closed reduction and  placement of an Ehmer sling for 10 days. After sling removal, the dog had a non–weight-bearing lameness in the left hind lim

Portal Hypertension: Pathophysiology, Diagnosis, and Treatment

S. Buob, A.N. Johnston, and 
C.R.L. Webster

J Vet Intern Med 

2011;25:169–18

Portal hypertension (PH) is the result of increased vascular resistance in the portal circulation, increased portal venous blood flow, or both. In veterinary medicine, where portal pressure is seldom measured directly, the diagnosis of PH often is inferred from identification of associated complications including multiple acquired portosystemic shunts, ascites, and hepatic encephalopathy. Likewise, treatment of PH primarily is aimed at controlling these complications. The goal of this review is to provide an update on the pathophysiology, diagnosis, and treatment of PH. The review draws from information in the veterinary hepatology literature, reviews, and consensus statements in human hepatology and the literature on experimental models of PH.

Canine parvoviral enteritis: a review of diagnosis, management, and prevention

Jennifer Prittie, DVM, DACVIM, DACVECC
Journal of Veterinary Emergency and Critical Care 
14(3), pp167-176
2004

To review and summarize current information regarding epidemiology, risk factors, and pathophysiology associated with canine parvoviral infection, and to outline diagnostic and treatment modalities for this disease. Preventative and vaccination strategies will also be discussed, as serologic documentation of immunocompetence and adoption of safe and effective vaccination protocols are crucial in limiting infection and spread of canine parvoviral enteritis.

Update on the diagnosis and management of Toxoplasma gondii infection in cats.

Michael R. Lappin DVM, PhD, DACVIM
Topics in Companion Animal Medicine
Volume 25, Issue 3, August 2010, Pages 136-141

Toxoplasma gondii is a coccidian that is one of the most prevalent parasites infecting warm-blooded vertebrates around the world.1-3 Only cats complete the sexual phase in the gastrointestinal tract and pass environmentally resistant oocysts in feces. Sporozoites develop in oocysts after 1 to 5 days of exposure to oxygen and appropriate environmental temperature and humidity (Fig 1). Sporozoites can penetrate the intestinal tract of cats or intermediate hosts and disseminate in blood or lymph as tachyzoites during active infection. Toxoplasma gondii can penetrate most mammalian cells and will replicate asexually within infected cells until the cell is destroyed. If an appropriate immune response occurs, replication of tachyzoites is attenuated, and slowly dividing bradyzoites develop that persist within cysts in extra-intestinal tissues. Tissue cysts form readily in the central nervous system (CNS), muscles, and visceral organs. Live bradyzoites may persist in tissues for the life of the host.

Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis

Thierry Olivry, Douglas J. DeBoer, 

Claude Favrot, Hilary A. Jackson, Ralf S. Mueller,

Tim Nuttall, Pascal Prélaud

Veterinary Dermatology
Volume 21, Issue 3, pages 233–248, 

June 2010

Atopic dermatitis (AD) is a common chronic relapsing pruritic skin disease of dogs for which treatment has varied over time and geographical location. Recent high quality randomized controlled trials and systematic reviews have established which drugs are likely to offer consistent benefit. The International Task Force for Canine AD currently recommends a multi-faceted approach to treat dogs with AD. Acute flares should be treated with a combination of nonirritating baths and topical glucocorticoids, once an attempt has been made to identify and remove the suspected causes of the flare. Oral glucocorticoids and antimicrobial therapy must be added when needed. In dogs with chronic AD, a combination of interventions should be considered. Again, factors that trigger flares of AD must be identified and, if possible, avoided. Currently recognized flare factors include food, flea and environmental allergens, Staphylococcus bacteria andMalassezia yeast. Skin and coat hygiene and care must be improved by bathing with nonirritating shampoos and dietary supplementation with essential fatty acids. The severity of pruritus and skin lesions can be reduced with a combination of anti-inflammatory drugs. Currently, medications with good evidence of high efficacy include topical and oral glucocorticoids, and calcineurin inhibitors such as oral ciclosporin and topical tacrolimus. The dose and frequency of administration of these drugs should be tailored to each patient considering each drug’s efficacy, adverse effects and cost. Allergen-specific immunotherapy should be offered, whenever feasible, in an attempt to prevent recurrence of clinical signs upon further exposure to environmental allergens to which the patient is hypersensitive.

