Small animal internal medicine for veterinary technicians and nurses

535 Pages·2012·1.49 MB·English

by  Merrill

Small Animal
Internal Medicine
for Veterinary Technicians
and Nurses
Th is book is accompanied by a companion website:
www.wiley.com/go/merrill
Th e website includes:
• More than 400 Multiple-Choice Questions
• Powerpoints of all fi gures and tables from the book for downloading
• Echocardiography video clips
Small Animal
Internal Medicine
for Veterinary Technicians
and Nurses
Editor
Linda Merrill,
LVT, VTS (Small Animal Internal Medicine and Canine/Feline Clinical Practice)
Seattle Veterinary Associates, Seattle, Washington
A John Wiley & Sons, Inc., Publication
Th is edition fi rst published 2012 © 2012 by John Wiley & Sons, Inc.
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Library of Congress Cataloging-in-Publication Data
Small animal internal medicine for veterinary technicians and nurses / editor, Linda Merrill.
p. ; cm.
Small animal internal medicine for veterinary technicians and nurses
Includes bibliographical references and index.
ISBN 978-0-8138-2164-1 (pbk. : alk. paper)
1. Cats–Diseases–Handbooks, manuals, etc. 2. Dogs–Diseases–Handbooks, manuals, etc. 3. Animal
health technicians–Handbooks, manuals, etc. 4. Veterinary nursing–Handbooks, manuals, etc.
5. Veterinary internal medicine. 6. Veterinary medicine. I. Merrill, Linda (Linda Lee),
1958- II. Title: Small animal internal medicine for veterinary technicians and nurses.
[DNLM: 1. Animal Diseases. 2. Animal Technicians. 3. Internal Medicine–
methods. 4. Pets. 5. Veterinary Medicine–methods. SF981]
SF981.S627 2012
636.089–dc23
2011052834
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may
not be available in electronic books.
Set in 10/12 pt Minion Pro by Toppan Best-set Premedia Limited
Cover images:
Top image: VD radiograph of a 6-month-old puppy with right-sided pneumothorax with secondary lung
lobe collapse showing retraction of the peripheral lung margins from the thoracic wall and presence of
avascular gas opacity (free air) fi lling the pleural space and compressing the lung lobes. Image courtesy of
Marcella Ridgway
Second image from top: Histoplasma capsulatum in a white blood cell in a dog. Image courtesy of
Stan Krogman.
Middle image: Image of author Ann Wortinger’s cat, Cheyenne, enjoying a garden view during a supervised
break from her protective bandage.
Second image from bottom: Focally a myocyte contain onion-cyst (arrow) also note a pyogranuloma (star).
Image courtesy of Kuldeep Singh.
Bottom image: Demonstration of the technique to add fenestrations to catheter prior to abdominocentesis.
Image courtesy of Diane Greene.
Right hand image: Cody, editor’s corgi
Disclaimer
Th e publisher and the author make no representations or warranties with respect to the accuracy or
completeness of the contents of this work and specifi cally disclaim all warranties, including without
limitation warranties of fi tness for a particular purpose. No warranty may be created or extended by sales
or promotional materials. Th e advice and strategies contained herein may not be suitable for every
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accounting, or other professional services. If professional assistance is required, the services of a competent
professional person should be sought. Neither the publisher nor the author shall be liable for damages
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potential source of further information does not mean that the author or the publisher endorses the
information the organization or Website may provide or recommendations it may make. Further, readers
should be aware that Internet Websites listed in this work may have changed or disappeared between when
this work was written and when it is read.
1 2012
Dedication
Th is textbook is dedicated to all those veterinary technicians with a thirst for learning and has been inspired by all the wonderful
animals that have touched my life. Th e idea for this textbook was made into a reality by the combined works of a fantastic group
of authors and editors. I hope it inspires you to continue your personal journey in veterinary medicine and provides you with the
means to expand your horizons.
I would like to give a special thank you to the veterinary technicians who have helped me along the way and to the veterinary
technician specialists of AIMVT and the other academies who continue to motivate me. You are too many to name, but I hope
you realize how great you all are. I would also like to express
my sincere appreciation to all the knowledgeable veterinarians and colleagues who have taken their time to answer my thousands
of questions.
Finally, I wish to acknowledge the love, patience, and support of my husband Jeff .
