SYED MUHAMMAD RAZA

SYED MUHAMMAD RAZA

[email protected]

Pir Mehr Ali Shah - Arid Agriculture University Rawalpindi

(PMAS-AAUR)
Canine Digits: Numbered from 1 to 5, starting medially with small 1st metacarpal that is associated with
Dewclaw. 1st is not visible from front side.

Urethral spasm: Phenoxybenzamine or Prazosin → ↓ sympathetic tone of urethra

Urinary Incontinence / Urethral Sphincter: Phenylpropanolamine → ↑ urethral sphincter tone and helps
prevent incontinence.

Benign prostatic hypertrophy can lead to constipation, ribbon stool, tenesmus, and urinary obstruction.
Treatment can be surgical (orchiectomy) or medical which include Finasteride or Medroxyprogesterone.
Finasteride is expensive but decreases prostate size by interfering with testosterone synthesis.

Borreli burgdorferi: causes Lyme disease. Use western blot or C6 peptide ELISA test to differentiate between
vaccinated dogs from naturally infected dogs.

Canine Distemper (Hardpad disease): caused by a paramyxovirus and spread via aerosol. Necropsy finding
include intracytoplasmic eosinophilic inclusion bodies, catarrhal enteritis and mucopurulent oculonasal
discharge. Clinical signs include hyperkeratosis of the footpads or nasal planum, catarrhal illness and
neurological signs in an unvaccinated dog. Immunofluorescent assay on affected epithelium

Canine Parvovirus: Necropsy will show intestinal crypt necrosis, lymphoid depletion of payer’s patches,
shortened, blunt villi and collapse of the lamina propria.

Cognitive Dysfunction syndrome: Selegiline. can be treated with donepezil (Alzheimer’s drug)

Cranial Cruciate ligament tear: leads to instability of the stifle joint. It usually also damages the medial meniscus.
Diagnosis by positive drawer sign.

Crotalus Atrox vaccine provided protection against Western Diamondback rattlesnake envenomation, found in
the southwestern US and Northern Mexico. Should be only administered in dogs with risk of exposure.

Degenerative valve disease: Endorcardiosis is characterized by nodular thickening of the mitral valve margins
and is the most common cardiac disease of dogs (75%).

Demodicosis
It is caused by demodex canis, leading to alopecia, deep folliculitis, scaling, and secondary infection. Demodex
canis is part of the normal flora and the animal needs to be immunocompromised for it to become a disease. In
young animals it is usually local and self-limiting. Treatment include ivermectin, local baths with amitraz or 1
fluralaner pill will solve it.

Host Specific Live Cigar shaped mite in Hair follicles Acquired from mother sebaceous glands es neonate.

Alopecia. Hyperpigmentation, folliculitis Papules, pustular, epidermal collaterals. Crusts cellulitis

Amitraz → FDA-Approved for generalized Demodicosis

Avoid to drop in eyes

Contraindicated in deep Pyoderma Do not use with MAO inhibiter a tricyclic antidepressant

Monoamine oxidase inhibitor (MAO) Alpha adrenergic agonist PG synthesis inhibitors Side effects: Sedation,
Hypothermia, Bradycardia, ataxia, transient hyperglycemia.

Ivermectin → not FDA approved

Treat until 2 negative skin Scrapings are obtained 30 Days sport Generalized Demodicosis in juveniles & Puppies
is usually caused by an inherited defect in Cellular immunity dog should not bred.

Dx: deep skin scraping.

Benzyl peroxide shampoo can be used for follicular flushing.

Dermoid Sinus: tubular skin lesion from a congenital neural tube defect on the dorsal midline of dogs.

Eclampsia (hypocalcemia or puerperal tetany) is an emergency medical condition associated with post-partum
hypocalcemia in dogs. Animal become stiff or tetanic. Treatment include IV calcium gluconate and animal should
be monitored for arrhythmias.

Ehrlichiosis: caused by Ehrlichia canis. Clinical signs include fever, generalized lymphadenopathy, splenomegaly,
and thrombocytopenia. May see stiffness, reluctance to walk, limb, scrotum edema, coughing or dyspnea.

Elbow dysplasia: there are 3 components for it: ununited anconeal process, fragmentation of the medial
coronoid process of the ulna and Osteochondrosis of the medial aspect of the humeral condyle.

Flea bite hypersensitivity

Flea allergy dermatitis is seasonal type 1 & 3 immune hypersensitivity reaction caused by flea bites. The affect
skin can be alopecic, erythematous, edematous and with some excoriation (from itching) in the tail base, caudo-
dorsal area and both hind legs. The animal will have pruritus. Keep in mind that intense reaction can be caused
by small number of fleas.

Afoxalaner (Nexguard): This flea medication contains an adulticide; whereas, pyriproxyfen and Lufenuron are
only insect growth regulators. Spinosad should never be used with extra-label doses of Ivermectin and is
probably why this client discontinued flea medications in the first place.

Permethrin is an excellent flea medication, as it is a repellent and adulticide, but it is toxic to cats.

Fipronil is toxic to rabbits.

Heartworm disease
It is caused by Dirofilaria immitis, a nematode transmitted by mosquito and can affect dogs and cats. See
enlarged heart touching the sternum and pulmonary knob as the parasite likes to live in the pulmonary artery.
Diagnostic tests for felines use Heartworm antigen test as positive test is diagnostic (very specific). For other
species, you can use heartworm antibodies where a negative test is good to rule out ongoing infection (very
sensitive). The modified Knott’s, the capillary hematocrit tube test and the fresh blood-saline preparation test
can be used to find heartworm microfilariae. Canine heartworm is classified in 4 parameters: Class I is
asymptomatic- to mild case with no radiographic signs and no lab abnormalities. Class II is moderate, with
occasional coughing and mild to moderate exercise intolerance. On physical exam there may be slight loss of
body condition and increased lung sound with mild-to-moderate radiographic changes and lab results may show
anemia and proteinuria. Class III is severe and characterized by weight loss, exercise intolerance, tachypnea at
rest, severe or persistent coughing, dyspnea, hemoptysis, fainting and ascites. There will be severely abnormal
radiographs, enlarged main pulmonary artery and diffuse pulmonary density. Lab work will indicate marked
anemia, thrombocytopenia, and proteinuria. Class IV (also called post-caval or caval syndrome) is an acute, shock
like presentation where there are worms in the vena cava. Clinical signs include collapse, hemoglobinuria,
respiratory distress and require surgery to physically remove worms. Treatment for dogs include first stabilize
the patients if it’s having Right side CHF with diuretics, cage rests and anti-thrombotic agents (aspirin or heparin)
or corticoids in cases of pulmonary failure. Then, macrocyclic lactone at day 1, 30 and 60, 28 days of doxycycline
starting on day 1 and at day 60 begin a 3-dose melarsomine, 1 dose IM at day 60 then 2 doses IM 24 hours apart
at least one month later. Use ivermectin, Milbemycin and others as preventive. For cats there is no definitive
treatment.

Dog activity restriction once treatment has been started & 4–6-week past treatment. This is to protect the dog
from events of thromboembolism and allow lungs to recover.

A +ve antigen test is diagnostic; a negative antigen test is inconclusive

Heartworm antigen test will be positive if there are female worms present. However, if there is an all-male worm
infection you can have a false negative test result.

Heartworm antibody test is prone to false-positive results because positive test con result from a cat that has
been exposed, but cleared the infection. A negative antibody test Con not absolutely rule out infection as some
animals with low worm burden may not mount a sufficient antibody response to be measured a
Hypertrophic osteodystrophy (HO) is more typically an older animal disease with periosteal proliferation
(swollen distal limbs) and secondary to thoracic or abdominal neoplasia.

Inflammatory bowel disease: Common sequela of moderate to severe IBD is cobalamin (B12) deficiency due to
intestinal malabsorption. Cobalamin absorption happens in the ileum and needs an intrinsic factor produced by
the pancreas. Therefore, exocrine pancreatic insufficiency can lead to B12 deficiency. Diagnosis is by measuring
serum B12 levels. Treatment is parenteral administration of high doses of cyanocobalamin.

Infectious tracheobronchitis (Kennel cough) can caused by Bordetella bronchiseptica (more common),
parainfluenza virus, adenovirus 2 and distemper virus. It is highly contagious and spreads via aerosol, therefore
pets should not be in the hospital unless they have severe bronchopneumonia. Most uncomplicated cases
recover within 7-14 days.

Legg-perthes disease: another name for aseptic necrosis of the femoral head. It is a disease of miniature and
small dogs.

Leptospirosis: Clinical signs are usually a combination of hepatic signs with renal signs and systemic infection
signs. Look for icterus, increased liver enzymes, bilirubinuria, isosthenuria in dehydrated patients, increased BUN
and Creatinine, neutrophilic leukocytosis, pyuria, and fever. Diagnosis is done by microscopic agglutination test
(MAT). In bovines it causes abortion in the last trimester, 2-6 weeks after maternal infection.

Best diagnosis by dark field microscopy.

Most common serovars for canine leptospirosis: Grippotyphosa, Pomona, Bratislava

Metritis: is a common complication of retained placenta in a bitch.

Most common location of coxofemoral luxation: Craniodorsal.

Orbital cellulitis: Presents in large and hunting breed of dogs. Look for acute pain when opening mouth, eyelid
swelling, unilateral prolapse of nictitating membrane, eye protrusion and conjunctivitis. The dogs face looks
swollen.

Osteochondrosis in dogs is usually in the shoulder or in the elbow. Usually in young, male, fast growing, large
breed dogs and is usually bilateral (51%). Differentials include panosteitis (think shifting leg lameness) and
Hypertrophic osteodystrophy (lameness and swollen long bones).

Portosystemic vascular anomalies (portosystemic shunt): can happen in any animal but is more common in
dogs. Clinical signs include vomiting, polyuria, polydipsia, weakness, head-pressing, disorientation, and stumbles
right after a meal and unthriftness. Hypersalivation is common in cats. Sometimes you can see hematuria,
pollakiuria, stranguria or urethral obstruction via ammonia biurate urolithiasis. Lab work shows microcytosis,
target cells and mild non-regenerative anemia and ammonium biurate urolithiasis. Treatment is surgical as
medical management is often ineffective.

Progressive retinal atrophy (PRA) leads to worsening of night blindness (nyctalopia). It is common in young dogs
with bilateral retinal abnormalities.

Pyometra: is a uterine infection that can happen in any species, but usually happens in dogs. It is a life-
threatening emergency which typically require immediate surgery (ovariohysterectomy). It can be open, and the
owner usually notice a purulent, malodorous or bloody discharged coming out of the vagina. Alternatively, it can
be closed pyometra and there is no evident vaginal discharge. It should be a top differential for an intact dog,
with fever and distended abdomen. Some animals may develop kidney problems due to inflammation and
deposition of immune complex.

Small Intestine Bacterial overgrowth (SIBO): occurs primarily in dogs. The causes are unknown, but it causes
decrease cobalamin and increase folate. It is usually a complication of exocrine pancreatic insufficiency.

Tracheal collapse: think honking cough that is usually chronic, without fever and that can be stimulated by
touching the tracheal area. Heart murmurs (mitral valve insufficiency/dysplasia) are usually also concurrent.

Wobbler’s syndrome: also known as cervical spondylomyelopathy (CSM) is a disease of the cervical spine that is
commonly seen in large and giant-breed dogs. CSM is characterized by compression of the spinal cord and/or
nerve roots due to cervical bone or ligament malformation, which leads to neurological signs and/or neck pain.
The term wobbler syndrome is used to describe the characteristic wobbly gait (walk) that affected dogs have.

Epidural anesthesia is injected in subarachnoid space.

Predisposed breed to copper storage disease: Bedlington terriers, Sky terries, Dobermans

Seizures: Diazepam (or midazolam) is the first drug you should reach for in a seizuring dog.

Atopic dermatitis
Atopy can occur in any aged dog but typically begins in dogs between 1.0 and 3 years of age. It frequently can
be seasonal, in contrast to food allergy. Ultimately, atopy is frequently a diagnosis of exclusion made by ruling
out flea and food allergy with measures such as strict flea control and an elimination diet.

Licking and scratching her ventrum, paws, ears, and face, particularly in the summer. Find crusted papules,
erythema, and alopecia at those sites.

Hyposensitization injections based on intradermal skin test results

Atopic dermatitis: clinical signs of Atopy typically start at 1-3 years of age. Atopy may present seasonally;
whereas, food allergy will be year-round.

Omega 3 fatty acids → reduce inflammation

Behaviour
Aggression → More common in male Dogs

Urinary tract infection, Mammary Cancer, Adenocarcinoma of Anal Sac → more common in females

Vectors
Ixodese pacificus → Lyme Disease (Get from white posted mouse)

Dermacenter Variabilis → Rocky Mountain spotted fever

Dermacenter andersoni → Rocky Mountain spotted fever

Amblyoma americanum → canine granulocytic Ehrlichiosis (Anaplasma phagocytophilia)

Rhipicephalus sanguineus → Ehrlichia conic

Acanthocheilonema (Dipetalonema) reconditum

It is a blood parasite that look similar to the microfilariae of Dirofilaria immitis.

A. reconditum is non-pathogenic, so not treated.

Septic Abdomen
This condition requires surgical intervention.

Sepsis is suspected if the Glucose in the ascites is at least 20mg/dl less than the peripheral blood. A blood lactate
level of 2 mmol/L lower than the ascites lactate level is also highly suggestive of a septic abdomen. Presence of
intracellular bacteria would also be diagnostic. Hypotension, Bradycardia, Hypothermia can also be attributed.

Hepatic Encephalopathy
Animals require Protein reduction in diets. Lactulose is given because it decreases colonic PH, trapping ammonia
and decrease transit time through the gut → decrease Ammonia uptake. Oral neomycin is used to dampen
urease producing microflora of the gut and consequently, ↓ ammonia production in Gut. vegetable and Dairy
Proteins are well tolerated than meat proteins.
GDV
occurs with repositioning of Pylorus to left dorsal abdomen.

Right Lateral recumbency Abdominal Radiograph → Recommended

It reveals, a Gas filled left dorsally-displaced pylorus with Gas filled ventral fundus separated by soft tissue band.
Gas accumulation make it difficult to Dx with ultrasound.

Large and giant breed pure-bred dogs, particularly with deep chests, are very predisposed to developing GDV.
Great Danes are a classic example; other common breeds include Weimaraner, Saint Bernard, and Irish Setters.

Sarcoptes
Extremely Pruritic and can be transmitted to people. Positive skin Scraping would be most definitive.

The mite has short legs, but long unsegmented pedicles.

Superficial skin scraping is indicated for Sarcoptic mange, since this mite lives in the stratum corneum. Pinnal-
pedal reflex can be positive in 70% of Sarcoptic mange infestation but can also be positive in any dog with
pruritus.

Clinical signs are helpful because Sarcoptes typically infects the non-haired portions of the skin such as the ear
pinnae, elbows, hocks, and ventral abdomen. If the mite is not found on skin scraping and you have clinical signs
indicative of Sarcoptes then a therapeutic trial is warranted.

Keep in mind that in most cases you will not be able to find the mite.

Nephrotic syndrome are

1. Proteinuria
2. Hypoproteinemia
3. hypercholesterolemia,
4. edema.

Mastitis
With the recent history of whelping, fever, and a firm, red, painful mammary gland, the most likely diagnosis is
mastitis.

Antibiotics that penetrate the barrier between the bloodstream and mammary gland should be considered such
as trimethoprim-sulfa, clindamycin, and cephalosporins.
 Spinal cord Localization
Canine/Feline Vertebral Anatomy
VERTEBRAS
Cervical Thoracic Lumbar Sacral caudal
7 13 7 3 Variable

Neuroanatomy
o Cord segments are named by where the spinal nerve exits, not where the neurons live.
o There 8 cervical spinal cord segments & nerves and 7 cervical vertebrae
o Spinal cord ends before the vertebrae
o Cord segments are cranial to the vertebrae of the same name.