Laboratory Tests for Diagnosis of Gastrointestinal and Pancreatic Diseases

Olivier Dossin DVM, PhD, Dipl. ECVIM-C

Topics in Companion Animal Medicine
Volume 26, Issue 2 , Pages 86-97, May 2011

The panel of laboratory tests available for diagnosis of gastrointestinal (GI) diseases in dogs and cats is wide, and, recently, several new tests have been developed. This article will focus on advances in laboratory tests that are available for the general practitioner for diagnosis of GI diseases. Laboratory tests for diagnosis of gastric and intestinal infectious diseases include fecal parasite screening tests, enzyme-linked immunosorbent assays for parvoviral enteritis, and some specific bacterial tests like fluorescent in situ hybridization for identification of specific bacteria attached to the intestinal epithelial cells. Serum concentrations of folate and cobalamin are markers of intestinal absorption, but are also changed in exocrine pancreatic insufficiency and intestinal bacterial overgrowth. Hypocobalaminemia is common in GI and pancreatic disease. Decreased serum trypsin-like immunoreactivity is a very sensitive and specific test for the diagnosis of exocrine pancreatic insufficiency in dogs and cats. Serum pancreatic lipase is currently the most sensitive and specific test to identify pancreatic cell damage and acute pancreatitis. However, serum canine pancreas-specific lipase is less sensitive in canine chronic pancreatitis. Increased serum trypsin-like immunoreactivity is also specific for pancreatic damage but is less sensitive. It is very likely that further studies will help to better specify the role of these new tests in the diagnosis of canine and feline 

Selection against canine hip dysplasia: Success or failure?

Bethany Wilson, Frank W. Nicholas and Peter C. Thomson 

The Veterinary Journal Volume 189, Issue 2,
August 2011, Pages 160-168

There is significant room for improvement in the current schemes through the use of estimated breeding values (EBVs), which can combine a dog’s CHD phenotype with CHD phenotypes of relatives, other phenotypes as they are proven to be genetically correlated with CHD (especially elbow dysplasia phenotypes), and information from genetic tests for population-relevant DNA markers, as such tests become available. Additionally, breed clubs should be encouraged and assisted to formulate rational, evidenced-based breeding recommendations for CHD which suit their individual circumstances and dynamically to adjust the breeding recommendations based on continuous tracking of CHD genetic trends. These improvements can assist in safely and effectively reducing the impact of CHD on pedigree dog welfare. Canine hip dysplasia (CHD) is a multifactorial skeletal disorder which is very common in pedigree dogs and represents a huge concern for canine welfare. Control schemes based on selective breeding have been in operation for decades. The aim of these schemes is to reduce the impact of CHD on canine welfare by selecting for reduced radiographic evidence of CHD pathology as assessed by a variety of phenotypes. There is less information regarding the genotypic correlation between these phenotypes and the impact of CHD on canine welfare. Although the phenotypes chosen as the basis for these control schemes have displayed heritable phenotypic variation in many studies, success in achieving improvement in the phenotypes has been mixed.

Interpretation of Laboratory Tests for Canine Cushing’s Syndrome

Chen Gilor DVM, PhD, Dipl. ACVIM and
Thomas K. Graves DVM, PhD, Dipl. ACVIM
Topics in Companion Animal Medicine
Volume 26, Issue 2, May 2011, Pages 98-108

Hypercortisolism (HC) is a common disease in dogs. This article will review the laboratory tests that are available for diagnosis of HC and laboratory tests for differentiating between causes of HC. An emphasis will be made on the clinical process that leads to the decision to perform those tests and common misconceptions and issues that arise when performing them. To choose between the adrenocorticotropic hormone (ACTH)–stimulation test and the low-dose dexamethasone suppression test (LDDST), the advantages and disadvantages of both tests should be considered, as well as the clinical presentation. If the index of suspicion of HC is high and other diseases have been appropriately ruled out, the specificity of the ACTH stimulation test is reasonably high with an expected high positive predictive value. Because of the low sensitivity, a negative result in the ACTH stimulation test should not be used to rule out the diagnosis of HC. The LDDST is more sensitive but also less specific and affected more by stress. A positive result on the urine cortisol:creatinine ratio does not help to differentiate HC from other diseases. A negative result on the urine cortisol:creatinine ratio indicates that the diagnosis of HC is very unlikely. The LDDST is useful in differentiating pituitary-dependent HC from an adrenal tumor in about two thirds of all dogs with HC. Differentiation of HC from diabetes mellitus, liver diseases, and hypothyroidism cannot be based solely on endocrine tests. Clinical signs, imaging studies, histopathology, and response to treatment should all be considered