Linda
v
Contents
Contributors xiii Section 5 Pancreas 31
Preface xv Feline diabetes mellitus 31
Canine diabetes mellitus 37
Canine diabetic ketoacidosis 40
Chapter 1 Insulinomas 41
Glucagonoma 45
Physical Examination 1 Section 6 Miscellaneous Hormones, Glands,
and Disease 47
Charting 1 Calcitriol 47
Goals of the consultation appointment 2 Erythropoietin 48
Conclusion 9 Gastrin 50
Gastrinoma 51
The kinins 52
Chapter 2 Melatonin 53
Natriuretic peptides 55
Endocrinology 11 Renin 57
Somatostatin 59
Section 1 Pituitary Gland 11 Other rare neuroendocrine tumors 60
Growth hormone disorders 11 Bibliography 62
Diabetes insipidus 13
Section 2 Thyroid Glands 14
Canine hypothyroidism 14 Chapter 3
Feline hyperthyroidism 16
Canine thyroid tumors 20 Musculoskeletal 69
Section 3 Parathyroid Glands 22
Hypoparathyroidism 22 Section 1 Anatomy and Physiology 69
Hyperparathyroidism 23 The skeletal system 69
Section 4 Adrenal Glands 25 The muscular system 71
Hypoadrenocorticism: Addison’s Section 2 Selected Diagnostics in Musculoskeletal
disease 25 Disease 72
Hyperadrenocorticism: Cushing’s disease 26 Arthrocentesis 72
Pheochromocytoma 29 Muscle biopsy 73
vii
viii Contents
Section 3 Diseases of the Musculoskeletal Chapter 6
System 73
Infl ammatory joint disease 73 Respiratory 137
Noninfl ammatory joint disease 76
Neuromuscular diseases 77 Section 1 Upper Airway Disease 137
Infl ammatory myopathies 78 Anatomy and physiology 137
Hepatozoonosis 79 Diseases of the upper airway 137
Neoplasia 80 Nutritional considerations 140
Section 4 General Musculoskeletal Anesthetic and analgesic considerations 140
Examination 81 Section 2 Mediastinal Disease 141
Section 5 Musculoskeletal Therapy 82 Anatomy and physiology 141
Veterinary rehabilitation therapy 82 Mediastinitis 141
Palliative radiation therapy 88 Pneumomediastinum 141
Section 6 Musculoskeletal Nutrition 89 Mediastinal masses 141
Nutrients 90 Section 3 Lower Airway Disease 142
Antioxidants 91 Anatomy and physiology 142
Energy and growth 91 Clinical signs 142
Osteoarthritis 92 Diagnostic testing 142
Body condition scoring 92 Specifi c airway diseases and treatment 143
Body condition score uses 92 Anesthetic and analgesic considerations 146
Muscle condition scoring 93 Section 4 Pulmonary Parenchymal Disease 146
Bibliography 96 Anatomy and physiology 146
Clinical signs 146
Diagnostic testing 147
Treatment 148
Chapter 4
Diseases 148
Nutritional considerations 151
The Neurological Examination 99 Anesthetic and analgesic considerations 151
Section 5 Pleural Disease 152
Clinical signs and the relevant anatomy 99 Anatomy and physiology 152
Seizures 102 Clinical signs 152
Encephalopathies 103 Diagnostic testing 152
Cerebral neoplasia 105 Treatment 154
Infl ammatory/infectious etiologies: encephalitis 105 Nutritional considerations 156
Meningitis 107 Anesthetic and analgesic considerations 156
Cranial nerve syndromes 107 Section 6 Anesthesic and Analgesic Considerations
Spinal diseases 109 in Respiratory Disease 156
Neuromuscular diseases 113 Premedication 156
Diagnostic testing 114 Induction 157
Pharmacology 119 Maintenance anesthesia 157
Nursing considerations 121 Monitoring 157
Neurological glossary 122 Recovery 157
Suggested readings 124 Section 7 Feeding Considerations for Respiratory
Disease 157
Bibliography 158
Chapter 5
Chapter 7
Thrombotic Disorders in Small Animal Medicine 127
Hematology 161
Physiology 127
Thrombotic disorders 129 Section 1 Anatomy and Physiology 161
Diagnosis 130 The circulatory system 161
Therapy 132 The lymphatic system 162
Client education 134 The spleen 162
Suggested readings 134 The coagulation system 163
Contents ix
Section 2 Red Blood Cell Disorders 163 Section 5 Feeding Tubes 242