UMN signs LMN signs

o Loss of proprioception o LMN is injured and cannot relay the
o Loss of voluntary movement (paresis, information to the muscles
paralysis) o Proprioceptive deficits
o loss "descending inhibition" o Lack of voluntary motor
o Limb is hypertonic o Hypotonic (aka flaccid)
o Hyperreflexia o Hyporeflexia
o Increase muscle tone o Decrease muscle tone

Spinal cord segments

UMN
Lumbar
Cervical
Intumescence
Intumescence

Brain C1-C5 C6-T2 T3-L3 L3-S1

Horner's Syndrome
LMN for the sympathetic input to the eye live from C8-T2 (in the cervical intumescence)

o Ipsilateral Horner's Syndrome

o Miosis
o Ptosis
o Enophthalmos
o Elevation of the third eyelid
Bladder Function
Complicated as involves both autonomic and somatic systems.

Somatic system is clinically the most important.

o UMN is still in the brain

o LMN is from S1-3.
1. Controls the External Urethral Sphincter (EUS)

UMN Disease: EUS is spastic, bladder is full and difficult to express

LMN Disease: EUS flaccid, bladder does not completely full as urine leaks out. Easy to express.

Anal Tone
o Anal Sphincter LMN located from S1-3
o With L4-S1 lesions can see decreased anal tone (LMN disease)
o UMN disease to the anal sphincter (spasticity) is not recognized.

Neurologic exam findings: review

o Mentation/Posture: normal
o Gait: paresis or plegia at the level of the lesion or caudal to it
o Cranial Nerves: Horner's with C6-T2 lesions
o CP deficits: at the level of the lesion or caudal to it
o Spinal reflexes/Tone: increased with solely UMN involvement, decreased with LMN involvement.
 CRANIAL NERVES (12 CNs)
CN1 Olfactory Smell
CN2 Optic Pupil See menacing motion
CN3 Oculomotor Iris sphincter (Parasympathetic NS)
CN4 Trochlear Dorsal obliques muscle of eye
CN5 Trigeminal Mandibular (motor) Blinking
Maxillary (sensory) Jaw tone
Ophthalmic (sensory) Masticatory movement

CN6 Abducent Motor nerve to lateral rectus & retractor bulbi muscle of eyes
CN7 Fascial Ear, Eyelid, Nose, Mouth Blinking
Lacrimal gland Hypothyroidism cause paralysis
Salivary gland (exposure keratitis)
Facial expression

The chorda tympani nerve, which branches off CN

VIl, is responsible for taste in the rostral 2/3 of the
tongue.
CN8 Vestibulocochlear Cochlear Auditory
Vestibular Posture, Muscle tone, Equilibrium
CN9 Glossopharyngeal Pharynx & Larynx
CN10 Vagus Pinch hyoid bone to elicit GAG-Reflex Dysphoria, Megaesophagus
CN11 Spinal accessory Trapezius, sternocephalicus, brachiocephalicus
CN12 Hypoglossal Tongue, Geniohyoid muscle Water licking response

Palpebral reflex: CN V (face sensation) & CN VII (close eyelid)

Pupil light reflex (PLR): Retina, Optic nerve, Optic chiasm, Midbrain, Ciliary ganglia, Parasympathetic fibers via
the oculomotor nerve, Iridial sphincter muscles. Cerebral cortex is not part of PLR.

Menace response test: Retina, CN II, CN VII, Cerebrum, Cerebellum

Dazzle response: Retina, CN II, CN VII, Rostral colliculus

Cutaneous trunci reflex: Actual spinal lesion is generally 2 spinal cord segments in front (cranial) to the line
where cutaneous spinal reflex stops.

If reflex stops at L1 then the lesion will be at T12-T13.

Head tilt: Damage to CN VIII, Inner ear, or parts of the cerebellum.

Intervertebral disc disease (IVDD)

Signs appear according to place of issues in spinal canal.

IVDD can be managed by surgical decompression or non-surgically. The most important aspect of non-surgical
management of IVDD is STRICT cage rest, usually for a full 8 weeks.
Cervical spondylopathy
Doberman Pinchers, Great Danes, and Thoroughbred horses → predisposed

It is a cervical vertebra malformation that causes cervical myelopathy in dogs and horses. The malformation is
usually stenosis or wedging of the vertebral canal, vertebral malalignment, or vertebral instability. This disease
usually manifests as ataxia and paresis of all four limbs and UM signs of all four limbs.

Approximately 80% of T3-L3 herniations are located in the T13-L1 region.

Degenerative myelopathy
It is a progressive, degenerative spinal cord disease that occurs most commonly in German Shepherd Dogs
between 5-9 years of age. This disease causes random axonal degeneration in all spinal cord segments, but it is
usually most severe in the thoracic cord.

It is a diffuse myelopathy that can look like a transverse myelopathy and is often confused with hip dysplasia.

Possible side effects of KBr

Sedation → imp

polyphagia, polyuria and polydipsia, ataxia, skin reactions, pancreatitis, and vomiting.

Hansen's Type 1 degenerative disc disease

The survey radiographs are enough to diagnose the disc rupture, but myelography should be performed to
better assess the areas of the spinal cord affected and to definitively identify which side should be approached
for decompression surgery.

The lack of deep pain is a poor prognostic indicator, so cage rest and NSAIDs are not adequate in such patient.

Type 1 the herniation is acute, while in Type 2 the herniation is slow and chronic.

Dachshunds are very predisposed to disc disease (particularly Type 1 disc herniation).

Hansen's Type 1 disc disease usually involves chondrodystrophic dogs (Dachshunds, Corgis, Shih-Tzus, etc.). It
is usually acute, painful, and should be considered an emergency.

The best imaging modality is an MRI

Prognosis for a dog with spinal trauma that has no deep pain → Poor

Sciatic nerve
Damaged → intramuscular injections given into the caudal musculature of the thigh

Largest nerve in the body of the dog.

It arises from L6, L7, S1, and sometimes S2 nerve roots. It begins as the lumbosacral trunk exits the pelvis and
travels down the caudal thigh. It then splits into the tibial nerve and common peroneal nerve further distal down
the thigh.

Increased intracranial pressure management

Mannitol is a hyperosmotic diuretic. It decreases cerebral edema by establishing an osmotic gradient between
plasma and cells. Some also believe that it increases oxygen delivery to the brain by decreasing the hematocrit,
which reduces blood viscosity and increases cerebral blood flow. Increasing oxygen delivery to the brain leads
to decreased intracranial pressure.
Myasthenia Gravis
Myasthenia Gravis can be caused by immune mediated disease (related to
hypothyroidism), caused by antibody-mediated destruction of acetylcholine
receptors.

Regurgitation of food after meals and exercise intolerance, megaesophagus

DX: Tensilon (edrophonium) response test

Rx: Cholinesterase inhibitors → pyridostigmine

Fibrocartilaginous embolism (FCE)

Non-painful myelopathy caused by an embolus of disc material in the spinal vasculature. It is unknown how the
disc material gets into the vasculature.

Superficial and deep pain perception and some motor function present in its pelvic limbs. Hyperreflexive patellar
and gastrocnemius reflexes.

FCE usually get better on their own with nursing care

The loss of pain perception and lower motor neuron signs are poor prognostic indicators.

Vestibular disease
Vestibular disease can be peripheral or central, and central vestibular disease can be classic in appearance or
paradoxical.

Peripheral vestibular disease is due to a lesion in the inner ear or vestibular portion of cranial nerve VIll. Classic
central vestibular disease is due to a lesion in the brainstem or cerebellum.

Causes of Peripheral vestibular disease: Chlorhexidine neomycin, kanamycin, tobramycin, amikacin, and
gentamicin.

Signs with peripheral and classic central vestibular disease include head tilt, falling, and circling to the same
side as the lesion with nystagmus with fast phase to the opposite side.

Paradoxical vestibular disease, the lesion is in certain regions of the cerebellum (floculonodular lobe) or caudal
cerebellar peduncle and produces signs to the opposite sides from which is seen with peripheral and classic
central disease. e.g.

left sided head tilt, a ventral strabismus on the left, and right horizontal nystagmus. → Central nervous system on the right

Canine idiopathic vestibular disease (Old dog vestibular disease). This disease is usually diagnosed after all
other vestibular causes have been ruled out.

Neospora caninum
A protozoan parasite.

The definitive host is the dog (or coyote or other canidae) which acquires the infection by eating infected meat
and spreads it to cows by shedding oocysts in the pasture or feed. Although clinical signs are mainly seen as
abortions and abnormal calves in herbivores, dogs may suffer from neurologic and muscular abnormalities.
Infection to other dogs is usually as a result of transplacental spread. IFA is usually performed to make the
diagnosis.

Mid-term abortion in their cows

Discospondylitis
It is caused by hematogenous spread of bacteria from a distant infected site.

Radiography showing vertebral endplate lysis is definitive for a diagnosis, but blood cultures and sensitivities
should be run to determine what type of antibiotics should be used.

Surgery is usually indicated if neurologic deficits are severe.

Brachial plexus avulsion

Horner's syndrome, and dragging of his right thoracic limb

Complete nerve root avulsions are not treatable and usually require amputation of affected limbs.

Partial avulsions carry a better prognosis but require large amounts of time and physical therapy
before seeing any improvement. The lack of deep pain and motor function in the limb is a negative
prognostic indicator supporting the diagnosis of a complete brachial plexus avulsion.

Idiopathic epilepsy
Most dogs with idiopathic epilepsy begin having seizures between 1 and 5 years of age.

Breeds commonly affected include Beagles, Keeshonds, Dachshunds, Labrador and Golden Retrievers, Shetland
Sheepdogs, Irish Wolfhounds, Vizslas, and English Springer Spaniels.

Idiopathic epilepsy is much less common in cats.

A 1-5 years old dog recently began having generalized tonic-clonic seizures approximately once weekly, most
frequently at night when resting. The dog appears and behaves normally between seizures.

Issues & predisposed breeds

The Yorkshire Terrier → portosystemic shunt.

The Chihuahua → hypoglycemia.

The Boxer's → intracranial neoplasia.

Peripheral nerve sheath tumor

o lameness of the affected limb
o no conscious proprioception
o no withdrawal reflexes
o atrophy of the muscles of the affected limb

They are most commonly found in the brachial plexus.

Limb amputation and tumor excision may be curative if the spinal canal has not been invaded.

Identify the lesion site

o Right side T13-L1
o Left side L2-L3
o Right side T12-T13
o Right side L2-L3
o Left side T12-T13
Hypertrophic Osteopathy
It is visible as periosteal proliferation in the diaphysis of affected bones.

Usually, the Metacarpal & Metatarsal bones are affected first and it may progress to long bones.

Lameness, Pain & swelling are usually evident, Joints are unaffected.

Causes: Pulmonary neoplasia, Bronchopneumonia, Spirocerca infection, Congestive Heart failure, less
commonly Abdominal neoplasia & Recent Vaccination leading to Hyper-reactivity of immune system.

o HO occurs in association with thoracic mass.

o HO is not linked with Age & Breed Predisposition.
o HO start at distal extremities & develops proximally.
o HO characterized by periosteal proliferation near joints, not sclerosis of the subchondral bone.

Hypertrophic osteodystrophy (HOD)

A condition of Young, growing, large breed dogs. It affects Metaphysis of all long bones
and appears as an abnormal radiolucent line within the metaphysis. The disease is usually
self-limited.

Etiology: Ca / P imbalance, vit-C deficiency, Canine distemper

Rx → Analgesia + Supportive Care
o HOD is extremely painful, causing Lameness in dogs
o HOD occurs usually young, large breed dogs
o HOD reoccur after an episode resolve
o HOD treatment involves Analgesia and Supportive Care
o Surgery is not a treatment option

Radiographically, appears as a line of latency where the bone has been destroyed, typically
parallel to the growth plates of affected bones. This is sometimes referred to as a "double
physis" sign.

Craniomandibular osteopathy (CMO)

It is seen in young dogs (Terrier breeds are mostly affected) Disease is self-limiting and typically regresses by 1-
year old, although not always.

It is thought to be a type of HOD and Pain, similar to HOD.

It occurs mostly in the mandible but can also affect the Tympanic bulla, temporal bones, and
temporomandibular Joints.

Treatment is supportive with anti-inflammatories to control

Prognosis is highly dependent upon whether the patient is able to open/close the mouth, prehend and chew
food and generally sustain themselves through the Course of the disease. Radiographic signs also regress with
time.

Degenerative Joint Disease (DJD)

Disease of overweight, older, large breed dogs.

Rx → weight management, controlled exercise, nutraceuticals that decrease inflammation e.g., Glucosamine /
Chondroitin, Omega 3 fatty acids

Physical Therapy and Swimming can be helpful

Panosteitis
Self-limiting, Painful condition characterized by limping and lameness.

Typically, affects the long bones of young dogs of 5-18 months age.

Radiographs shows focal intramedullary densities within Humeral diaphysis

Rx: Limit activity + NSAID

Prognosis is Excellent → >95% dogs recover

Aggressive Bone lesion Non-aggressive bone lesions

Indistinct lesion margins Sharp lesion margins
Active periosteal reaction Organized trabecular bone
Heterogenous reaction Homogenous periosteal reaction

3 Goals of Repairing Articular fractures in dogs

1. Rigid fixation of the fracture segments: Neglecting to do this will result in loose fracture fragments
within the joints that will promote Osteoarthritis.
2. Anatomic Realignment: 50% or even 75% is not adequate with articular fractures in contrast to long
bones fractures.
3. Early Return to function: In Long bone fractures, extended rest is preferred to promote stability and
healing of bone. But in articular fractures prolonged rest will promote fibrosis causing decreased range
of motion is the joint.

Hyperextension injury to Corpus

Rx of choice is Carpal arthrodesis.

This procedure is accomplished by debridement of the articular cartilage of the joints, implantation of a
cancellous autograft into the debrided joint spaces and fixing a bone plate across the injured joints.

Angular limb deformity

Radial valgus in the antebrachium

Corrective osteotomy of the Radius and ulna are often performed to relieve pain and the functional
abnormalities induced by Angular limb deformities.

Physeal injury in young dogs

Injury to an open physis in a young dog led to premature closure of the physis.

o Sequela to Premature physis closure

o Angular limb deformities
o Shortened limb
o Malarticulation
o Ligamentous deformity
o Osteoarthritis

Internal fixation: Proper internal fixation will achieve the best reduction and thereby maximize the chances of
adequate healing. Small breed dogs have a decreased blood supply to distal limbs, which results in a slower
healing of fractures and a higher incidence of non-union when there is no surgical intervention.
Immune-mediated polyarthritis (IMPA)
IMPA can be associated with a variety of systemic diseases or precipitating factors including systemic infectious,
inflammatory or neoplastic disease or reactions to drugs or vaccines. Systemic lupus erythematosus is a
progressive multiorgan autoimmune disease which frequently manifests with polyarthritis and may also cause
concurrent hemolytic anemia, thrombocytopenia, glomerulonephritis, skin lesions, and lymphadenopathy. Drug
induced IMPA has been associated with a variety of medications including sulfonamides, lincomycin,
erythromycin, cephalosporins, phenobarbital, and penicillins. Vaccine associated polyarthritis has been
suggested but association has been difficult to prove. Some breeds of dogs have particular predispositions to
IMPA including Akitas (in association with meningitis) and Shar- Peis (in association with "Shar-Pei fever"). IMPA
can also be associated with chronic infectious or inflammatory diseases including pyoderma, urinary tract
infections, pneumonia, endocarditis, mastitis, heartworm, fungal infection, and severe periodontal disease.