Orthopaedic examination of the dog - 1. Thoracic limb and 2. Pelvic Limb

Gareth Arthurs
In Practice 2011;33:126-133 doi:10.1136

The purpose of an orthopaedic examination is to evaluate a patient for the presence or absence of orthopaedic disease and to localise any abnormalities found. This examination is arguably the most critical part of an orthopaedic work-up as it is at this point that important decisions are made with regard to selecting further diagnostic tests and/or discussing treatment options and prognosis. This article, the first of two, considers the need for a systematic approach to the orthopaedic examination and discusses how this might be applied to the thoracic limb. Part 2, to be published in the April issue of In Practice, will discuss how to perform an orthopaedic examination on the pelvic limb. An article published in the January issue described the use of orthopaedic examination as part of an approach to forelimb lameness.

Orthopaedic examination of the dog - 1. Thoracic limb





Orthopaedic examination of the dog - 2. Pelvic limb

Treatment and monitoring of epilepsy in dogs

Kate Chandler

In Practice 
2011;33:98-104 
doi:10.1136

Epilepsy is a brain disorder and is defined as the propensity to have recurrent seizures. It is the most common chronic neurological disorder seen in dogs. Most dogs that present with recurrent seizures have idiopathic epilepsy, which is thought to have a genetic basis and has no identifiable underlying cause when a full diagnostic work-up is undertaken. Symptomatic epilepsies, which arise secondary to brain diseases such as intracranial neoplastic lesions or central nervous system inflammatory disorders, are less common. By addressing some of the most frequently asked questions relating to the treatment of seizures, this article suggests some practical and effective strategies for managing and monitoring dogs with idiopathic epilepsy.

Understanding Viruses in Veterinary

Kerstin Erles
In Practice 
2011;33:302-308 doi:10.1136

Viruses are important pathogens that are frequently encountered in veterinary practice. The diagnosis of viral infections has become more readily available owing to the development of rapid molecular methods. This article explains the basic properties of viruses, how they interact with their host and how this knowledge aids the diagnosis and control of infection. It also briefly discusses different diagnostic techniques and the challenges posed by viral evolution.

When Normal Is Abnormal – Keys to Laboratory Diagnosis of Hidden Endocrine Disease

Graves TK. Source
Topics Companion Animal Medicine 

2011 May;26(2):45-51

Although veterinary clinicians commonly rely on panels of laboratory tests with individual results flagged when abnormal, care should be taken in interpreting normal test results as well. There are several examples of this in evaluating patients with endocrine disease. The finding of a normal leukogram (absence of a stress leukogram) can be indicative of adrenal insufficiency in dogs, and this disorder can be especially elusive when there are no overt indicators of mineralocorticoid deficiency. Cats with hyperthyroidism can have normal serum thyroid hormone concentrations, normal hematocrits, and normal serum concentrations of creatinine despite the presence of disease that affects these parameters. A normal serum phosphorus concentration, in the face of azotemia, isosthenuria, and hypertension can point a clinician toward a diagnosis of primary hyperaldosteronism rather than primary renal disease. A normal serum parathyroid hormone concentration in the face of hypercalcemia is inappropriate and can indicate the presence of primary hyperparathyroidism. Similarly, hypoglycemia accompanied by a normal serum insulin concentration can be found in cases of hyperinsulinism. These normal findings in abnormal patients, and their mechanisms, are reviewed

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Analgesia for Anesthetized Patients

Lemke KA, Creighton CM.
Topics in Companion Animal Medicine
2010 May;25(2):70-82.

Many perioperative pain management protocols for cats and dogs are overly complex, some are ineffective, and still others expose patients to unnecessary risk. The purpose of this article is to provide clinicians with a basic understanding of the pathophysiology of perioperative pain and a working knowledge of the principles of effective therapy. First, the concept of multimodal analgesic therapy is discussed. Next, the pathophysiology of perioperative pain and the clinical pharmacology of the major classes of analgesic drugs are reviewed. And last, a simplified approach to managing perioperative pain in cats and dogs is presented.