Anemia 163 Feeding tubes 242
Polycythemia 167 Esophagostomy tube placement 243
Transfusion medicine 167 Gastrostomy tube placement 244
Immune-mediated hemolytic anemia 171 Jejunostomy tube placement 247
Section 3 Leukocyte Disorders 174 Conclusion 247
Methods for determining the leukogram 174 Feeding tube management and complications 247
Disorders of neutrophils 175 Section 6 Food Intolerance and Food Allergy 251
Disorders of eosinophils 180 Clinical signs 251
Disorders of basophils 180 Causes 251
Disorders of monocytes 180 Diagnostics 251
Disorders of lymphocytes 181 Treatment 251
Section 4 Platelet, Coagulation, and Inherited Elimination diets 252
Disorders 182 Proteins 252
Diseases of coagulation 182 Carbohydrates 252
Disorders of platelets 184 Prebiotics and probiotics 253
Breed-related disorders 188 Section 7 Anesthesia and Analgesia Considerations
Bibliography 189 in Gastrointestinal Disease 255
Premedication 255
Induction 255
Chapter 8 Maintenance anesthesia 256
Monitoring 256
Gastrointestinal 193 Recovery 256
Bibliography 256
Section 1 Clinical Signs and Examination of
the GI Patient 193
Patient history 193 Chapter 9
Physical examination 194
Clinical signs of gastrointestinal disorders 194 Liver 263
Conclusion 197
Section 2 Selected Diagnostics in Gastrointestinal Section 1 Hepatic Disease 263
Disease 197 Acute hepatitis 263
Laboratory evaluation 198 Chronic hepatitis 265
Microscopic fecal evaluation 198 Copper-associated chronic hepatitis 266
Bacteriologic examination 199 Hepatic lipidosis 268
Virologic examination 199 Toxic hepatopathy 270
Occult blood 199 Hepatocutaneous syndrome 272
Alpha -protease inhibitor 200 Congenital vascular anomaly 274
1
Imaging 200 Liver neoplasia 275
Special tests 201 Section 2 Posthepatic Disease 276
Conclusion 201 Feline cholangitis complex 276
Section 3 Gastrointestinal Disease 201 Biliary cysts 278
Oral disease 201 Extrahepatic biliary obstruction 279
Esophageal disorders 204 Gallbladder mucocoeles 280
Gastric disease 207 Section 3 Nutrition in Liver Disease 282
Alimentary tract parasites 213 Protein 283
Diseases of the small intestine 216 Fats 283
Diseases of the large intestine 235 Carbohydrates 283
Section 4 Pharmacology 238 Fiber 283
Antacids 238 Vitamins and minerals 284
Antiemetics 239 Feeding plan 284
Anti-infl ammatory and immunosuppressive drugs 240 Section 4 Anesthesia and Analgesia Considerations
Antibiotics 241 in Hepatic Disease 284
Gastromucosal protectants 241 Premedication 284
Digestive enzymes 241 Induction 284
Laxatives 241 Maintenance anesthesia 285
x Contents
Monitoring 285 Chapter 11
Recovery 286
Bibliography 286 Infectious Diseases 349
Section 1 Infectious Bacterial Diseases 349
Bartonella 349
Chapter 10
Lyme borreliosis 350
Canine brucellosis 352
Urinary and Renal Diseases 289 Ehrlichiosis 353
Helicobacter-associated disease 355
Section 1 Urinary Anatomy and Physiology 289 Leptospirosis 357
Section 2 Clinical Signs 291 Methicillin-resistant Staphylococcus aureus 360
Section 3 Urinary Diseases 292 Mycobacterial disease 361
Chronic kidney disease 292 Mycoplasmal diseases 363
Acute renal failure 293 Plague 365
Urinary tract infections 294 Section 2 Fungal Diseases 366
Pyelonephritis 295 Histoplasmosis 366
Urolithiasis 295 Aspergillosis 368
Prostatic diseases 298 Coccidioidomycosis 368
Lower urinary tract disease in cats 299 Cryptococcosis 369
Ectopic ureters 299 Blastomycosis 370
Urethral sphincter mechanism Section 3 Protozoal Diseases 374
incompetence 300 Amebiasis 374
Protein-losing nephropathy 301 Babesiosis 374
Urinary neoplasia 301 Giardia 375
Section 4 Urinary Diagnostics and Therapeutic Trichomoniasis 375
Implications 302 Leishmaniasis 376
Urinalysis 302 Toxoplasmosis 376