Chronic inflammatory bowel disease, intestinal overgrowth, and ulcerative colitis have been associated with
IMPA. Distant neoplasia has also been associated with IMPA including squamous cell carcinoma, mammary
adenocarcinoma, leiomyoma, heart based tumors, and seminoma.

The clinical signs associated with IMPA are anorexia, weight loss, fever, lethargy, and lymphadenopathy. Up to
25% of dogs present with only nonspecific signs of systemic illness and without apparent gait abnormality or
joint effusion. It is an important consideration for dogs with fever of unknown origin and may be the cause up
to 20% of the time. IMPA is diagnosed by synovial fluid analysis although additional baseline diagnostics are
indicated to screen for potential systemic or infectious causes. Normal synovial fluid is clear and viscous with
<2.5 g/dl protein and <3,000 cells/ul with predominantly mononuclear cells. Joint fluid in IMPA may be thin,
turbid, and increased in volume with higher amounts of protein and cells, often primarily nondegenerate
neutrophils.

Treatment of idiopathic IMPA centers on immunosuppressive therapy, often starting with prednisone and
sometimes including an additional immunosuppressive drug such as azathioprine or cyclophosphamide. About
80% of dogs will respond to immunosuppressive doses of prednisone; however, half of dogs require tong-term
or additional drug therapy to maintain remission.

Hypervitaminosis D
Excess of vid-D → 25-hydroxyvitamin D3 → Compete with 1, 25-dihydroxyvitamin D3 for its receptors on the
intestines and bones → ↑ Absorption of Ca and P from intestine and Bone resorption → ↑ Ca & P

Familial Shor-Pie Fever (FSF)

Characterized by high fever, unilateral or bilateral tarsal swelling. The swelling affects tissues around the joint,
rather than within the tarsus itself, meaning that we expect normal synovial cytology. Hyperemic mucus
membranes but absent cyanosis & Panosteitis.
Seasonal Nasal Hypopigmentation
season associated Lightning of the nasal planum occurs during winter months and can darken in spring and
summer. Complete depigmentation is not noted.

Hypopigmentation and discoloration of the nose and mucocutaneous junctions can vary from benign immune
mediated diseases such as Vitiligo that lower the number of melanocytes in the skin to seasonal variations in
coloring, commonly called as Dudley nose or Snow nose. Certain breeds are more predisposed than others such
as Siberian huskies, Golden and Labrador Retrievers and Bernese Mountain dogs.

Vitiligo
It is a benign immune related depigmentation, antimelanocyte antibodies can be found in circulation and a
biopsy will Show decreased melanocytes.

Typically, multiple areas will be affected, including ear tips, footpads, claws and hair coat.

Predisposed Breeds → GSD, Collies, Rottweilers, Doberman, Giant Schnauzers.

No Rx to Prevent these disorders and they typically cause no harm to animals.

Deep Pyoderma
This involves tissues deeper than the epidermis including the dermis and even subcutis. Deep infections have
resulted from uncontrolled superficial infection. Deep lesions heal before the deeper infection is resolved and
making Clinical cure difficult to assess.

o Antibiotic should be continued 7-21 Days after tissue return to normal.

o superficial infection → 3-4 wk. Antibiotic therapy / 1 wk. post clinical resolution
o Deep infection → 6-8 wk. Antibiotic (12 wk. in severe cases)

o Staphylococcus →folliculitis
o Sarcoptes scabiei → intense pruritis
o Cheyletiella → intense pruritis
o Trichodectes → chewing louse
o Demodex → folliculitis
o Dermatophytes→ folliculitis

Chin acne
Chin acne is a chronic inflammatory disorder of young short coated animals. It is characterized by folliculitis and
furunculosis. Secondary bacterial infections can develop if it becomes more advanced.

The chin and lips should be kept as clean as possible with frequent bathing and antibiotic ointment to prevent
plugging of the follicles.

Some cases can be simply managed by modifying behaviors that can traumatize the chin (chasing balls) and
topical antibioties. Severe cases will need long courses of systemic antibiotics to resolve the infection and then
topical corticosteroids to prevent new lesions. The papules should not be expressed, as this can increase
inflammation.

Benzoyl peroxide is good choice for a topical antibiotic since it has follicular flushing action. Keep in mind that
topical application of benzoyl peroxide can be irritating to the skin if overused.
Methicillin-resistant Staphylococcus pseudintermedius
Good hygiene practice such as hand washing should be performed after contact with the animal. There is a low
risk of transfer of Staphylococcus pseudintermedius from animals to humans since this staphylococcus is host-
adapted to dogs. The risk is higher for immunocompromised humans and humans with open wounds. Euthanasia
is unnecessary, since this is a curable disease and the risk to humans is low. Quarantine is generally not indicated.

Trimethoprim-sulfa will probably be effective; however, this antibiotic should be avoided in Dobermans as they
are prone to side effects such as anemia, thrombocytopenia, arthritis, and renal toxicity. These side effects are
due to a type-three hypersensitivity.

Chloramphenicol may also be effective against the infection, but clindamycin would be a better choice, as it has
fewer side effects.

Chloramphenicol can cause peripheral neuropathy, gastrointestinal upset, bone marrow suppression, and
hepatotoxicity. Additionally, chloramphenicol can also cause aplastic anemia in humans. Clindamycin can also
cause gastrointestinal upset but seems to be better tolerated than chloramphenicol.

Staphylococcus aureus
The risk to humans would be much greater. Most dogs do not culture Staphylococcus aureus, since it is host-
adapted to humans. Additionally, it is believed that most cases of Staphylococcus aureus in dogs are a result of
transfer from their owners. Quarantine may be necessary for select cases of Staphylococcus aureus in dogs if
their owner is immunocompromised.

Canine familial Dermatomyositis

The disease cause atrophy of muscles and erosion, crusting and alopecia of skin which is exacerbated by heat
and sun exposure

Predisposed Breeds → Collies & Shetland Sheepdogs

Rx →often unrewarding
High doses of Corticosteroids. vit. E. Omega 3 fatty acids.

Educating the owner on the fact that signs will reoccur despite treatment can alleviate some owner frustrations.
Often times signs will regress with or without treatments. Educate owners on neutering animals to prevent
propagation of diseased animals.

Dermatomyositis (DMS)
Dermatomyositis (DMS) is a relatively unusual condition that results in skin lesions as well as myositis. The skin
lesions initially appear as papules and vesicles which then rupture, ulcerate, and may progress to crusty alopecia
lesions. The myositis sets in a little later, and atrophy of the temporalis muscle is often seen. In more severe
cases, the muscles of the distal extremities become involved, and megaesophagus may be observed. Since
muscle changes usually lag, other diagnostic tests such as a skin scraping and cytology is performed first to rule
out other common conditions. The condition has a variable prognosis, as the clinical signs may wax and wane.

Medical management usually consists of pentoxifylline, prednisone, and cyclosporine. Prednisone and
cyclosporine serve as immunomodulatory medications. Pentoxifylline is used to help improve blood flow.

Hycodan contains hydrocodone and is used as a cough suppressant. Meloxicam would be contraindicated in a
patient on steroids. Although it looks similar to a zine-responsive dermatosis, zinc would not be a treatment for
DMS.
Acanthosis nigricans
The primary inherited form of this condition almost exclusively occurs in Dachshunds. Other dogs may get a
form of the Condition secondary to other skin diseases. Characterized by: Hyperpigmentation of the axillary
and groin regions and can spread to other parts of the body. Secondary infections and Seborrhea commonly
develop in the affected regions.

Mode of inheritance has been proposed to Autosomal recessive or Polygenic inheritance.

Juvenile Cellulitis (Puppy strangles)

Sterile granulomas and pustules that respond dramatically to glucocorticoids.

Cause is thought to be an underlying immune dysfunction.

Acutely swollen face, lethargy, submandibular lymphadenopathy. Immunosuppressive dose of Glucocorticoids

after ruling out other all infectious diseases.

Lupoid Dermatosis
A fatal disease, that initially cause crusting and scaling of the dorsum and head in young German shorthaired
pointers.

Color dilution alopecia

A heritable alopecia that develops in animals with less melanin in their hair shafts than normal e.g., faw colored
Doberman Pinscher.

Malassezia dermatitis
Causes → allergies, immunodeficiency, endocrine cause seborrhea aleosa and pruritis.
Azoles (Ketoconazole Fluconazole, Itraconazole) are best treatments. Terbinafine can also be used. Griseofulvin
is not effective

Claws infections produces Red-brown discoloration. biting the nails, symptoms of allergy.

Staphylococcus pseudointermedius (S. intermedius)

o intracytoplasmic cocci from Dog’s skin.
o Host adopted specie to canines.
o Lethargy, Hair Loss, Greasy skin, mild pruritis

Canine Scabies mite infection

Zoonotic → less contact with dog and wear gloves

It is common for Skin scrapings to be negative in this infection Patchy areas of alopecia, crusting, erythema,
scaling and severe pruritis around Pinnae, ventral thorax, ventral abdomen and legs.

Rx → Ivermectin, Amitraz, Milbemycin oxime, Selamectin

Alopecia x (endocrinopathy)
Common in Pomeranians. Chow Chow, Alaskan Malmutes, Toy Poodles and Samoyeds.

Clinical signs → Truncal alopecia, Hyperpigmentation

Treatment of choice is to neuter.
Common to relapse in clinical signs in 1-2 years after neutering.

Melatonin helps to grow new hairs if a relapse occurs.

Acral Lick dermatitis
o Most lesions are Solitary and affect Corpus or metacarpus.
o About 50% of dogs will be diagnosed as idiopathic Psychogenic
o Most of the lesions have deep bacterial infection and treatment Should include systemic antibacterial
medications.
o Tropical antibiotics may not penetrate or resolve the infection.

Other issues e.g., allergies, arthritis contribute to this issue

Rx → Steroids, Antibiotics, Tropical, E. collars, Fluoxetine (Depression & absessive compulsive Disorder)
Hepatocutaneous syndrome
Hepatocutaneous syndrome refers to a necrotizing skin disorder that is often associated with metabolic or
vacuolar liver diseases.

Diseases that potentially cause this syndrome in the dog include glucagonoma, phenobarbital-induced
hepatopathy, mycotoxin hepatopathy, copper-associated hepatitis, glucagon-secreting hepatic tumors, and
hepatopathies of unknown origin. Hepatocutaneous syndrome is most often associated with some sort of
hepatopathy in the dog. Your clues in this patient were the history of phenobarbital use, elevated liver enzymes,
and the skin lesions.

Skin biopsy and histology are required for definitive diagnosis of this condition. Abnormalities include marked,
diffuse parakeratotic hyperkeratosis, intercellular and intracellular edema, keratinocyte degeneration, and
hyperplastic basal cells. These changes create a characteristic red, white, and blue histologic appearance (see
image). Biopsy samples should be taken from multiple sites, with footpad samples included. Ultrasound of the
liver often shows a pathognomonic honeycomb appearance.

Discoid lupus erythematosus (DLE)

Depigmentation of nasal planum, erythema, scaling and loss of the “cobblestone” appearance of nasal planum.
Alopecia, crusting, scaling & ulceration can also see on face, muzzle, lips, Pinnae and periorbitally.

Systemic Lupus erythematosus (SLE)

Joints are affected in this condition.
Primary Hyperparathyroidism
There are 4 Parathyroid glands.

Cell types
Chief cells: secrete Parathyroid hormone. interacts with vit-D at level of Bone, intestine, kidneys & Results in ↑
ionized Ca

oxyphilic cells: function unknown

Etiology: Adenomas but occasionally malignant Carcinoma

Clinical Signs: Hypercalcemia, PU/PD, Lethargy, weakness, Urinary calculi, rarely Pathologic fractures
Treatment:

o 0.9 % Saline Diuresis o Evaluate contralateral side

o Surgical removal o Ultrasound guided ethanol injection

Post-operative Period

o Be ready to treat Hypocalcemia

o Calcium gluconate for emergencies
o Calcitriol to increase Ca absorption
o Ca supplementation

Increased Intracranial Pressure (ICP) → Bradycardia, Hypertension

In order to perfuse the Brain when there is ↑ ICP, the body needs to increase systemic blood pressure to
overcome that pressure. This occurs primarily through reflex vasoconstriction. The increase in blood pressure
leads to decreased H.R Therefore, Cushing’s reflex is when increased ICP leads to Hypertension and Bradycardia.

Cushing's Response
Compensatory increase in MAP to maintain Cerebral Perfusion Pressure

CPP = MAP - intracranial Pressure

Response is seen in situations where ICP ↑ such as in Brain trauma. In this case, you need to think before you
intervene to decrease your patient's MAP as this might eliminate Cerebral blood flow and kill your patient.

Rattlesnake Bite
o Rapid swelling around the bite. o Thrombocytopenia
o Coagulopathy o Prolonged PT & PIT
o Presence of echinocytes o Local Painful swelling

25% Rattlesnake bites are dry, but presence of echinocytes Indicates presence of toxins in blood so Anti-venom
should be administered immediately.

Side effects of Anti-venom

main side effect is Anaphylaxis

Serum sickness 1-2 wk. Post treatment

Venom → Neurotoxic OR coagulopathies OR Hybrid

Antivenoms
The Product produced by Fort Dodge is FDA approved but only treat the Coagulopathic venom.

Antivipmin is USDA but not FDA approved & treats both neurotoxic and Coagulopathy by venom.

Crofab is a human product but expensive.

Horner's Syndrome
Sympathetic innervation to the eye is a 3-neuron pathway

1. Originating in Hypothalamus
2. Traveling to T1-T3 Is where they synapse and course back to the cervical sympathetic trunk and then
synapse in the Cervical Ganglion.
3. The last neuron goes by the middle ear and to the eye

Causes of Horner’s
Otitis, neoplasia in chest affecting the sympathetic trunk, Retrobulbar disease, Hypothyroidism Guttural pouch
diseases. Horner’s is often idiopathic.

Hydroxyamphetamine acts by encouraging release of the norepinephrine (NE) from the Postsynaptic neuron. If
there is a pre-ganglionic lesion, NE will still be released by the post-synaptic neuron and signs will resolve.

If there is a post-ganglionic lesion, denervation hypersensitivity to NE occurs. As a result, adding Phenylephrine

topically Can Cause a rapid response.

With Pre-ganglionic lesion, the response usually takes greater than 20 minutes.

Canine Portosystemic shunt

o single, congenital extrahepatic → Small breeds (Yorkshire terriers, Maltese, Pugs, Miniature Poodles)
o Intrahepatic shunt →Large breeds (usually less than 1 year.)
o cats with shunts hove classic "Copper" colored eyes (iris)

Anatomy & Pathogenesis

All blood from GIT drains into portal vein for detoxification in Liver. Liver receives 2/3 of its blood from portal
circulation. A shunt involves a vessel that bypass the liver and blood enters the circulation

Clinical findings
Hepatic Encephalopathy (Vomiting, diarrhea, Polyphagia, PU/PD Seizures)

Diagnosis
o Microcytic hypochromic anemia
o Decrease → BUN, Albumin, Glucose, cholesterol
o Increase →Liver enzymes, ALP (bone isoenzyme)
o Dramatically ↑ post-prandial bile acids should make you highly suspicious of a shunt.
o ↑ Ammonia levels
o Ammonium biurate crystals
o Microhepatica on radiographs
o Abberant vessels and bladder stones
o Mesenteric Portovenogram
o Transplenic schintiography
o Transcolonic scintiography

Treatment
 o Metronidazole or Neomycin: ↓ urease producing bacteria in colon. Neomycin is unique that is not
absorbed through GIT
o Lactulose: Decrease colonic PH resulting in ↓ ammonia absorption
o Low protein diet: Decrease Substrate for ammonia production
o KBr in Seizures
o Surgery is recommended
o Ameroid constrictor
o Cellophane band
o Partial or complete ligation

Post-op complications
o Hypoglycemia, Seizures, pain

Vascular Ring Anomalies

o Congenital malformation of the great vessels and their branches.
o Constriction of the esophagus and signs of esophageal obstruction
o Persistent right aortic arch 95% of the time
o Six Pairs of aortic arches surround the esophagus & trachea.
o Normal maturation & selective regression of these arches from the adult vasculature.
o All vascular ring anomalies have resulted from abnormal development of arches Three, Four and Six.

o Third arch joins the dorsal aortic arch and continues anteriorly as the right and left internal carotid
arteries. Third arch also forms Brachiocephalic trunk.
o Left fourth aortic arch and dorsal aortic root persist to form the permanent aortic arch.
o The left sixth arch becomes the ductus arteriosus.
o Right fourth arch contributes to the right subclavian artery.

