Diseases #8
Cholangitis is often lumped into the category of cholangitis-cholangeohepatitis syndrome. Cholangitis is inflammation of the bile duct and associated intrahepatic ducts. The liver and gall bladder are anatomically situated together. If one is affected the other may also be affected. Cholangitis is not that common in dogs but it is common in cats. The causes include: bacterial infections and the result of bile duct obstruction. It may also be caused by diseases that are not directly related to the gall bladder. These include diseases of the intestinal tract and pancreas.
Bile is produced in the liver and stored in the gall bladder for when it is needed. When food reaches the small intestine bile is released into the lumen (opening) of the small intestine. Biles main function is to emulsify fats. When bile reaches the lower intestines it is recycled back to be used again. This is performed by the enterohepatic circulation of bile. Anything that interferes with the movement of bile, the consistency of bile or problems obstructing or inflaming the bile and liver ducts can lead to clinical signs.
Clinical signs associated with cholangiohepatitis include: fever, abdominal pain due to liver pain plus abdominal fluid, a yellowing of the skin (jaundice), renal failure and hypovolemic shock. Most animals are weak and lethargic. Cats will lose weight extremely fast.
All cholangitis patients require a complete diagnostic work up. This entails a CBC and Chemistry profile and other tests that may be needed when other organ systems are involved. A urinalysis may show bile pigments present. Chemistry profiles will show elevated bilirubin plus an elevation in liver enzymes. The liver and surrounding tissues may be visualized by radiographs or ultrasound. A diagnostic laporotomy may be performed to actually view the liver and gall bladder.
Diagnosis is made by combining the results of the history, physical exam and pertinent lab data.
The treatment for most cases of cholangeohepatitis is supportive. If a bacterial infection is suspected the animal will be placed on broad spectrum oral or intravenous antibiotics. Intravenous fluids are always needed to maintain the blood pressure and renal perfusion. Intravenous feeding with dextrose and vitamin B12 & K is crucial. Care must be taken to control the clotting ability of the blood. Clotting factors are made in the liver and signs of DIC may develop. This is a problem when the clotting mechanism goes awry and the blood takes on the viscosity of water. If bile appears thickened and thick, the patient may require Actigall® which improves the stasis or movement of bile. The goal of therapy is to heal the hepatic and bile tissues so normal functioning can return. If the disease is extrahepatic, those diseases such as pancreatitis must be treated. Some cases require surgical intervention. Gall bladder obstruction is one of them. Animals are eventually discharged on an appropriate diet such as Hill's Prescription Canine l/d or Hill's Prescription Feline l/d, antibiotics, nutrical for caloric support and other supportive care measures.
The prognosis for cholangitis patients depends upon: the severity of the disease, if other organ systems are affected plus the time the animal has been ill. Once the animal has been hospitalized, the clearing of jaundice has occured, normalization of the CBC plus the animal's general demeanor and appetite has returned; the prognosis improves. The dog or cat is not out of the woods even after discharge. It is imperative that animals receive follow up physical exams and lab work to follow the condition and be on the alert for future flareups or relapses.
Coccidia is a uni-cellular parasite seen in dogs and cats that produce loose stool in some cases but bloody diarrhea in severely infected animals. The cause belong to the genus Isospora sp and Eimeria sp.
Coccidia is transmitted via the oral fecal route. Ingestion of contaminated feces is the usual route of transmission. It is seen in young cats and dogs since their immune system is immature plus many young animals are kept in close quarters such as pet shops or shelters. Many kittens and puppies pick up the parasite from their infected mother. The parasite reproduces in the cells lining the small intestine. The cells die, eventually releasing a batch of small organisms that lead to clinical signs.
Some animals have a very light infection and are usually asymptomatic. Others will have a mucous stained loose stool and in severe infections, puppies and kittens can have a hemorrhagic enteritis that requires immediate attention.
The age of the animal and a fecal flotation will easily diagnose the condition.
Diagnosis is made by a fecal flotation sample and animal history.
Most animals are not really sick. All of them should be treated with sulfa type drugs. The most common is Albon® (sulfadimethoxine). Treatment is administered daily for three weeks and a fecal exam is performed to make sure the entire population of organisms has been rid of. Animals suffering from acute diarrhea will require further medical treatment: fluids, antibiotics and anti-diarrheals.
The prognosis for treating coccidia is excellent. Most animals are young but they are also resilient. Reinfection is possible so it is important to pick up all outdoor bowel movements and keep animals away from potentially ill animals.