Complete blood count and serum biochemistry Neosporosis 377
profi le 306 Cytauxzoonosis 378
Proteinuria 309 Hepatozoonosis 379
Blood pressure 311 Section 4 Infectious Viral Diseases 381
Urine culture 313 Canine and feline herpesvirus 381
Section 5 Urinary Tract Biopsy Techniques 315 Infl uenza 383
Aspiration biopsy 315 Papillomas 384
Biopsy 316 Section 5 Infectious Disease Testing 385
Sample handling 319 Disease prevention and control in the small
Postbiopsy nursing care 319 animal hospital 395
Section 6 Urinary Imaging 319 Bibliography 400
Radiology 319
Ultrasound 321
Cystoscopy and vaginoscopy 323 Chapter 12
Computed tomography 323
Section 7 Renal and Urinary Disease Vaccine, Vaccination, and Immunology 403
Pharmacology 324
Fluid therapy and correction of electrolyte Section 1 The Immune Response and Cancer
imbalances 327 Immunotherapy 403
Section 8 Anesthetic and Analgesic Innate and adaptive immune response 403
Considerations 335 Humoral and cell-mediated immunity 404
Anesthesia 335 Immunomodulation 404
Pain management 336 Cancer vaccines 404
Section 9 Nutritional Considerations 336 Cytokine immunotherapy 405
Chronic kidney disease 336 Summary 405
Urolithiasis 338 Section 2 Laboratory Diagnostics in Immunology 405
Feline idiopathic cystitis 341 Serology 405
Bibliography 341 Biopsy techniques 407
Contents xi
Section 3 Immunosuppressive Medications 409 Hazards in the workplace 450
Corticosteroids 409 Chemotherapy safety 452
Immunosuppresives 411 Conclusion 453
Less commonly used immunosuppressives 412 Section 2 Pharmacological Implications in
Novel immunosuppressive medications 412 Internal Medicine 453
Immunomodulating medications 413 Drug calculations, compatibilities, dosing,
Conclusion 413 and administration 453
Section 4 Vaccines and Vaccination 413 Constant rate infusion 453
Vaccination strategies 413 Drug compatibilities 454
Canine vaccines 416 Drug dosage adjustments in patients
Feline vaccines 422 with heart, renal, and hepatic insuffi ciency
Vaccinations and adverse reactions 427 or failure 454
Bibliography 429 Oxygen therapy 460
Drug calculations 461
Client education 462
Chapter 13
Section 3 Nutritional Support 463
Nutritional support 463
Pain and Its Management 433
Energy balance: weight loss versus weight gain 468
Refeeding syndrome 471
Veterinary technician as pain management
Section 4 Diagnostic Procedures 474
team leader 433
Cystocentesis 474
What is pain? 434
Abdominocentesis 475
Pathophysiology of pain 434
Thoracocentesis 478
Types of pain 435
Urinary catheters 480
Causes of pain 436
Bone marrow collection 484
General approach to pain control 436
Section 5 Endoscopy 487
General rules of thumb in managing pain 436
Flexible endoscope 487
Questions to consider 437
Videoendoscope 489
How to be an analgesic advocate for your patient 437
Instrumentation 489
Clinical signs and means of detection 438
Rigid endoscopes 490
Pain scoring systems 439
Reprocessing 492
Analgesics 439
Patient and equipment preparation 495
Nursing care as analgesic 446
Section 6 Selected Nursing Considerations of
Clinical examples 447
Internal Medicine Patients 495
Conclusion 448
Thermoregulation 495
Bibliography 448
Fever or hyperthermia? 495
Hypothermia 498
Chapter 14 The sepsis syndrome 499
Bibliography 504
Nursing 449
Appendix Accredited State Veterinary Diagnostic
Laboratories 509
Section 1 Occupational Health and Safety 449
Abbreviations 515
Making the work place safe 449
Index 521
Health and safety committees 449
Th is book is accompanied by a companion website:
www.wiley.com/go/merrill
Th e website includes:
• More than 400 Multiple-Choice Questions
• Powerpoints of all fi gures and tables from the book for downloading
• Echocardiography video clips