History

o Regurgitation when solid or semisolid food is first fed

o Voracious appetite; some immediately eat regurgitated food
o May have aspiration pneumonia
o Tracheal stenosis, can occur secondary to a double aortic arch

Diagnosis

Radiographs, Barium Swallow, Fluoroscopy, CT, Angiography, Echocardiography, Endoscopy

Radiographs: megaesophagus

Differentials

o Primary megaesophagus o foreign body

o Stricture o mass hiatal hernia

Medical management: not a Solution

Prognosis
o 80% of patients expected to survive initial post-operative period
o Persistent regurgitation → most common postoperative Problem
o Aspiration Pneumonia and Death
o Prognosis is Poor with esophageal dilation caudal to constriction without surgery, regurgitation usually
continues
Amyloidosis
Proteinuria suggesting Glomerular disease

Increase BUN, ↑ Creatinine

Shar-Pie dogs are predisposed to condition.

Waxy kidneys

Emphysematous cystitis
It is caused by the presence of gas forming bacteria. Even if a patient is asymptomatic, emphysematous cystitis
typically has an underlying cause that should be determined and treated.

The most common rule outs include Cushing's disease (ACTH stimulation test), Diabetic mellitus (urinalysis for
Glucosuria), Chronic urinary tract infections (urine culture) and bladder stones.

Prostatitis
Use antibiotics having good penetration of the Prostate until the urine cultures are back.

Chloramphenicol, Erythromycin, Trimethoprim, Fluoroquinolones are able to pass Blood Prostate barrier

OTHERS
Hydronephrosis → dilation of renal Pelvis
Renal infarcts → Triangular Pyramidal shaped lesions
Lyme disease → Glomerulonephritis → Hemorrhagic spots
Suppurative, nonseptic inflammation →non-degenerate neutrophils without intracellular organisms
Granulomatous → Predominantly Mononuclear cell population (Lymphocytes, Macrophages. plasma calls)
Pyogranulomatous → Mixed (neutrophils + mononuclear cells)
Osteoarthritis → mild ↑ in mononuclear cells with few neutrophils but should not produce markedly
inflammatory joint fluid.
 Exocrine Pancreatic insufficiency
o Genetically predisposed Breed → German shepherd
o EPI is believed to be an autosomal recessive trait that results in atrophy of the exocrine pancreas. Dogs
lose the ability to digest fat and protein and become emaciated.
o They have voluminous, soft feces, a voracious appetite and may develop Pica.
o Trypsin-like immunoreactivity (TLI) is diagnostic for EPI.
o Rx → adding Powdered pancreatic enzyme extract or raw Pancreas to meal
o Control → Dogs should not be bred

>85-90% of normal function lost before signs of the malabsorption / maldigestion occur. In the absence of
pancreatic secretion, dogs Can Still absorb up to 63% of indigested protein and 84% of indigested fat

1. Lingual lipase
2. Gastric pepsin and lipase
3. Brush border esterase & peptidases

Pancreatic Acinar cell Atrophy is the most common cause in dogs (GSD's, Collies)

Chronic Pancreatitis (Cats)

Females are more affected than males

Diagnosis
History & Clinical Signs

o weight loss and good appetite

o increased fecal volume
o Vomiting

12 hours fasting Serum Trypsin-Like Immunoreactivity

o Dogs < 2.5 ug/L o Cats < 8.5 ug/L

Fecal Elastase

o Produced exclusively in pancreas

o <10 ug/g of feces is diagnostic for EPI.

↓ Cobalamin, ↑Folate: Lack of Pancreatic Proteases to release Cobalamin from transport Proteins Bacteria
consume Cobalamin and Produce Folate (SIBO)

↓ Eat soluble vit (Vit. A.D.E.K)

Dietary management
i. Highly digestible iii. Moderate fat
ii. Low fiber iv. High Protein

Prognosis
a) Treatment is life-long and expensive. 20% of Dogs with EPI are euthanized.
b) Response to initial treatment
i. 60% Good
ii. 17% Partial
iii. 23% Poor

Cobalamin deficiency is associated with shorter survival time

Complication of intestinal resection and anastomosis surgery
Leakage at the surgery site and resultant septic peritonitis. The most common time for anastomosis failure is 3-
5 days postoperatively. This is due to the degradation of fibrin at the site prior to deposition of sufficient
collagen. Abdominocentesis would likely reveal a septic inflammatory process, confirming your clinical suspicion
with the finding of intracellular bacteria.

Raising a large breed puppy

It is important to limit calcium intake to prevent skeletal abnormalities. In fast-growing, large-breed puppies,
diets high in calcium have been shown to predispose them to osteochondrosis and retained cartilage cores.

Lymphangiectasia
It is a classic example of a protein-losing enteropathy. It is characterized by dilation and dysfunction of intestinal
lymphatics and leakage of protein-rich lymph into the intestinal lumen.

o ↓ protein
o ↓ cholesterol
o ↓ lymphocytes
o ↓ Calcium
o ↓ vitamin D

Megaesophagus
high-calorie diet

fed in upright positions, at a 45-to-90-degree angle from the floor.

Patients should stay in that position for 10-15 minutes after eating to give time for the food to properly settle in
the stomach

Regurgitating vs Vomiting
Active abdominal contractions indicate vomiting. Regurgitation is a passive event that does not have abdominal
contractions.

Salivation is a sign of nausea that generally indicates vomiting rather than regurgitation.

Cricopharyngeal dysphagia
This is a congenital disorder characterized by in-coordination of the swallowing reflex.

Regurgitation after eating & dog will repeatedly attempt to swallow and bring up food and will sometimes cough
or sneeze concurrently.

Hemorrhagic gastroenteritis (HGE)

HGE can be due to a hypersensitivity reaction in the intestines or from Clostridium perfringens enterotoxin.

It usually affects small dogs such as Miniature Poodles and Miniature Schnauzers.

Acute severe raspberry jam-like diarrhea, vomiting, and abdominal pain

High PCV and total protein of 6.0 (5.5-7.3 g/dL).

Aggressive fluid therapy is extremely important for these patients to prevent shock, disseminated intravascular
coagulation, and renal failure.

An abnormally high PCV can be a good indicator of this disease if there is a history of bloody diarrhea.
Salmon-poisoning disease
sporting breed dog eats the fish which had a fluke (Nanophyetus salmincola) which had Neorickettsia
helminthoeca.

Clinical signs include fever, vomiting, diarrhea, enlarged lymph nodes, and depression. Rare cases can develop
neurologic signs such as seizures and muscle twitching.

On fecal sedimentation, trematode eggs.

Rx: oxytetracycline

Praziquantel is usually given to eliminate the fluke in order to prevent contamination of other waterways.

Perianal fistula
German shepherds are predisposed to development of perianal fistulas.

Tenesmus, tail chasing, and hematochezia. Malodorous mucopurulent discharge near his anus, multiple
ulcerations around his perineum, reduced anal tone and mucosal thickening.

The key finding is the presence of multiple draining tracts in the perianal region that can actually be quite deep

This disease is thought to be primarily immune-mediated. The treatment of choice for perianal fistula is medical
management with cyclosporine, as resolution is achieved in greater than 65% of dogs. Surgical correction may
lead to fecal incontinence or stricture formation, however, surgery for removal of the anal sacs in combination
with cyclosporine has recently shown promise.

Anal gland abscess

Lancing the abscess and drain placement with systemic antimicrobial therapy would be indicated

Perineal hernia
Adult intact male dogs (and cats) are at increased risk of perineal hernias. The deviation of the rectum on rectal
palpation is how the diagnosis is usually made. Tenesmus and a swelling near his anus are found.

The cause is often not identified, but if frequently occurs as a sequela to chronic tenesmus.

Oral surgeries cause significant bacteremia, which may be an endogenous source of wound infection.

Salmonella
acute nature, mucoid hemorrhagic diarrhea

BARF diet history → raw meat and bone diet

Bismuth subsalicylate (Pepto-Bismol)

It forms bismuth sulfide in the colon, which is a very dark compound that makes feces black and can lead to the
misdiagnosis of melena.
Campylobacteriosis
Gram-negative motile, thin, S-shaped, or gull-shaped rod. It can occur singly, in pairs, or in chains.

mucus-laden diarrhea

Kids with puppies are 16 times more likely to acquire Campylobacteriosis.

Gastric outflow obstruction

Hypochloremia + Metabolic alkalosis

This leads to emesis of material with a high concentration of gastric hydrochloric acid.

Giardia
Young, immunodeficient, and grouped animals tend to show signs.

Diarrhea that appears to be of the malabsorptive and maldigestive kind.

On smears notice a protozoal organism swimming around in a "falling leaf" motion.

These organisms also have a ventral concave disc, are pear shaped, binucleate

Dental cleaning & Periodontal diseases

Chlorhexidine rinses can be used short-term, such as prior to or immediately after any dental procedure. Daily
usage kills off normal bacterial flora in the mouth and will stain teeth over time. Daily chlorhexidine use is
sometimes advocated as a long-term treatment of severe periodontal disease, but alternative therapies should
be recommended if possible.

Beta-lactam antibiotics (especially Clavamox) or clindamycin are better choices for oral infections because of
their activity against anaerobes.

Calculus removal
Raw hide chews, daily teeth brushing, and chew toys all help to reduce plaque and calculus when used regularly.

TERTIARY DENTIN
Aggressive chewing of things like rocks, tennis balls, cage bars, etc., causes abrasion of dentin. Tertiary dentin,
which is produced as a response to the wearing of the teeth stains easily. Tertiary dentin will usually prevent the
exposure of the pulp cavity unless its production cannot keep up with its rapid wear.

Inflammatory bowel disease (IBD)

A diet trial is considered an important diagnostic test to rule out dietary intolerances in animals with suspected
inflammatory bowel disease (IBD). It is not wrong to pursue the other diagnostic options, but many internists
will recommend a strict diet trail to start. To definitively diagnose IBD you will need a biopsy and histopathology,
and it is important to warn the clients that this is a disease to be managed, not necessarily cured.

Pancreatitis
Hypoechoic pancreas with Hyperechoic surrounding mesentery

The pancreas appears hypoechoic due to edema, and the mesentery appears hyperechoic due to focal
peritonitis.

Sometimes, the pancreas will also be enlarged and may appear mottled.

Inflammatory bowel disease

It is characterized histologically as lymphoplasmacytic inflammation within the Gl tract. Treatment is aimed at
suppressing the inflammation with glucocorticoid therapy (not NSAIDs), a novel protein diet, and often times
metronidazole, which is thought to have some immunomodulatory effects.
 Canine Brachycephalic Syndrome
Congenital Components
1. Elongated soft palate: Normal soft palate extends to caudal aspect of tonsil and tip of palate barely
touches the epiglottis. b. Elongated soft palate typically extends into laryngeal opening, blocking air
flow.
2. Stenotic nares: Severe narrowing of nasal lumen
3. Hypoplastic trachea: Narrowing of trachea. Esp. prevalent in English Bulldogs

Acquired Components- as a result of increased airway resistance

1. Everted laryngeal saccules: This is the mucosal lining of the laryngeal ventricles. These can evert
into the lumen of the larynx, compounding the problem
2. Laryngeal edema
3. Laryngeal collapse
4. Redundant (edematous) pharyngeal fold

Breed → Small breeds: Bulldog, Boston Terrier, Pug, Pekingese

Clinical Signs
o Exercise intolerance o Open mouth and loud, stertorous
o Respiratory distress breathing
o Gagging and dysphagia o Collapse/cyanosis
o Aspiration pneumonia

Diagnosis
o Physical Exam
o Thoracic Radiographs → Evaluate for hypoplastic trachea
o Oral exam under anesthesia

Treatment
Elongated Soft Palate: Resect to normal size. Be very careful as over-resection can predispose to aspiration
pneumonia. Monitor very carefully for excessive post-op swelling resulting in life-threatening airway
obstruction.

Stenotic Nares: Wedge resection of nasal fold

Hypoplastic Trachea: There is no effective treatment. As long as you fix the other problems, animals can
typically live with this. If you have other underlying diseases such as heart failure, it may become a problem.

Laryngeal Collapse: Make sure this diagnosis is accurate and that it is not laryngeal paralysis. Occurs with
very advanced brachycephalic syndrome. Permanent tracheostomy is probably the best treatment option.

Everted Laryngeal Saccules: Can grab saccule at the base with long pair of hemostats or Allis tissue forceps
and remove with traction.
 Canine Collapsing Trachea
Signalment and Clinical Signs
o Small breed (Yorkshire terriers, Pomeranians, Chihuahuas, Pugs, etc.)
o Older animals (around 7 years) with signs of respiratory distress.
i. Early signs- mild productive cough and exercise intolerance
ii. Advanced signs- development of honking cough, substantial exercise intolerance, and possible
cyanosis.
o Dyspnea triggered by excitement or anxiety
o Typically, obese patients

Pathophysiology
o Can be a result of a weak or redundant dorsal tracheal membrane.
o Cartilaginous rings become hypoplastic or fibrodystrophic
i. If involving extrathoracic trachea (neck), trachea will collapse on inspiration
ii. If intrathoracic, will collapse on expiration

Diagnosis
o Palpation of trachea incites severe coughing spasms. (Honking cough)
o May see on radiographs (flattened trachea)
o Fluoroscopy on an awake patient in lateral recumbency is a helpful diagnostic test in practice.
o Endoscopy allows evaluation and visualization of bronchi which may be collapsing.

Treatment
o First, identify and treat any other primary condition affecting the upper respiratory system.
i. Frequently, this may obviate the need to perform additional procedures on the trachea
ii. May include conditions such as:
1. Stenotic nares
2. Elongated soft palate
3. Everted laryngeal saccules
4. Laryngeal paralysis
o Rule out concurrent cardiac disease
o If bronchial collapse is present, surgical treatment for tracheal collapse is less likely to be successful.
i. Medical management may be the best option for these cases:
1. Weight loss
2. Anxiolytics as necessary
3. Bronchodilators if indicated

Surgical Options
o Dorsal tracheal membrane plication
i. If cartilage is normal can plicate the redundant tracheal membrane.
ii. Only use for mild cases of tracheal collapse.
iii. Not done very commonly because many choose to manage mild cases medically.
o Intratracheal stenting
I. Stent can fracture
II. May begin to see collapse proximal or distal to stent placement.
III. May induce severe mucous and granulation tissue production.
IV. If used properly up to 80% success rate.
o External support
I. Surgeons have attempted to use long solid materials to externally support the trachea.
1. Plastic rings partially around trachea
2. Polypropylene syringe cases
3. Teflon tubing
II. Results have not been consistent.
 Laryngeal paralysis
Acute Respiratory distress, loud stridor, changing bark

The arytenoid cartilages fail to abduct during inspiration, resulting in upper airway obstruction. These patients
often present with acute clinical signs even though the disease is chronic in nature.

Surgical arytenoid lateralization (tie-back) is the treatment of choice but with the chronically opened airway,
aspiration pneumonia can be a common side effect.

