Notes on Canine Internal Medicine

Preface xvii

Acknowledgements xix

Using this book xxi

Commonly used abbreviations xxii

Section 1

Presenting Complaints 1

1.1 Abortion 3

1.2 Alopecia 4

1.3 Altered behaviour 7

1.4 Altered consciousness 10

1.5 Anorexia/hyporexia/inappetence 12

1.6 Anosmia 14

1.7 Anuria/oliguria 15

1.8 Ataxia 17

1.9 Bleeding 19

1.10 Blindness 21

1.11 Constipation 23

1.12 Corneal opacity 25

1.13 Coughing 26

1.14 Deafness 29

1.15 Diarrhoea 30

1.15.1 Acute diarrhoea 31

1.15.2 Chronic diarrhoea 34

1.16 Drooling 38

1.17 Dysphagia 39

1.18 Dyspnoea/tachypnoea 41

1.19 Dysuria 44

1.20 Dystocia 46

1.21 Epistaxis 48

1.22 Exercise intolerance 49

1.23 Faecal incontinence 51

1.24 Flatulence/borborygmi 52

1.25 Haematemesis 54

1.26 Haematochezia 55

1.27 Haematuria and discoloured urine 57

1.28 Haemoptysis 60

1.29 Halitosis 61

1.30 Head tilt 62

1.31 Melaena 64

1.32 Nasal discharge 66

1.33 Nystagmus 67

1.34 Paresis/paralysis 69

1.35 Perinatal death 70

1.36 Polyphagia 72

1.37 Polyuria/polydipsia (PU/PD) 73

1.38 Preputial discharge 77

1.39 Pruritus 78

1.40 Red eye (and pink eye) 80

1.41 Regurgitation 81

1.42 Seizures 84

1.43 Sneezing 86

1.44 Stiffness, joint swelling and generalised lameness 87

1.45 Stunting 89

1.46 Tenesmus and dyschezia 91

1.47 Tremors 92

1.48 Urinary incontinence 94

1.49 Vomiting 96

1.50 Vulval discharge 98

1.51 Weakness, collapse and syncope 100

1.52 Weight gain/obesity 104

1.53 Weight loss 105

Section 2

Physical Abnormalities 109

2.1 Abdominal enlargement 111

2.2 Abdominal masses 113

2.3 Abnormal lung sounds 115

2.4 Arrhythmias 118

2.5 Ascites 121

2.6 Cyanosis 124

2.7 Eye lesions 126

2.8 Hepatomegaly 129

2.9 Horner’s syndrome 131

2.10 Hypertension 133

2.11 Hypotension 134

2.12 Hypothermia 135

2.13 Icterus/jaundice 136

2.14 Lymphadenopathy 139

2.15 Murmur 140

2.16 Oral masses 141

2.17 Pain 142

2.17.1 Abdominal pain 142

2.17.2 Generalised pain 146

2.18 Pallor 147

2.19 Perineal lesions 148

2.20 Peripheral oedema 149

2.21 Pleural effusion 151

2.22 Pneumothorax 154

2.23 Prostatomegaly 154

2.24 Pulse abnormalities156 2.25 Pyrexia and hyperthermia 158

2.26 Skin lesions 160

2.27 Skin pigmentation changes 167

2.28 Splenomegaly 169

2.29 Stomatitis 171

2.30 Stridor and stertor 172

Section 3

Laboratory Abnormalities 175

3a Biochemical tests 177

3.1 Acid–base 177

3.2 Ammonia 178

3.3 Amylase and lipase 179

3.4 Azotaemia 180

3.5 Bile acids 181

3.6 Bilirubin 182

3.7 Calcium 182

3.7.1 Hypercalcaemia 182

3.7.2 Hypocalcaemia 183

3.8 Cardiac biomarkers 184

3.8.1 N- terminal pro B-type natriuretic peptide (NT-proBNP) 184

3.8.2 Troponin I 185

3.9 Chloride 186

3.9.1 Hyperchloraemia 186

3.9.2 Hypochloraemia 186

3.10 Cobalamin 187

3.11 Cortisol (basal) 188

3.12 Creatine kinase 189

3.13 Creatinine 189

3.14 C- reactive protein (CRP)190 3.15 Folate 191

3.16 Fructosamine 191

3.17 Glucose 192

3.17.1 Hyperglycaemia 192

3.17.2 Hypoglycaemia 193

3.18 Iron profile 194

3.19 Lipids 195

3.19.1 Hyperlipidaemia and hypercholesterolaemia 195

3.19.2 Hypocholesterolaemia 196

3.20 Liver enzymes 196

3.20.1 Hepatocellular marker enzymes 196

3.20.1A Alanine aminotransferase (ALT)197

3.20.1B Aspartate aminotransferase (AST)197 3.20.1C Other hepatocellular enzymes 197