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Approach to ocular examination in small animals

Natasha Mitchell

In Practice 

2011;33:146-154 doi:10.1136

While a thorough ocular examination is clearly important in the diagnostic work-up of dogs and cats presenting with eye conditions, an assessment of the eyes should also be included in every routine health check in small animal practice. Eye examinations require basic equipment, good clinical observation and lots of practice. It is also important for clinicians to be familiar with the normal anatomy of the eye, so that abnormalities can be recognised and the significance of the findings appreciated. This article describes a step-by-step approach to examination of the eye in dogs and cats, and highlights the key diagnostic tests that should be carried out as part of this procedure.

Cognitive Dysfunction in Cats - Clinical Assessment and Management

Gunn-Moore DA.
Topics in Companion Animal Medicine
2011 Feb;26(1):17-24.

Increasing numbers of cats are living to become elderly and they commonly develop behavioral changes. The objectives of this article are to consider the possible causes and prevalence of behavioral problems in pet cats, to describe how cognitive dysfunction syndrome (CDS) typically presents, and how its diagnosis and management are often complicated by the concurrent presence of multiple interacting disease processes. The most frequently reported behavioral problems in old cats are loss of litter box training and crying out loudly at night. The most common causes of these problems are CDS, osteoarthritis, systemic hypertension (commonly secondary to chronic kidney disease or hyperthyroidism), hyperthyroidism (even without hypertension), deafness, and brain tumors. These conditions all occur frequently in older cats, many of which suffer from a number of concurrent interacting conditions. Owners and veterinary surgeons often mistake these for "normal aging changes," so many treatable conditions are neglected and go untreated. Almost one third of cats 11 to 14 years of age develop at least one geriatric-onset behavior problem that appears to relate to CDS, and this increases to over 50% for cats 15 years of age or older. For optimum management of elderly cats with behavioral problems, all interacting conditions need to be diagnosed and addressed concurrently with management for CDS.

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Protein-losing Nephropathy in Small Animals (Nefropatia Perdedora de Proteínas en Pequeños Animales)

Meryl P. Littman, VMD

Veterinary Clinics of North America: Small Animal Practice

Volume 41, Issue 1 , Pages 31-62, 
January 2011

Genetic and acquired defects of glomerular permselectivity may lead to proteinuria and protein-losing nephropathy (PLN). Morbidity and mortality from complications of PLN may be severe even before progression to azotemia and renal failure. Leakage of plasma proteins into the glomerular filtrate can damage tubular cells and the function of the entire nephron. Detection, localization, and treatment of proteinuria are important to decrease the clinical signs and complications of PLN and the likelihood of progression to renal failure. Thorough diagnostic work-ups help to identify subsets of glomerular disease and their response to specific treatment protocols.

Chronic Kidney Disease in Small Animals (Enfermedad Renal Cronica en Pequeños Animales)

David J. Polzin, DVM, PhD

Veterinary Clinics of North America: Small Animal Practice

Volume 41, Issue 1 , Pages 15-30, January 201

Chronic kidney disease (CKD) affects multiple body systems and presents with a wide variety of clinical manifestations. Proper application of conservative medical management can profoundly affect the clinical course of CKD. Diagnosis and management is facilitated by staging CKD and applying therapies that are appropriate for the patient's stage of CKD. Therapy and follow-up of CKD are described, with emphasis on stage-based therapy to ameliorate clinical signs and slow progression.

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Acute Kidney Injury in Dogs and Cats (Insuficiencia Renal Aguda en Perros y Gatos)

Linda Ross, DVM, MS

Veterinary Clinics of North America: Small Animal Practice

Volume 41, Issue 1 , Pages 1-14, January 2011

The term acute kidney injury (AKI) has replaced the historical term acute renal failure for renal damage occurring over a short period of time (hours to days) because it is thought to better describe the pathophysiologic changes and duration of the different phases of injury. There are many potential causes of AKI in dogs and cats, and the prognosis has been shown to vary with the cause as well as with therapy. This article reviews current concepts of the pathophysiology, causes, clinical presentation, approach to diagnosis, and medical management of AKI in dogs and cats.

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