If surgery is not an option, prednisone can be given to help reduce laryngeal inflammation.

Laryngeal examination for Laryngeal paralysis: Doxapram

It is a central nervous stimulant that has effects on respiratory centers.

When performing a laryngeal exam, the goal is to have the patient just deep enough so you can perform a
laryngeal exam. Injectable aesthetics such as thiopental or propofol are used. Overzealous administration of
these can result in a false diagnosis of laryngeal paralysis and it is therefore recommended to administer
Doxapram to help stimulate respiration and definitively confirm your diagnosis.

Brachycephalic airway syndrome

Bulldog has difficulty breathing, stertor, and a cough

I. tracheal hypoplasia
II. stenotic nares
III. elongated soft palate
IV. everted laryngeal saccules
V. laryngeal collapse

It is easy to get these confused with tracheal collapse, which affects older toy and miniature dogs. The difference
is that tracheal hypoplasia is a congenital narrowing of the trachea (Definition: lumen is less than twice the width
of the third rib where they cross on radiographs), and collapsing trachea is an abnormality in the tracheal rings
themselves.

Intrathoracic tracheal collapse → end expiratory thorax

Treatment options for Intrathoracic tracheal collapse include bronchodilators (i.e., theophylline, terbutaline),
cough suppressants (hydrocodone, butorphanol), weight loss, and corticosteroids to control inflammation. In
severely affected dogs, sedation may be necessary to break the cough cycle. Dogs should be kept away from
smoke and environmental pollution. About 70% of dogs respond to medical management. Those that don't are
sometimes treated with stents or tracheal rings, but neither repairs the underlying cartilaginous defect.
Furosemide is not an appropriate treatment as there is no evidence of heart failure.

Aspiration pneumonia
Aspiration pneumonia is the most likely complication from this type of anesthesia and surgery.

Dog usually exhibits moderate respiratory distress upon recovery that worsens over the next two hours.

Radiographs → bronchoalveolar pattern in the cranial lung field

Lung tumor
If a primary lung tumor can be excised with wide margins, usually with a lung lobectomy, this is the best chance
for a cure.

Chemotherapy may be useful in cases where the tumor cannot be excised.

Long-term prognosis is still guarded because benign pulmonary neoplasia is uncommon.

Pleural effusion
Pleural fissure lines are typically diagnostic for pleural effusion. The fissures are the normal divides between the
lung lobes and are not visualized on radiographs unless there is fluid in the chest or the pleura is very thickened.
When there is a large amount of fluid, you may begin to appreciate a loss of detail, and it is possible lung lobes
will collapse as a result of an inability to properly expand in the face of the pleural effusion. A lobar sign is seen
when there is a line of demarcation between a radiopaque (consolidated) lung lobe and a radiolucent (normal)
lung lobe. There can be several causes for a lobar sign including hemorrhage, edema, or pus within the lobe. An
air bronchogram is seen when alveolar edema occurs as a result of fluid accumulating within the alveoli. Alveolar
edema will result in a sharp contrast between the fluid in the alveoli and the air in the bronchi.

Pulmonary thromboembolism
PTE should be immediately suspected in any dog with profound dyspnea and unremarkable radiographs.

The split-second heart sound is heard due to pulmonary hypertension from the PTE.

Angiography is the gold standard for diagnosing PTE. (contrast radiographs)

Radiographs which appear normal

Rx: warfarin therapy

PT is the best of these indexes to monitor warfarin therapy since, at these doses (usually 0.1-0.2 mg/kg), PTT
and ACT will be unchanged. An even better method is to use the international normalization ratio (INR). which
is a fancy way of taking into account how different PT reactions are run. The goal is to get an INR of 2.0 to 3.0.

Aspergillus
Aspergillus is typically a disease of healthy, apparently immunocompetent dogs that are young to middle-aged.
Dolichocephalic breeds are overrepresented. Immunocompromise does predispose to development of
disseminated aspergillosis. Being in a large group of dogs does not increase risk, as it is not a contagious disease.
Aspergillus is fairly ubiquitous in the environment, and hunting dogs are probably not exposed significantly more
than any other dog.

Topical antifungal therapy is considered more efficacious and less costly than long-term systemic antifungal
therapy.

The currently recognized treatment of choice is clotrimazole, a synthetic imidazole that has an 80% cure rate
with single administration. The main potential complication is CNS exposure to the drug if there has been
erosion of the cribriform plate.

Instilling clotrimazole into the frontal sinus and nasal cavity following debridement of the fungal plaques and
irrigation with saline.

Laryngeal inflammation following intubation is the most common complication seen with this procedure.
Seizure is a possible sequela if the cribriform plate is compromised.

Definitive diagnosis of aspergillosis → Histopathology

Diagnosis of nasal aspergillosis is based on demonstrating the organism in diseased tissue.

Ketoconazole is hepatotoxic and can cause elevated liver enzymes. It is a potent inhibitor of P450 enzymes and
can significantly affect metabolism of other drugs. It can cause adrenal insufficiency and actually is sometimes
used as an alternative treatment for Cushing's. Anorexia is a common and important side effect, especially in
cats.

Blastomycosis
Anorexia, weight loss, and progressive exercise intolerance and dyspnea with a dry, hacking cough, febrile and
has diffuse peripheral lymphadenopathy.

Thoracic radiographs show a diffuse nodular interstitial pattern in all lung fields

Blastomyces is seen as a broad-based budding yeast.

Definitive diagnosis in this patient would be a transtracheal wash or bronchoalveolar lavage.

Cyanosis or blue mucous membranes is an indicator of oxygenation & is generally observed when arterial PO2
is less than 50.

Bacterial pneumonia in dogs

Primary bacterial pneumonia in dogs → Bordetella bronchiseptica

Treatment of bacterial pneumonia in a dog?

Coupage, systemic antibiotics, oxygen therapy, and nebulization

Coupage may mechanically jar secretions and stimulate cough and can be performed for 5-10 minutes several
times daily. Nebulization is to maintain airway hydration. It is not always necessary but is appropriate. Cough
suppressants are contraindicated as are corticosteroids since they both interfere with normal defenses. Diuretics
are contraindicated as well as they decrease airway hydration. Bronchodilators are controversial but are not a
mainstay of therapy for pneumonia unless bronchoconstriction is present.

Actinomyces
This is a filamentous, branching, gram positive bacteria that is a normal inhabitant of the mouth and
oropharynx. It is commonly associated with grass awn migration. These are usually contaminated in the
oropharynx and then migrate through the body from the respiratory or Gl tracts. Many times, it takes months
to years to make a diagnosis.

FUNGAL FEATURES
Coccidioides immitis → spherule

Blastomyces → broad-based budding yeast

Cryptococcus → small yeast with large capsule

Aspergillus → branching fungal hypha

Histoplasma → small intracellular yeast

Smoke inhalation
Carbon monoxide inhalation is an important component of smoke inhalation morbidity as it leads to
carboxyhemoglobin formation and displacement of oxygen. Carbon dioxide inhalation is another cause of
morbidity, because at high levels it leads to severe acidosis, leading to an increase in respiratory rate. Damage
to the larynx from the heat causes edema and swelling, contributing to upper airway obstruction. The heat
damage does not usually reach the level of the bronchi or lower airways. Smoke also can inhibit pulmonary
macrophage function (not increase it), and skin burns can worsen pulmonary status.

Trauma due to accident

I. Rib fractures
II. Pulmonary contusions
III. Pleuroperitoneal diaphragmatic hernia

Pulmonary contusions can cause respiratory deterioration in the apparently stable patient for up to 24 hours
after trauma. They usually then improve over the next 24-48 hours.

On thoracic radiographs they appear as regions of localized consolidation.

Difference between stertor and stridor

Stertor is a gurgling noise usually generated in the nasal passages while stridor is a high-pitched sound
usually generated near the larynx. This is always a source of confusion for veterinary students.

Both noises are audible without the aid of a stethoscope and indicate an extrathoracic problem.

Lymphoplasmacytic rhinitis
Mixed population of lymphocytes and plasma cells on biopsy.

Specific etiology is unknown.

Typical clinical signs include a history of unilateral or bilateral nasal discharge of several months’ duration. Large-
breed dogs are more often affected, and the age may vary.

Chyle
The best way to definitively classify chyle is finding an elevated triglyceride level compared to serum. If you
chose differential cell count, this is also a good answer because most chylous effusions are composed primarily
of lymphocytes, unlike other effusions. However, with prolonged loss of lymphocytes, chronic chylous effusions
may be composed primarily of neutrophils, which may lead you to believe it is an exudate.

Bronchopneumonia
Cough, dyspnea, fever, neutrophilia, monocytosis, eosinophilia

Areas of alveolar pattern

Aggressive and broad-spectrum antimicrobial therapy with ampicillin and enrofloxacin is the best answer, with
supportive care with oxygen as needed.
Left-sided heart failure
Left ventricular enlargement, dorsally displacing the trachea
on the lateral film, left atrial enlargement seen at the caudal
heart base and compressing the mainstem bronchi, and
widening of the cardiac silhouette suggestive of right-sided
cardiomegaly.

Left-sided failure is evident from the enlarged pulmonary veins

and interstitial densities seen in the perihilar region. Right-
sided failure is also suspicious given the wide cardiac
silhouette and hepatomegaly with the gastric axis shifted
caudally.

Oxygen, furosemide, and nitrates (nitroglycerin or

nitroprusside)

Nitroprusside provides both venodilation and arteriodilation, while nitroglycerin principally causes venodilation,
are the primary treatments for acute congestive heart failure. This dog's left-sided congestive heart failure is
likely secondary to severe mitral valve degeneration and regurgitation.

Congestive heart failure

Furosemide + Enalapril

Mitral valve prolapses

The mitral valve bends back into the left atrium consistent with mitral
valve prolapse. The valve is also thick and mitral regurgitation is likely,
which fits with the heart murmur reported. The left ventricular lumen
is dilated and walls appear of normal thickness, so concentric
hypertrophy is not present.

Cough and rapid, shallow breathing. You auscult a grade IV/ VI left
apical holosystolic murmur and crackles throughout both lung fields.

Myxomatous mitral valve degeneration

THIS OCCURS IN OLD ANIMALS: as a result of degeneration and accumulation of acid-staining
mucopolysaccharides in the valves (most commonly the mitral valve).

Left systolic murmur over the apex of the heart + small regurgitant jet across a mildly thickened mitral valve.

Dx: Color Doppler echocardiography reveals a

Initially does not need cardiac medications at this time, but she should be rechecked in several months.

As the disease progresses and the heart chambers enlarge and the animal begins to show signs of heart failure,
the dog should be placed on medications such as diuretics, ACE inhibitors, +/- pimobendan.

This do not need to be placed on antibiotics for fear of bacterial endocarditis. Patients with subaortic stenosis
are placed on prophylactic antibiotics if put at risk for bacteremia.
Mitral valve dysplasia

A left systolic murmur is heard best over the apex of the heart. + enlarged left atrium.
It is a congenital anomaly of the mitral valve. The valve leaflets may be thickened, fused, fibrosed, etc. The
chordae tendinae or the papillary muscles attaching to the mitral valve may be irregular as well.

German Shepherd Dogs, Great Danes, and other large breed dogs are predisposed to this disease.

Pericardial effusion
Markedly enlarged globoid cardiac silhouette on the DV projection.

Pericardiocentesis is necessary for therapeutic and diagnostic

purposes.

Atenolol and furosemide would be contraindicated. While this dog

is showing signs of heart failure, furosemide would decrease
preload on the heart and make diastolic filling even worse in cases
of pericardial effusion. Atenolol would decrease contractility.

Tetralogy of Fallot
It is a congenital defect of the heart which includes

1. Pulmonic stenosis 3. RIGHT ventricular hypertrophy

2. Dextro-positioned aorta (over-riding) 4. Ventricular septal defect

It causes shunting of venous blood across the VSD into the arterial circulation which leads to hypoxemia, and an
increased drive for erythropoiesis, causing polycythemia.

Affected animals tend be underdeveloped in size and have a history of exercise intolerance, dyspnea, tachypnea,
or syncope due to hypoxemia.

Thoracic radiographs usually show a normal to mildly enlarged cardiac silhouette with right ventricular
enlargement and pulmonary hypoperfusion due to the shunting of venous blood into the arterial circulation.

Subaortic stenosis
Systolic murmur at the left heart base. Thoracic radiographs show mild left-sided cardiomegaly with left atrial
enlargement and segmental enlargement of the ascending aorta.

Beta blockers → Atenolol (reduce myocardial oxygen demand, lessen the frequency of ventricular arrhythmias,
and provide cardiac muscle protection)

The dog should receive prophylactic antibiotics for any situation in which the dog may develop a bacteremia
since subaortic stenosis is known to carry a high risk of developing infective endocarditis (i.e., prior to surgical
or dental procedures). Surgical repair is difficult, expensive, and does not give very good results either.

The prognosis is fair. Animal can die anytime. Increased risk of infective endocarditis

Dx: Echocardiogram

1. Aortic stenosis → Beta blockers → Atenolol

2. Pulmonic stenosis → Balloon dilation (valvuloplasty)
3. Patent ductus arteriosus → Occlusion by ligation or coil
4. Dilated cardiomyopathy → Pimobendan
Ventricular septal defect (VSD)
In dogs with a VSD, the shunt occurs during systole when both ventricles are contracting so blood is shunted
from the left ventricle almost directly into the pulmonary artery. The right ventricle acts as a conduit between
the left ventricle and pulmonary artery and is less commonly affected by the shunted blood.

The excess blood flow is found in the pulmonary vasculature, left atrium, and left ventricle, thus enlarging these
structures.

Atrial septal defect

An atrial septal defect with systemic hypertension results in oxygenated blood shunting into the venous
circulation or left-to-right shunting, which usually does not cause hypoxemia.

Atrial fibrillation
"Tennis shoes in a dryer" sound on auscultation.

Patients with enlarged atria can develop the

arrhythmia atrial fibrillation. Atrial fibrillation is characterized by a rapid irregularly irregular rhythm.

Primary atrial fibrillation occurs idiopathically in some large-breed dogs, and patients are usually asymptomatic.
Secondary atrial fibrillation is more common and occurs secondary to underlying cardiac disease.

Rx → procainamide, Atenolol, Diltiazem, Digoxin

Patent ductus arteriosus (PDA)

PDAs are the most common congenital heart defect in dogs.

PDAs results from the failure of ductus closure after birth resulting in a shunt (usually left-to-right) from the
aorta to the pulmonary artery. The shunting causes excess volume in the pulmonary arteries, veins, left atrium,
left ventricle, and aortic arch.

In addition to the enlarged left heart and pulmonary vasculature, there is also usually an aneurysmal bulge of
the aorta near the PDA on the DV view. The bounding pulses result from a widened pulse pressure (difference
between systolic and diastolic pressure) because of the run- off of blood from the aorta to the pulmonary artery.

Continuous murmur over left heart base, bounding arterial pulses

o Funnel-shaped PDAs → Coils

o Cylindrical PDA → surgical ligation

Most canine PDAs are funnel-shaped with the smaller end of the funnel attached to the pulmonary artery, and
the wider end attached to the aorta. The funnel shape is what allows the coils to lodge in place and cause closure
of the PDA.

Coils would not stay in place in a large, cylindrical PDA, so surgical ligation is the treatment of choice for this
patient. There are newer nickel-titanium devices (Amplatz Canine Ductal Occluder) that show promise for
minimally- invasive closure of PDAs which do not taper, but this answer was not provided. Ameroid constrictor
rings are typically used for ligating hepatic shunts, and not for PDAs.
Endocarditis
Dogs with endocarditis are most commonly affected on the mitral and aortic valves. The tricuspid and
pulmonary valves are rarely affected in dogs and cats, but are the more common sites of infection in large animal
species.