Most pets enjoy a happy life and the most important thing is to please their owner. Going on walks, trips to the store, swimming in the pool and being called for that well deserved meal is a true pleasure for dogs. An animal ages in front of our eyes. The muzzle may grey, the animal may have problems moving around or getting to the food bowl. Walks that were looked forward to are more difficult due to arthritis and muscular atrophy. The brain also changes along with the neurotransmitters and this degregation leads to the clinical signs of cognitive deficiency syndrome.
Many of the chemical and physical changes in dogs and cats are similar to human Alzheimer patients. A degregation in the lipid layer of the myolin sheath is a big cause in these patients. Because of these chemical changes, many of the taken for granted behaviors such as recognizing family members, looking for the food and water dish and going outside to go to the bathroom are noticed.
Animals with Cognitive Deficiency Syndrome do not demonstrate all known symptoms. All animals suffering from this disease are different. Each animal demonstrates signs in his or her own personal way. The most common signs are: disorientation, forgetting where the food and water bowls are, forgetting the response to verbal commands, being startled by someone petting the animal, urinary or fecal incontinence, lack of appetite, irritability and personality changes.
Most patients are senior dogs and cats. A CBC and Chemistry profile need to be done to rule out other physical causes of an animals behavior change. Radiographs and a general body ultrasound may be performed to rule out other conditions or those associated with cognitive deficiency syndrome.
Most cases of Cognitive Deficiency Syndrome are made by obtaining a complete, detailed history plus physical exam. Diagnostic lab work will help to rule out conditions or diseases not associated with this disorder.
There is no actual specific treatment for Cognitive Deficiency Syndrome. There is hope though. Most veterinarians will perform a therapeutic trial using the drug Anipryl® (selegiline). This drug increases the amount of circulating dopamine. Dopamine is a neurotransmitter that effectively communicates between brain cells. Some dogs respond to the drug, others do not but it definitely is worth a try. Most of the supportive care is provided by the owners at home. A lot of TLC goes a long way. Go slow and talk slowly to the animal. If it needs time to get up and figure out where it is, so be it! Provide appropriate support on slippery tile or wood floors. Animals in this condition do not like change so try to keep the home environment stable. Strange people may also upset the animal. Praise goes a long way in making a pet feel comfortable.
The prognosis for the individual animal varies since each animal is different in his or her own right. Mild degrees of cognitive dysfunction can lead to a happy life. Animals that are unable to stand or are demonstrating fecal or urinary incontinece do not have a good prognosis. Our animal friends have given us so much love during their short lives that it is imperative that we treat them with respect and devotion as they age.
The colon is part of the lower digestive tract in the mammalian body. Most of the water in the intestinal tract is reabsorbed into the general circulation from the colon. In animals there is an ascending, transverse and descending intestinal loop. Causes of colitis are: bacterial, viral, foreign body, tumors, immune-mediated, parasitic, food allergy and pancreatitis.
The normal physiologic function of the colon is to form stool and absorb water from the colon back into the general circulation. When anything irritates the colon mucosa, clinical signs will begin and most commonly they are associated with loose stool and mucous production.
The most commonly seen clinical signs in general colitis are: straining to defecate, loose stool, mucous production and bright red blood coating the stool. Mucous is a normal protective substance of the colon lining and bleeding arises from rupture of colon capillaries. The blood is bright red not dark, since the bleeding originated in the lower bowel and not in the small intestine. In that case the blood appears as dark, tarry stools.
A CBC and Chemistry Profile are performed to look at the electrolytes, organ function and the hematocrit. The latter being elevated in most cases of dehydration. Radiographs and ultrasound imaging can help study the colon plus search for any tumors or foreign bodies present. A fecal flotation test should be done as well as any other organ specific test.
Diagnosis is made by obtaining a detailed history and physical exam. Coupled with diagnostic lab work a working diagnosis of colitis can be made.
Treatment is geared at finding the exact cause of the colitis in the first place. General cases are treated with fluids, subcutaneous or intravenous, drugs that slow the motility of the gastrointestinal tract (aminopentamide), intestinal coating agents (Carafate®), Metamucil® or facsimile plus vitamins and minerals. Dogs and cats do fantastic when put on Hill's® Prescription Canine i/d or Hill's® Prescription Feline i/d. It is recommended many times to keep the pet on the special diet for the remainder of its life. Antibiotics may be used and in the case of immune-mediated colitis, corticosteroids such as budesonide are often used.
The prognosis for acute colitis that is diagnosed and treated early is good. Colitis that is caused by tumors/neoplasms has a much more guarded prognosis. Colitis that is chronic and caused by bacterial, immune-mediated and idiopathic are more guarded. Owners have to understand that flareups or relapses can occur anytime if the animal or its immune system is stressed by exterior factors or by conditions that weaken the cellular or humoral immunity.