The most commonly reported organisms recovered in animals with endocarditis include

o Staphylococcus aureus o Erysipelothrix

o Streptococcus sp. o E. coli,
o Corynebacterium sp. o Bartonella sp.
o Pseudomonas aeruginosa

3rd degree AV block

The rhythm is complete heart block (also known as 3rd degree AV block). There is no consistent PR interval; the
ventricular beats are escape beats.

Atropine can be considered, but is typically not effective in 3rd degree AV block. The only way to restore a normal
heart rate in this patient is by implanting a pacemaker, which will require referral to a cardiologist.

Cardiac tamponade
Cardiac tamponade comes from excessive accumulation of fluid in the pericardium resulting in an increased
intrapericardial pressure impairing diastolic filling of the heart. Causes of pericardial effusion includes.

o right atrial hemangiosarcoma o infectious pericarditis

o heart base tumors o trauma, foreign body
o right sided congestive heart failure o coagulopathy
o idiopathic pericardial hemorrhage o hypoalbuminemia
o peritoneopericardial diaphragmatic hernia

First degree AV block

least likely to be able to auscult in a dog

This is a very subtle prolongation between the P and the R wave which can usually only be recognized by
evaluation of an ECG strip.

LHF RHF
Coughing Tachypnea
Pulmonary edema and/or bronchial compression Dyspnea can develop due to pleural effusion
Enlarged left atrium Hepatomegaly
Muscle wasting
Exercise intolerance
venous distention
ascites
peripheral edema
HEARTWORM PREVENTION
o Ivermectin once a month
o Milbemycin oxime once a month
o Diethylcarbamazine (DEC) once daily

Ventricular premature complexes

If frequent ventricular ectopy is seen, particularly with runs or R-on-T episodes.

Treatment is advised with oral ventricular antiarrhythmics. Mexiletine is an oral class

I antiarrhythmic that is well-tolerated in dogs.

o Pimobendan → improves systolic function

o Amlodipine → systemic hypertension
o Diltiazem → supraventricular tachycardias to slow conduction down the
AV node
o Furosemide → diuretic/ CHF

Premature ventricular contractions

It is commonly observed after splenectomy.

A heart rate greater than 180 bpm, or greater

than 20 second stretch of continuous VPCs.

Lidocaine is an anti-arrhythmic and is the

typically the drug of choice for treatment of
VPCs. A bolus is administered first to determine if the rhythm is responsive to lidocaine and then a CRI is initiated
at 20-80 micrograms per kilogram per minute.

There are several general guidelines/recommendations regarding treatment of ventricular premature

contractions which is what is shown on the ECG strip. These include a heart rate of over 180 bpm, pulse deficits,
clinical signs, and VPCs for over 20 seconds in duration.

Supraventricular tachycardias & ventricular tachycardias

Supraventricular tachycardias → atrial fibrillation and cause progressive left ventricular dysfunction

Ventricular tachycardias → ventricular fibrillation and death

supraventricular tachycardias considered clinically more important in dogs than Ventricular tachycardias.
Protocol: Vaccine schedules vary by hospital. This presentation discusses the types of vaccines and
recommended schedules based on the standards of the American Association of Feline Practitioners (AFP) and
American Animal Hospital Association (AAHA)

Vaccines: A vaccine is a biological preparation to increase immunity to a specific disease. They are made from
weakened or killed forms of the microbe or its surface proteins or toxins. It causes an immune response in the
individual vaccinated so that antibodies are formed. If exposure to the disease occurs, the body recognized it as
a foreign so the immune system destroys it. Most vaccines are prophylactic (preventative). Some are therapeutic
(like the canine melanoma vaccine).

Adjuvants: Vaccine adjuvants are chemical proteins that enhance the immune response to vaccine antigens.
Mostly used in killed vaccines, but sometimes used in modified-live. Some adjuvants may contain aluminum
(controversial use in cats as some believe may be linked to vaccine associated sarcomas; hence the non-
adjuvanted rabies and FeLV vaccines for cats).

Types of Vaccines
Killed- rabies (canine or the canine/feline) Contains killed virus and an adjuvant to stimulate the immune system

Modified live (live attenuated): Distemper, Hepatitis, Parvo, Parainfluenza (DHPP), intranasal Bordetella, FVRCP-
contains virus cells themselves which pass through multiple cell cultures to make them less virulent

Cellular antigen extract: Injectable Bordetella vaccine

Canarypox: Feline Rabies (Purevax) and Leukemia-isolates the genes for specific proteins of a virus inserted into
the genome of a carrier canarypox virus, which acts as a vector to transfer this immunity-simulating genetic
material to the patient

Bacterin (Inactivated): Leptospirosis, Lyme

Vaccination Schedule for Dogs (Core Vaccines)

o DHPP (Distemper/Hepatitis (Adenovirus)/Parvo/Parainfluenza) or DHPPC (with Corona).
a. Dogs receive this vaccine starting between 6-8 weeks, and receive it at 2–4-week intervals until
at least 16 weeks of age.
A common example of this schedule would be: 8, 12, 16 weeks or at 6, 10, and 14,
and 18 weeks.
Booster at 1 year, then every 3 years.
Some hospitals include the Leptospirosis vaccines (DHPP-L or DHPPC-L) (Corona is
usually only given to puppies).
Dogs that are over 16 weeks at initial vaccine should receive 1 booster 3-4 weeks after
the first vaccine.
o Rabies between 12-16 weeks of age. Booster at 1 year, then every 3 years.

Maternal Antibodies: Newborn puppies are usually naturally immunized by maternal antibodies for a time
period of 3 months for the distemper and parvo viruses. The natural immunity of puppies starts declining after
6-8 weeks of age, so an initial dose of DHPPC should be administered during this time.

Additional Vaccines to Consider

o Bordetella: May be a 1-year vaccine, or some may require 1 booster 3 weeks apart, then yearly.
a. Some institutions require it every 6 months for boarding, but the vaccine is labeled as a 1 year.
o Leptospirosis vaccine: 2 series vaccine, 3 weeks apart, then yearly, based on risk of the patient.
a. Includes only 4 out of the 7 serovars (L. icterohaemorrhagiae, L. canicola, L. pomona and L.
grippotyphosa. (Zoonotic disease).
o Lyme vaccine: 2 series vaccine, 3 weeks apart, in endemic areas and based on the risk assessment of
the individual patient.
Gastropexy
Incorporating gastropexy: This technique is easy and rapid to perform. It involves making an incision through
the seromuscular layer of the stomach and then suturing it to the linea alba as you are closing your incision. As
a result, if one ever goes back into the abdomen, there is a risk of cutting into the stomach since it will be adhered
to the linea alba. For this reason, some surgeons will advise against this procedure.

Circumcostal gastropexy: This technique involves wrapping a section of the seromuscular layer of the stomach
around a rib and then suturing it back onto the stomach.

Incisional gastropexy: This technique involves making an incision onto the abdominal wall and the seromuscular
layer of the stomach, and then suturing them together so the stomach ends up sutured up against the body wall.

Belt loop gastropexy: This technique involves making two parallel incisions into the abdominal wall musculature
and then passing a section of seromuscular layer of the stomach through one incision, out the other, and then
suturing it back onto the stomach.

Endoscopically-assisted gastropexy: It is a method of performing a fast and relatively easy prophylactic

gastropexy.

Holding layer of hollow organs

At one time, it was thought that the mucosa was the holding layer, but it has now been shown that it is the
submucosa. The submucosa is essentially the holding layer for all hollow viscera.

Splenic hemangiosarcoma
Chest radiographs to check for metastasis and an abdominal ultrasound to confirm the location of the bleeding
mass.

Golden Retrievers are predisposed to having splenic hemangiosarcoma.

A splenectomy will save the patient's life and provide a histologic diagnosis.

Dogs with hemangiosarcoma can be expected to live approximately 3 months after surgery without
chemotherapy. If chemotherapy is provided post- operatively, a 6–7-month survival time is expected.

The suspected bleeding splenic mass may continue to hemorrhage until surgically removed. Fluids should be
administered to stabilize the patient.

Diaphragmatic hernias
Simple continuous pattern of an absorbable suture

Acute, traumatic, diaphragmatic hernias should be repaired primarily without the use of any "substitute"
material for the diaphragm to reduce the risk of complications. It is very rare to have insufficient tissue/muscle
to close an acute defect to the diaphragm. Using the native diaphragmatic wall decreases the risk of failure
because this technique involves tissue with a direct blood supply as opposed to a mesh type material that is
foreign to the body.

Hip luxation treatment

Healthy hip bones → toggle pin fixation

Fracture or osteoarthritis → total hip replacement or FHO

Pyometra
Most commonly cultured culprit → Escherichia coli

Pyometras are usually a surgical emergency and should not be treated medically unless the animal is truly stable
or the owners refuse. Pyometras in cats usually occur 1-4 weeks after estrous and in dogs 4-8 weeks after
estrous.

Neurological deficits
Dorsal laminectomy to relieve disc compression

Basic bloodwork, and a CT or MRI of the lumbosacral region.

Progressive lameness in the hind, intermittently scuffing her hind limbs, weak or drunken gait in the hind as she
walks, and trouble rising.

Urethral prolapse
This condition is almost exclusive to young English bulldogs.

The cause of urethral prolapse is not always determined but may be

secondary to excessive masturbation, sexual excitement, or an infection.

Treatment involves either urethropexy to replace the prolapse or

amputation of the tip.

Triple pelvic osteotomy Total hip replacement

Not performed if degenerative changes are present Performed as soon as the physes in the region have
finished their growth.
Performed in dogs that are 6mo - 1yr of age. THRs have been performed in dogs as young as 1 year
of age and sometimes even younger.
TPOs will not eliminate the progression of arthritis; A caudoventral luxation can occasionally occur with a
however, it is believed that the degree of arthritis total hip replacement

Approximately 30% of dogs evaluated for hip dysplasia have a cranial cruciate ligament injury

Vascular necrosis of the femoral head / Legg-Calves-Perthes

This condition results in a collapse or fragmentation of the femoral epiphysis because of a disruption in blood
flow.

The condition occurs in young small-breed dogs prior to closure of the capital femoral physis.

The condition can be seen bilaterally in 10-17% of patients. Dogs are usually, 6-7 months of age when they first
start showing clinical signs but the age may range from 3-13 months.

Treatment with a femoral head and neck ostectomy (FHO) generally yields excellent results. Alternatively, if
owners demand perfect biomechanics, a total hip replacement may be considered.

Radiographs will typically show a shortening of the femoral neck as well as osteochondrosis with chronicity, as
appreciated in this patient. Note the significant muscle atrophy of the patient's left limb as compared to the
right.

Patellar luxation should always be a differential in any small breed dog.

Septic arthritis of the femoral head
It is an uncommon condition which is more often seen in large-breed dogs with a history of degenerative joint
disease of the hips. They present with acute lameness, severe hip pain, and are usually febrile.

Radiographs usually show degenerative joint disease along with potentially lytic areas associated with the
femoral head.

TPLO
2-7% → post-operative meniscal injury rate

This is in contrast to a study on the tibial tuberosity advancement procedure which had a much higher incidence
of post-operative medial meniscal tears.

Meniscal injuries
The two most common meniscal injuries observed are the

1. Bucket handle tear (caudal longitudinal tear)

2. "crush" of the caudal horn of the meniscus (this is essentially an incomplete bucket handle tear).

The outer 25-30% of the meniscus is vascular which helps explain why meniscal injuries don't heal well.

Additionally, the inner 2/3 of the meniscus is also avascular.

Fragmented medial coronoid process

Intermittent lameness in the right forelimb.

On physical examination, pain on flexion and extension of the elbow joint.

Radiographs of the elbow show a blunted medial coronoid process, sclerosis of the subchondral bone along the
trochlear notch of the ulna and mild degenerative joint disease.

Rx: Arthroscopy for evaluation and treatment of fragmented medial coronoid process

Perineal hernia
Older intact male dogs are most commonly affected. The hernia results
from a weakened pelvic diaphragm. It is thought that there may be a
hormonal component which results in weakening of the pelvic diaphragm
with time.

Overrepresented breeds include Boxers, Collies, Kelpies, Pekingese, and

Boston terriers

Complications of repairing perianal hernia

I. Infection II. Fecal incontinence III. Failure of repair

Traumatic injuries → flank or prepubic hernia (most common). diaphragmatic hernias (less common)
Congenital → Umbilical hernias
Hormones → Perineal hernias
Hiatal hernia
Persistent regurgitation, a ravenous appetite.

Dx: fluoroscopy

Differentials: persistent right aortic arch, idiopathic megaesophagus, and hiatal hernia.
Rx: esophagopexy in conjunction with a left-sided gastropexy

Performing these will help prevent the esophagus from herniating back into the thoracic cavity. The left-sided
gastropexy increases the barrier pressure at the gastroesophageal junction.

Medially luxating patella

TREATMENT OPTIONS:

I. Lateral imbrication of the retinaculum

II. Medial release of the soft tissues
III. Block recession of the trochlear groove

medial transposition of the tibial tuberosity is not an option

If you have a medially luxating patella, you need to transpose the tibial tuberosity laterally in order to line up
the patellar tendon with the rest of the stifle in an effort to reduce the likelihood of patellar luxation.

The two most important procedures that reduce the incidence of recurrence are

I. lateral transposition of the tibial tuberosity

II. modifying the trochlear groove of the femur.

Canine laryngeal paralysis Unilateral arytenoid lateralization

Elongated soft palate Resection of the soft palate
Everted saccules and causing respiratory distress Resection of the laryngeal saccules
Mass or tumor Partial laryngectomy

Ideal incision site for a foreign body gastrotomy

Halfway between the greater and lesser curvature of the stomach

At this site, you avoid any major bleeding and retain good blood supply from both sides to help with the healing
of your incision. Cutting along the greater and lesser curvature is not recommended due to the need to avoid
blood vessels. Cutting along the pylorus has a risk of disturbing the sphincter and causing the formation of a
pyloric stricture. Additionally, this does not provide a good view inside the stomach.

The most common complication of end-to-end anastomosis of intestine

The leakage at the surgery site, resulting in septic peritonitis. Few days post-operatively, Inappetence, Fever

An abdominal tap and labwork should be performed. The dog should be stabilized immediately and will need to
go back to surgery.

Muscle incorporated in the closure of the abdominal incision

Preputialis muscle: This muscle is usually cut when making a midline incision in male dogs and should be
incorporated into the closure to avoid penile deviation.
Test before performing surgery on a patient with compromised liver function
Coagulation panel: If you have compromised liver function, the liver may not be able to produce enough
coagulation factors; thus, a surgical procedure would bring the risk that the animal could bleed to death.

Umbilical hernias
Congenital in origin. They result from failure or delayed fusion of the rectus abdominis muscle and fascia.

Small hernias may close up by six months of age. Schedule surgery after 6 months of age if the hernia is still
present.

Also assess for cryptorchidism as many of these patients are concurrently cryptorchid.

Nerves
• Sympathetic innervation of the bladder → Hypogastric nerve
• Parasympathetic innervation to the bladder → Pelvic nerve
• somatic nervous system → Pudendal nerve

The pudendal nerve is part of the somatic nervous system and branches to become the perineal nerve, which
provides innervation to the external genital organs.

The pelvic nerve supplies parasympathetic innervation to the bladder and gives branches to the descending
colon and erectile tissue of the penis or clitoris.

The sciatic nerve is the largest nerve in the body and originates from spinal segments L6, L7, and S1. This nerve
has two main branches, the tibial and common peroneal nerves.

The obturator nerve arises from L4, L5, and L6. It is responsible for innervating the external obturator muscle,
pectineus, gracilis, and adductor muscles.

The most common complication associated with an ovariohysterectomy

Hemorrhage: If you see hemorrhage of the left ovarian pedicle, use the mesocolon to retract the jejunum
medially to expose the left paravertebral space. If you see bleeding associated with the right ovarian pedicle,
use the mesoduodenum to retract the jejunum medially and expose the right paravertebral space.

Internal inguinal ring

I. The rectus abdominis
II. The inguinal ligament
III. Internal abdominal oblique

The external abdominal oblique is a component of the external inguinal ring.

Flaps
Caudal superficial epigastric flap: This is an axial pattern flap and as with all axial pattern flaps, it is named after
its primary blood supply. The caudal superficial epigastric flap provides the primary blood supply to the 3rd, 4th,
and 5th mammary glands. With familiarity of the dog's anatomy, you can preserve the blood supply and rotate
the area of skin to cover a defect as was done with this patient.

Both the genicular and deep circumflex iliac flaps are axial pattern flaps that are in different regions.

A full thickness skin graft: It is a section of skin that is completely elevated from one region and applied to a
defect. Skin grafts do not survive in high motion areas.

A microvascular free transfer flap: This involves elevating a section of skin and isolating its blood supply and
then re-anastomosing its blood supply with vasculature in the area of the defect. These procedures require an
operating microscope and are very difficult to perform.
 Corneal Ulcers
Histopathology Section of a Normal Canine Cornea
I. Corneal Epithelium: The most superficial layer:
Comprised of 5-10 cell layers
II. Corneal Stroma: Occupies 90% of the corneal
thickness. Mostly collagen, followed by
glycosaminoglycans, and a few keratocytes.
III. Descemet's Membrane: Basement membrane
IV. Corneal Endothelium: The most inner layer

Uncomplicated Corneal Ulcers

Very superficial erosions in which there is only loss of the corneal epithelium

They always heal within seven day.

Diagnosis: Fluorescein Stain Strip

o Only binds to the hydrophilic
stroma
o Will NOT bind to the hydrophobic
epithelium
o

Causes of Superficial Corneal

Ulceration in Dogs
I. Traumatic
o Exogenous: Very common with foreign body (plant material,
cat claw, etc.)
o Endogenous: Usually due to an eyelid abnormality (ectopic
cilia, distichia or entropion)
II. Decreased Corneal Protection
o Decreased tear production (Keratoconjunctivitis Sicca (KCS))
o decreased tear quality (exposure keratitis or pigmentary
keratitis)
o Decreased blink reflex (lagophthalmos, CN 5 or 7 deficit)

Primary Goal: Prevent the superficial erosion from becoming a very complicated corneal
ulcer
1. Find and remove the cause if possible
2. Use a broad-spectrum topical antibiotic: Prevents secondary infection and promotes healing
 3. Cycloplegia, using a topical
anticholinergic such as Atropine:
Provides increased comfort and
decreases secondary reflex anterior
uveitis
4. Prevent self-trauma: Use of an e-collar
to prevent worsening of the defect
5. NEVER use a topical steroid: Number
one cause of progression and promotion of melting corneal ulcer in the dog.

Prognosis
Carries Excellent Prognosis

o Should always heal within 5-7 days

o If ulcer does not heal within this time
o Do not just change therapy, change your diagnosis

Complicated Corneal Ulcers

o Involve the corneal stroma
o Have some depth to them
o Persist longer than 1 week
o Are infected
o Are malacic (melting)

Diagnosis by Fluorescein Stain

Fluorescein stain binds to the hydrophilic stroma and NOT the hydrophobic
epithelium

Causes of Complicated Corneal Ulceration in Dogs

1. Failure to find, diagnose and/or treat the underlying cause of previously uncomplicated ulcer
2. There is a secondary bacterial infection with or without secondary malacia
3. The secondary ulcer has now become indolent

Treatment
Goal: Prevent progression and promote healing

1. Aggressive Topical Antibiotic

2. Cycloplegia: Atropine once or twice daily
3. STOP Corneal Melting: Photo shows corneal melting
4. Prevent Self Trauma: Use of an e-collar
5. Anti-inflammatory Therapy - ORAL Only
6. Structural Support (referral) If Necessary

Progression
 1. May Result in Descemetocele or Corneal Perforation
Descemetocele: a defect that occupies 99% of the corneal thickness in
which only Descemet's membrane remains
2. Requires Emergency Structural Support

Treatment: Structural Support

Conjunctival Graft

A piece of conjunctiva is placed over the defect, sutured in

place.

This will provide tectonic support and a direct blood supply to the defect to allow
healing.

Corneal-Conjunctival Transportation (CCT)

A piece of adjacent cornea is slid over the defect and sutured in place.

The benefit is that it allows for a clear visual access to promote better vision, long term.

Prognosis
o Fair: healing may take several weeks
o May result in significant scarring that may affect long-term vision

Indolent corneal ulcers

Considered "complicated" because they fail to heal within 7 days.
Unlike complicated corneal ulcers these do not have a stromal loss
and are not infected.

Nomenclature
o Indolent Corneal Ulcer
o Spontaneous Chronic Corneal Epithelial Defects
o Boxer Ulcers: They are frequent in this breed
o Recurrent Erosions: What they are typically called in humans

Definition: Chronic, non-healing superficial erosion with non-adherent epithelial edges

o Arrows point to edge of the corneal epithelium that has been debrided, ulcer is to the right
o Hazy aspect is corneal edema, from the lack of an intact corneal epithelium

Causes of Indolent Ulcers

I. Occur spontaneously
II. Trauma (microtrauma)
o Both happen due to failure of the epithelium attaching to the underlying stroma
a. Abnormal basement membrane
b. Superficial stromal hyaline acellular zone

Diagnosis
I. Fluorescein stain binds to the hydrophilic stroma and NOT hydrophobic epithelium
 II. Stain appears to permeate under epithelium
giving a hazy or "halo" effect

Treatment
Anesthetize the eye using Proparacaine or Tetracaine and then debride off the abnormal epithelium. If left
behind, it will inhibit further healing

Corneal debridement with cotton tipped applicator.

Once abnormal epithelium is removed

I. Disrupt abnormal basement membrane

II. Grid keratotomy (Most common technique)
III. Multiple superficial punctate keratotomy
IV. Diamond burr keratectomy
V. Superficial keratectomy

Treatment: Medical

I. Topical Antibiotic: Terramycin

II. Cycloplegia
III. E-collar

Prognosis
I. Very good: 85% treated with a grid keratotomy heal within 2 weeks
Significant or minimal scarring based on the size and chronicity of the defect
II. Scar tissue can be treated at later date with other types of therapy

Keratoconjunctivitis Sicca (Dry Eye)

The tear film is comprised of three layers
1. Lipid (outermost)
o Secreted by meibomian glands
o Prevents tear film evaporation
2. Aqueous (middle layer)
o Increases or improves corneal lubrication
o Provides corneal nutrition
3. Mucin (innermost)
o Secreted by goblet cells
o Smooths out imperfections on the corneal surface
o Stabilizes tear film

Aqueous Background
The aqueous portion of the tear film is derived from:

o Lacrimal Gland (50-70%, blue)

o Gland of the Third Eye (30-50%, red)

Any decreases in the normal production of the aqueous phase of the tear film results in inadequate corneal
lubrication and nutrition leading to corneal and conjunctival inflammation.
Clinical Signs
o Mucoid to mucopurulent discharge
o Corneal vascularization
o Dry, lackluster corneal surface
o Conjunctival hyperemia
o Mucoid crusting of eyelids

Some cases can include

o Corneal pigmentation
o Corneal ulceration
o Blepharospasm

Diagnostic Testing
The Schirmer Tear Test
o Test of choice for diagnosing a quantitative tear film deficiency
o Normal is over 15mm wetting/minute

Causes of Dry Eye

o Immune-Mediated o Surgery-Induced
o Drug-Induced o Neurogenic
o Congenital
Other Rare Causes

o Trauma to supraorbital region o Infectious: canine distemper, Leishmania

o Radiation o Vitamin A deficiency

Most common cause

Secondary to lymphoplasmacytic infiltration with secondary acinar atrophy

Drug-Induced KCS
o Sulfa drugs (TMS, sulfasalazine, etc.)
a. 60% of dogs on a sulfa will have decreased tear production
b. 15% will develop KCS
c. Can be transient depending on length of treatment
o Etodolac (Etogesic)
a. Affects < 1% of dogs on therapy
b. Greater chance of resolution if treated for < 6 months
o General anesthesia
a. Decreased tear production for at least 24 hours following GA
o Atropine (topical and parenteral)
b. Decreased tear production for up to 5 hours after administration

Congenital KCS
o Lacrimal acinar hypoplasia
o Usually results in severe dryness (xerosis)
Surgery-Induced KCS
latrogenic KCS is secondary to surgical removal of the gland of the third eye. The gland of the third eyelid
contributes 30-50% to the aqueous portion of the tear film .

Neurogenic KCS
Secondary to lack of parasympathetic innervation to the lacrimal glands

i. Usually, unilateral
ii. May be associated with other neurologic conditions
iii. May have ipsilateral if xeromycteria is lesion is proximal to pterygopalatine ganglion

Treatment
Identify cause if possible

Stimulate tearing

o Topical immunomodulating agents

i. Cyclosporine
ii. Tacrolimus

Increase lubrication

o Artificial tear gels

Anti-inflammatory

o Chronic cases: topical steroid

o Acute cases: DO NOT USE STEROIDS, prone to ulcerate

Neurogenic KCS Treatment

o Replace absent neurotransmitter (acetylcholine)

o Pilocarpine (eye drop) 1% given orally
o Fine line between therapeutic and toxic effects
o May cause SLUDDS

If no response to topical therapy

o Chronic lubricating therapy

o Surgery (Parotid Duct Transposition)

Prognosis
Immune-mediated: Good: > 80% of dogs respond to topical therapy

Drug-Induced: Fair: Depends on drug and length of therapy

Congenital: Poor: Requires chronic lubricating therapy and/or surgery

Surgery-Induced: Fair: Depends on breed, overall predisposition, degree of aqueous deficiency

Neurogenic: Fair: Responds well if dogs tolerate appropriate pilocarpine dose

Chronic Anterior Uveitis
Chronic uveitis can lead to Cataract formation & Corneal Scarring. because the inflammatory mediators in the
anterior chamber can destroy corneal and lens proteins. It can lead to glaucoma when debris from uveitis plugs
the iridocorneal angle. Uveitis cannot extend into lacrimal gland and destroy them, so not cause KCS.

Hyphema and Keratic precipitates are Specific signs of Anterior Uveitis. Sometimes blood in the Anterior
chamber of eyes.

Uveal cyst
This description is most consistent with a uveal cyst and not a melanoma because it is free-floating.

It is often difficult to distinguish these two conditions because cysts can also be attached to the pupillary margin
or posterior iris. The other way to try to distinguish the two is with transillumination. Melanomas will not
transilluminate while many cysts will. Also, cysts are usually very spherical or ovoid and smooth while
melanomas are usually fleshier-appearing masses

Progressive Retinal Atrophy (PRA)

Progressive Retinal Atrophy (PRA) occurs when the Photoreceptors in the retina develop abnormally, causing
early onset blindness. It is heritable. (Toy, Miniature poodles). Tapetal Hyperreflectivity, gray, vermiform lines
on fundus, retinal vascular attenuation, Pale optic disc. Night blindness progressing to Complete blindness due
to loss of rods prior to cones. Retinal lesions

Sudden Acquired Retinal Degeneration Syndrome (SARDS)

A condition usually Seen in Middle-aged obese female spayed Dogs.

They develop acute blindness and initially have no optic or fundoscopic lesions. Flat-line ERG (no response)

In 1-2 months, they develop retinal vascular attenuation and tapetal hyperreflectivity.

Dogs with Hyperadrenocorticism have increased incidence to get this.

Dogs show PU/PD, Polyphagia, ↑ Liver enzymes & ↑ Cholesterol.

Anterior Lens Luxation

Immediate Lens removal is indicated because they usually cause discomfort and cause Uveitis and Glaucoma.

Lens removal is done in posterior lens luxation and incipient Cataracts but most important in case of anterior
lens Luxation

Orbital Neoplasia
Progressive exophthalmos and third eyelid protrusion. No pain on palpitation. Eye do not retropulsed.
Extraocular Polymyositis

Primarily in Young Goldens Retrievers

Exophthalmos, PLR is normal, both eyes effected

Rx: prednisone + Azathioprine

Idiopathic Anterior uveitis in in Dogs

The goal in treatment is to reduce inflammation & resultant intraocular damage.

Topical steroids ore frequently used (prednisolone or Dexamethasone but not Hydrocortisone

Topical NSAIDS (Flurbiprofen, Voltaren) are newer options Topical Atropine be used to relieve ciliary spasm &
reduce posterior synechia, however avoided in Glaucoma.

In Uveitis, the Pressure is Low (High in Glaucoma) -> Dorzolamide is not indicated

Cocker Spaniels is predisposed to developing eye problems such as i Cataracts, Distichiasis, Retinal
abnormalities, Primary Glaucoma.

Glaucoma: It is an increase in IOP which is dependent Production & Outflow of Aqueous. Clinical increases are
always from Decreased outflow.

Meibomian Gland
Meibomian Gland Adenoma most common ocular tumor of dog and is usually benign. See a moss projecting
from the margin of the upper eyelid.

Chalazion is obstruction of the meibomian gland and appears as a swelling within the eyelid rather than
projecting from it.

Chorioretinitis (Posterior retinitis)

Inflammation of choroid and Retina. Poorly defined gray spots throughout the Fundus, retinal separation Active
disease, such as in to retinal hemorrhage. dogs typically caused by systemic disease. is It can also lead to
Glaucoma os complication.

Optic Nerve Hypoplasia: It is a genetic condition where the Optic Nerve never fully develops and causes vision
losses blindness.

Collie Eye Anomaly: Seen in up to 80% of Breeds. Some are completely blind & some show no visual deficits.
Congenital ocular anomaly characterized by choroidal hypoplasia, manifested by varying degree of visual
dysfunction with signs of large bizarre vessels visible on fundic exam. other signs include, Optic disc coloboma,
Retinal choroidal hemorrhages, Retinal separation.

Incomplete Cataracts: not completely opacified and a taperal reflection seen through it. Animal can see not
as clearly as normal.

Complete Cataracts: Completely opacified lens, taperal reflection cannot be seen. Animal cannot see.
Resorbing Cataract: Degradation of Lens Proteins after developing Cataract
Focal Cataract: incipient cataract
Nuclear Sclerosis: Normal aging change to the center of the lens
Iris Atrophy: Normal aging change seen in almost all dogs 10 years old. It leads to Scalloping of the iris margins
and sometimes a mouth-eaten stroma. It can cause absent or incomplete PLRs, dyscoria or anisocoria.
Persistent right aortic arch: This vascular ring anomaly is an inherited defect that causes a constricting
obstruction of the esophagus at the level of the heart base. There is a breed predilection for German Shepherd
Dogs and Irish Setters. Clinical signs of regurgitation usually manifest as the puppy is weaned off of milk and
onto solid foods. PDAs, pulmonic stenosis, and diaphragmatic hernias of the small intestines should not cause
regurgitation; however, vomiting may be a clinical sign if there is an obstruction associated with the
diaphragmatic hernia of the small intestine.

Cryptorchidism: It is a heritable characteristic in dogs and his offspring may be affected. Dogs with one testicle
are not considered infertile. One testicle is enough to inseminate a bitch. Adverse health risks resulting from
leaving a cryptorchid testicle in the abdomen includes the development of Sertoli cell tumors.

Willebrand's disease: Doberman Pincher with epistaxis. This is a condition that results in poor primary
hemostasis (formation of a platelet plug) due to a loss of von Willebrand's factor, which is critical for allowing
platelets to adhere to sites of hemorrhage.