The heart consists of a left side and right side. The function of the heart is to pump oxygenated blood to all body tissues as well as exchanging deoxygenated blood in the lungs which is converted to oxygenated blood than out the aorta to service bodily needs. Failure of the valves pumping this blood as well as dilating of the myocardium (dilitative cardiomyopathy) can lead to congestive heart failure.
Congestive heart failure is seen commonly in small breeds of dogs such as: Poodles, West Highland Terriers, Pugs, Miniature Schnauzers, Yorkshire Terriers and others. Cats and large dogs that develop cardiomyopathy also can suffer from congestive heart failure.
The tricuspid valve is the main valve on the right side of the heart. The mitral valve is the main valve on the left side of the heart. In right sided heart failure, the tricuspid valve becomes leaky and blood backs up in the liver. Fluid buildup there leads to fluid in the abdomen (ascites) and buildup of fluid in the limbs (anasarca). In left sided heart failure the mitral valve becomes leaky allowing fluid buildup in the lungs. This causes all sorts of respiratory problems such as pulmonary edema. It is this basic pathophysiology that explains the majority of clinical signs seen. Dilitative cardiomyopathy can cause one or the other types of failure or both if both valves are effected.
The most common clinical signs seen in congestive heart failure are: anorexia, weakness, coughing and respiratory difficulties known as dyspnea. Some animals are so weakened and lacking oxygen that their tongue can turn blue (cyanotic) just by over excitation or exercise. Dogs with right sided heart failure will also have a distended abdomen due to fluid accumulation and liver enlargement. The heart also enlarges and puts pressure on the trachea (windpipe). This crucial organ passes right over the base of the heart. Enlargement of the latter puts pressure on the trachea causing a typical "heart cough". This cough is extremely persistent making it difficult for the animal to rest or even eat. For these reasons and organ dysfunction, many dogs and cats lose weight extremely fast. Due to the heart cough and pulmonary edema, animals have an extremely difficult time getting comfortable. Many will sit with their elbows abducted (opened outwardly) to allow the lungs to take in as much air as possible. This puts strain on the animal's musculature, weakening it further.
A complete cardiac workup needs to be performed. This includes a CBC and Chemistry profile. A urinalysis will also be performed. This provides a minimal database for the doctor. Imaging of the thorax is crucial so radiographs and or ultrasounds are performed to visualize the pulmonary edema as well as heart enlargement. By taking special linear measurements of the width and height of the heart and comparing it to the distance between certain vertebrae, veterinarians can say specifically how large that heart is for that animal. Electrocardiograms are also done to view the electrical activity of the heart. To differentiate between cardiac and pulmonary disease, the Idexx® Pro BNP test is usually run. This gives a quantitative face to the heart disease so individual therapy can be introduced.
Making a diagnosis of congestive heart failure is pretty straight forward. A complete history is important. Likewise, a complete physical exam. Auscultation of the chest will produce easily detected murmurs as well as lung sounds suggestive of pulmonary edema. Diagnostic lab work will confirm the presence of congestive heart failure and the Idexx® Pro BNP test will differentiate between pulmonary and cardiac disease.
Congestive Heart Failure can not be cured. Medical care is geared towards strengthening the heart muscle, controlling the pulmonary edema plus decreasing the return blood flow pressures to the heart. Bronchodilators are used to open up the bronchi so that more air can be exchanged. Special low sodium diets are employed to reduce fluid retention caused by excessive sodium. Vetmedin® is commonly used in dogs (not approved in cats) to strengthen heart tone (inotropic). Furosemide is used to treat the pulmonary edema as well as also help decrease the return blood flow pressure to the heart. Benazepril, an ACE inhibitor, decreases return flow blood pressure and will help maintain a stable urine protein creatinine ratio which will minimize glomerular issues of the kidneys secondary to the heart failure. Theophylline is used as an effective bronchodilator. The majority of the coughing subsides when the pulmonary edema is cleared but some animals have that persistent heart cough due to tracheal pressure and are put on low doses of Hycodan® or Butorphanol. Effective diets that can be fed to dogs and cats are available.
The short term prognosis for dogs diagnosed and treated early for congestive heart failure is good. They all feel so much better after treatment and their quality of life is good. Most veterinarians do not "throw" all conceivable drugs at any cardiac patient but tailor the therapy to suit the animals medical needs. It is extremely important that dogs and cats receive frequent medical exams and repeat blood work to insure all is working well. As the disease condition worsens, more drugs can be added or the dose of current drugs can be increased. There will come a time where the heart failure does not respond to any medical therapy and at this point the prognosis is grave.