Dilated cardiomyopathy It is also common to Dobermans but results in conduction abnormalities, heart failure,
and sudden death rather than epistaxis.

Acanthosis nigricans: inherited form of this condition almost exclusively occurs in Dachshunds. Other dogs may
get a form of the condition secondary to other skin diseases. The condition is characterized by
hyperpigmentation of the axillary and groin regions and can spread to other parts of the body. The mode of
inheritance has been proposed to be autosomal recessive or polygenic inheritance.

Inherited glaucoma: Cocker Spaniels are predisposed to developing eye problems such as cataracts, distichiasis,
retinal abnormalities, and primary glaucoma. High Intraocular pressure.

EPI: It is believed to be an autosomal recessive trait in German Shepherd Dogs that results in atrophy of the
exocrine pancreas. Dogs lose the ability to digest fat and protein and become emaciated. They have voluminous,
soft feces, a voracious appetite, and may develop pica. The trypsin-like immunoreactivity (TLI) is diagnostic for
EPI. Treatment entails adding powdered pancreatic enzyme extract, or raw pancreas to meals. These dogs should
not be bred.

Zinc responsive dermatosis: This disease commonly affects Huskies, Malamutes, and German Shorthaired
Pointers. The defect causes an increased requirement for zinc. Clinical signs are usually responsive to oral
supplementation with zinc.

Familial dermatomyositis: is an inflammatory disease of the skin and muscles of Collies and Shetland Sheepdogs.

Lupoid dermatosis: is a fatal disease that initially causes crusting and scaling of the dorsum and head in young
German Shorthaired Pointers.

Color dilution alopecia: is a heritable alopecia that develops in animals with less melanin in their hair shafts than
normal; one example would be a fawn-colored Doberman Pinscher.
Malignant Mammary Tumors in Dogs
These are Hormones dependent.

OVH before a Heat cycle prevents the hormonal effects on the mammary glands that predisposes them to
developing tumors.

o Dogs spayed prior to 1st Estrus → 0.05 times likely to develop

o Dog spayed after 1st Estrus → Risk rises to 8%
o Dogs sprayed after 2nd estrus → Risk rises to 24%

50% of mammary masses in dogs are malignant and thorax is most Likely site of spread, so do Thorax x-ray
before doing surgery for mammary carcinoma.

The lymph node aspirate results are a negative prognostic indicator. You should never find sheets of epithelial
cells in a lymph node unless it is infiltrated with metastasis (or unless you aspirated something else on accident,
like a salivary gland).

Metastasis of mammary gland tumors in dogs is a negative prognostic indicator.

Canine Oral Papillomatosis

o caused by Papillomavirus, spread by direct and indirect contact, infection occurs at sites of damaged
skin or mucus membranes
o Most cases resolve without treatment might include surgical removal, Laser ablation, cryotherapy.
o Rarely they can transform into Squamous cell carcinoma.

Sebaceous gland tumor

most common skin tumor in the dog.

This group of tumors include: sebaceous hyperplasia, sebaceous epithelioma, sebaceous adenocarcinoma.

They usually found in older dogs and are especially common in Cockers, Beagles, Poodles and Miniature
Schnauzers.

They usually Look like wart or Cauliflower like Lesions <1cm and can occur anywhere but usually are seen On the
limbs, trunk and eyelids

Canine Cranial mediastinal mass

Top differentials should be Thymoma or Lymphoma

Tumors in Cranial mediastinal seats are associated with causing Myasthenia gravis and Megaesophagus as
paraneoplastic syndromes.

As long as Thymoma are encapsulated, the prognosis is good and surgery via a median sternotomy is
recommended.

Dx → Chest Radiographs
• Sertoli cell Tumor: Bilateral alopecia, occasional pruritis, papular eruptions
• Hypothyroidism: Alopecia, Seborrhea, Pyoderma
• Hyperadrenocorticism: Alopecia, Hyperpigmentation, calcinosis cutis, Seborrhea, pyoderma
 CANINE ORAL TUMORS
1. MELANOMA

OMM -> must common malignant oral tumor in Dogs

o Malignant
o Over 50% of dogs have bone involvement
o Metastasis in tonsils & regional lymph nodes.
o Can also metastasis to the lungs

Dx via biopsy

Survival time is 2 months without any treatment

Mandibulectomy Maxillectomy

• Survival time is 6-12 months

• Survival time is 2 years if chemotherapy is added

Radiation therapy is also an option

Tumor reoccurrence is a possibility

Prognostic factors include. Size, Location, stage and local reoccurrence

Rostral Oral Cavity tumors have a good prognosis than caudal.

Immunotherapy
Melatonin is often an immunogenic tumor. Xenogeneic Human Vaccine Treat already developed OMM

Injected DNA encodes for a human protein called tyrosinase, which is found in melanocytes and melanoma cells.
As tyrosinase is a human protein the canine immune system recognizes it as a foreign antigen and mounts a
foreign response by forming antibodies against its Similarities b/w Human & Canine tyrosinase cause the
antibodies to Cross-react and bind canine tyrosinase as well as creating an immune response to the melanoma
cells.

2. SQUAMOUS CELL CARCINOMA

2nd most common oral tumor

o More than 70% of Dogs have bone involvement

o Metastasis to regional lymph nodes & Lungs is not as common as OMM.

Dx via biopsy

Mandibulectomy & Maxillectomy

About 18-month median survival time

Radiation therapy Chemotherapy (Same survival time as surgery)

Radiation + Surgery ……>Survival time doubles is not effective

Melanoma
Melanoma is an important differential for a nail bed tumor. At this site, they are frequently malignant and the
local lymph node should be palpated and aspirated. Additional staging (thoracic
radiographs and abdominal ultrasound) should also be considered. If there is no
evidence of metastasis, the affected digit should be amputated.

The cytology shows cells with large nuclei, stippled chromatin with prominent and
sometimes multiple nucleoli (labeled with 1). A few cells (labeled with a 2) have dark
green/black melanin granules.

Metastatic melanoma
The image shows a lymph node with metastatic melanoma (the large cell with black
melanin pigment). The ONCEPT vaccine, also commonly referred to as the "melanoma
vaccine" was given a conditional product license in 2007 and was USDA approved in
2010 as a therapeutic vaccine for cancer treatment.

Synovial cell sarcoma

This radiograph has a component of lytic and proliferative lesions that cross the joint.
The differentials include neoplasia, fungal osteomyelitis, or bacterial osteomyelitis. Since
the bony involvement is crossing the joint, it is most likely a synovial cell sarcoma.

Osteosarcoma, fibrosarcoma, and chondrosarcomas are less likely to cross a joint as seen
in this image. The marked lytic component seen should eliminate severe osteoarthritis
as a differential.

Strongly recommend chest radiographs and a biopsy prior to initiating treatment.

Anti-fungal therapy or any definitive treatment should ideally not be initiated until a
diagnosis is obtained.

Transitional cell carcinoma of the bladder

Transitional cell carcinoma of the bladder in dogs can be palliatively managed with
non-steroidal anti-inflammatory drugs such as piroxicam.

Piroxicam + carboplatin

Progression-free interval and survival can be extended with the addition of chemotherapy. The most commonly
used agents are carboplatin, cisplatin, and mitoxantrone.

Although cisplatin is effective against CC, it has increased nephrotoxicity.

HEMAGIOSARCOMA
Most common site is right atrium.

Ruptured splenic hemangiosarcoma

Schistocytes are fragmented red blood cells that are mechanically broken up due to the irregular vessels and
fibrin strands they pass through in hemangiosarcoma patients. Other typical findings on a CBC in a patient with
hemangiosarcoma are thrombocytopenia, anemia (although not with Heinz bodies), and leukocytosis.
Canine Nasal Tumors
o 60-80% of respiratory tumors & 2% all neoplasms
o Dolichocephalic and mesaticephalic

Clinical Signs
o Epistaxis o Enlarged mandibular o Lethargy
o Sneezing L.N o Dyspnea
o Nasal discharge o ↓ Nasal Airflow o Exophthalmos
o Epiphora o Stertor o Mouth breathing
o Facial deformity o Cough o CNS signs

Tumor Types
I. Carcinoma → Adenocarcinoma (most common)
II. Sarcoma → Chondrosarcoma (most common)
III. Round cell tumors →uncommon

Biologic Behaviors
Locally aggressive, varying degrees of bony destruction and involvement of Sinuses and Cribriform.

1. 98% have destruction of turbinates

2. 80-90% have bilateral involvement
3. ½ have changes to the maxillary bones
4. 20-25% have cribriform plate involvement
5. 1/3 have hard palate involvement

Diagnosis
Nasal imaging, Rhinoscopy, Biopsy

Nasal tumors
Nasal adenocarcinoma → most common intranasal tumor in dogs

Lymphoma → most common intranasal tumor in cats

Anal sac tumor

A mass in the 4 o'clock or 8 o'clock regions is most consistent with an anal sac tumor, which are most commonly
apocrine gland adenocarcinomas; however, a fine needle aspirate or biopsy is needed for a definitive diagnosis.
Hypercalcemia is occasionally associated with this tumor type and dogs commonly present for tenesmus or
licking around the perianal region.

The sublumbar lymph nodes are the most common site for metastasis so abdominal ultrasound prior to excision
of the mass is recommended to determine the extent of the disease. Depending on the size of the mass, surgical
removal should be recommended along with surgical removal of the sublumbar lymph nodes if they are
enlarged. Radiation therapy of the anal sac region along with the lymph nodes (if not excised) may also be
recommended to slow or prevent tumor recurrence. Chemotherapy has been used in conjunction with other
therapies but results are variable.

Perianal adenoma
testosterone- dependent and is therefore found most frequently in dogs that are intact males or have
testosterone-secreting tumors These tumors are primarily seen in older male intact dogs. These tumors will
often shrink or resolve after castration.
Sertoli cell tumor
Feminization syndrome in dogs including gynecomastia, sexual attraction of males, and bilaterally symmetric
alopecia. The tumor sometimes secretes estrogen and other hormones, which can lead to this syndrome.

Canine Mast Cell Tumors

Most common skin tumors in dogs

Gl ulcers + perioperative hypotension + coagulation abnormalities + Local inflammation

Key Points
o Predisposed Breeds: Boxers, Pugs, Boston terriers, Brachycephalic. They frequently develop multiple
MCTs over their lifetime, but are usually associated with lower grade tumors that are less aggressive in
metastasizing.
o Mast cell Granules release Histamine, Heparin, proteases, cytokines when they degranulate. May cause
GI ulcers, bleeding, poor wound healing, anaphylactic reactions.
o Most common grading system is "Patnaik system". Grade 3 is more aggressive than Grade 1 Only MCT
arising from skin are graded.
o Considered the "Great Pretender” as they can look and feel like anything from a Skin plaque, nodule,
rash, or lipoma.

Cytology (Fine needle aspirate)

1. Individual round cells.
2. Darkly staining granules in cytoplasm and in background
3. Eosinophils common

Treatment
Surgery Radiation therapy

a. 2-3cm lateral margins a. for incompletely excised tumors

b. 1 fascial plane deep

Electrochemotherapy (ECT)

a. eliminates residual MSTs post-surgery

b. entails injection of chemotherapy directly into the surgical bed and application of electrical impulses

Systemic Treatment

Tyrosine kinase inhibitors, such as toceranib (Palladia) and masitinib (Kinavet, which is no longer available),
target c-kit, a stem cell factor receptor involved in mast cell proliferation and differentiation. Palladia and Kinavet
are FDA approved for treatment of high-grade canine cutaneous mast cell tumors.

Supportive treatment for those with gross disease

i. H1 blockers →Diphenhydramine
ii. H2 blockers →Famotidine, Ranitidine
iii. Proton pump inhibitors→ Omeprazole
iv. Sucralfate

Prognostic indicators
o Negative Prognostic indicators o Poorly differentiated tumors
o Large tumor size o Poorly defined tumor margins
o Recurrent tumors o Mitotic index of 5/10 hpf
 o High grade o Mucosal or mucocutaneous junctions
o visceral metastasis
Having multiple dermal tumors is not considered a negative prognostic indicator.

Mast Cell Tumors have 3 grades:

Grade 1-least likely to metastasize. Well differentiated and superficial. Usually curative with surgical excision.

Grade 2- well to good differentiation. SQ involvement. Prognosis is varied and dependent upon cell surface
markers, signs of metastasis, and local reoccurrence. Can be cured with surgery.

Grade 3- Poorly differentiated. Poor prognosis with likelihood of metastasis, reoccurrence. Aggressive treatment
needed.

In order to determine prognosis, it is ideal to fully stage the animal with local lymph node aspiration, metastasis
check in the abdomen and thorax, blood work, and grade of the tumor itself. More recently, it has been
discovered that the number of mitotic figures identified per high per field correlates greatly with how aggressive
the tumor will behave.

Renal carcinomas
Renal carcinomas have been associated with erythropoietin secretion, causing elevations in hematocrit as a
paraneoplastic syndrome.

Doxorubicin (Adriamycin) → cardiotoxicity + tissue necrosis if done extravasation

L-asparaginase → anaphylaxis

Cisplatin → nephrotoxicity

Cyclophosphamide → cystitis

Osteosarcoma
Most common primary bone tumor in dogs affecting Appendicular skeleton of large breed Dogs. (9 months).

Sites: Away from the Elbow. Towards the Knee → Proximal Humerus, Distal Femur, Proximal tibia, Distal Radius

Radiographs Lytic & Productive lesions of bone metaphysis Do not cross joints into adjacent bones

Fine needle Aspirate cytology Aspirate the center of lesion Aspirate of the periphery often
result in "Reactive bone"

Thoracic radiographs: Pulmonary metastasis → Pour Prognosis

Blood Work → ALP Worse Prognosis Treatment Survival times

Treatment & Prognosis

o No Rx → few weeks
o Only Amputation → 3 month (12 months in dogs)
o Amputation & Therapy → 9-12 months

Bisphosphonates (Pamidronate) osteoclast inhibitor

Metastatic bone tumors Diaphysis → Less in Cats

Canine Lymphoma
o Most common Hematopoietic tumor in dogs.
o Most are lymphoblastic or high grade
o Multicentric form is most common
o Considered as systemic disease

Diagnosis
Presenting Complaints

a. often from owners palpating large L.N or bumps

b. General signs of illness: Lethargy, low appetite, PU/PD if hypercalcemic

Physical exam findings

a. Enlarged peripheral L.N

b. Enlarged Liver & Spleen

Lymphoma
The cytology depicts the classic finding of a population of lymphoid cells that are
predominantly lymphoblasts based on their size and characteristics. If you were
unsure about their size due to magnification, there is a neutrophil in the lower
left corner for comparison. The lymphoblasts are considerably larger than the
neutrophil. Mature lymphocytes would be smaller than a neutrophil. Note that
there is a mitotic figure in the middle of the slide.

There are many treatments and protocols for lymphoma and some of the main
agents known to have efficacy are prednisone, doxorubicin, cyclophosphamide, vincristine, L-asparaginase, and
Lomustine. There are many other efficacious chemotherapeutic for lymphoma but carboplatin is not considered
a first line treatment for lymphoma in dogs.

Chronic lymphocytic leukemia

Chronic' describes the clinical course of the disease, which is considered indolent or slowly progressive. The
neoplastic cells of chronic leukemias are well differentiated or mature cells; therefore, CLL is considered a
chronic or indolent form of leukemia made up of small, mature lymphocytes. These are difficult to distinguish
from normal lymphocytes. The mildly prominent lymph nodes and prominent spleen are classic findings for
chronic leukemias. The large disease burden within the bone marrow and relatively less affected lymphoid
tissues (relative to lymphoma) makes this a lymphocytic leukemia as opposed to a small cell or low-grade
lymphoma.