3.20.2 Cholestatic marker enzymes 197

3.20.2A Alkaline phosphatase (ALP or ALKP)198

3.20.2B Gamma- glutamyl transferase (GGT)198

3.21 Pancreatic lipase (cPL)198 3.22 Phosphate 199

3.22.1 Hyperphosphataemia 199

3.22.2 Hypophosphataemia 200

3.23 Potassium 200

3.23.1 Hyperkalaemia 200

3.23.2 Hypokalaemia 201

3.24 Sodium 202

3.24.1 Hypernatraemia 202

3.24.2 Hyponatraemia 202

3.25 Symmetric dimethylarginine (SDMA)203 3.26 Thyroid hormone 204

3.27 Total protein (albumin and globulin) 206

3.27.1 Hyperproteinaemia 206

3.27.1A Hyperalbuminaemia 206

3.27.1B Hyperglobulinaemia 206

3.27.2 Hypoproteinaemia 207

3.27.2A Hypoalbuminaemia 207

3.27.2B Hypoglobulinaemia 207

3.28 Trypsin- like immunoreactivity (TLI)208 3.29 Urea 208

3b Haematology 210

3.30 Red blood cells (RBCs)210 3.30.1 Anaemia 210

3.30.2 Erythrocytosis 213

3.31 Platelets 214

3.31.1 Thrombocytopenia 214

3.31.2 Thrombocytosis 215

3.32 White blood cells (WBCs)216 3.32.1 Leukocytosis 216

3.32.2 Leukopenia 217

3.33 Pancytopenia 218

3c Urinalysis 219

3.34 Biochemical analysis 219

3.34.1 Protein 219

3.34.2 Bilirubin 219

3.34.3 Glucose 219

3.34.4 Haem 220

3.34.5 Ketones 220

3.35 Sediment 220

3.35.1 Red blood cells 220

3.35.2 White blood cells 220

3.35.3 Epithelial cells 221

3.35.4 Crystals 221

3.35.5 Tubular casts 221

3.35.6 Waxy cast 221

3.36 Urine protein: creatinine (UPC) ratio 221

3.37 Urine specific gravity (USG)222

Section 4

Imaging Patterns 223

4.1 Abdomen 225

4.1.1 Radiography 225

4.1.1A Abdominal enlargement and mass(es) 225

4.1.1b Calcification (bone/mineral density) 225

4.1.1c Extra- intestinal gas 228

4.1.1D Gas dilation of GI tract229 4.1.1e Loss of contrast/peritoneal detail/serosal detail 230

4.1.1f Metal densities 230

4.1.1G Organ displacement 231

4.1.1H Organomegaly or change in shape 231

4.1.2 Ultrasound 232

4.1.2A Free abdominal fluid 232

4.1.2b Lymphadenopathy – mesenteric/inguinal/sublumbar 232

4.2 Bone 234

4.2.1 Bone deformities 234

4.2.2 Bone density changes 234

4.2.2A Decreased bone density (osteopenia) 234

4.2.2b Increased bone density 235

4.2.3 Bone lucencies and proliferative lesions 236

4.3 Thorax 239

4.3.1 Alveolar pattern 239

4.3.2 Bronchial pattern 239

4.3.3 Changes in cardiac outline and pulmonary vasculature 240

4.3.4 Interstitial pattern 244

4.3.5 Loss of detail 245

Section 5

Organ Systems 247

5.1 Alimentary system 249

5.1.1 Oropharynx 252

5.1.1A Craniomandibular osteopathy 252

5.1.1b Cricopharyneal achalasia 253

5.1.1C Masticatory myositis 253

5.1.1D Oral neoplasia 254

5.1.1e Stomatitis 255

5.1.2 Salivary glands 255

5.1.2A Hypersialosis/salivary gland infarction/sialoadenitis 256

5.1.3 Oesophagus 256

5.1.3A Foreign body 257

5.1.3b Megaoesophagus (MO) 258

5.1.3C Oesophagitis 261

5.1.3D Sliding hiatal hernia 262

5.1.3e Stricture 263

5.1.4 Stomach 264

5.1.4A Acute gastritis 265

5.1.4b Chronic gastritis 267

5.1.4C Gastric carcinoma 268

5.1.4D Gastric dilatation-volvulus (GDV) 269

5.1.4e Delayed gastric emptying 270

5.1.4f Gastric ulcer 272

5.1.5 Small intestine 273

5.1.5.1 Acute small intestinal diseases 274

5.1.5.1A Acute enteritis 275

5.1.5.1b Acute haemorrhagic diarrhoea syndrome (AHDS)/ haemorrhagic gastroenteritis (HGE) 276

5.1.5.1C Bacterial enteritis 277

5.1.5.1D Parvovirosis 278

5.1.5.1e Small intestinal obstruction 280

5.1.5.2 Chronic small intestinal diseases 281

5.1.5.2A Alimentary lymphoma (AL) 282

5.1.5.2b Antibiotic-responsive diarrhoea (ARD) 283

5.1.5.2C Chronic inflammatory enteropathy (CIE) 285

5.1.5.2D Dietary sensitivity 287

5.1.5.2e Intestinal parasitism 288

5.1.5.2f Intestinal protozoal infections 291

5.1.5.2G Lymphangiectasia 292

5.1.6 Large intestine 293

5.1.6A Acute colitis 294

5.1.6b Chronic colitis 295

5.1.6C Constipation 297

5.1.6D Granulomatous (histiocytic ulcerative) colitis 298

5.1.6e Large intestinal neoplasia 298

5.1.7 Pancreas 299

5.1.7A Acute pancreatitis 300

5.1.7b Chronic pancreatitis 302

5.1.7C Exocrine pancreatic insufficiency (EPI) 303

5.2 Cardiovascular system 305

5.2.1 Acquired cardiac diseases 310

5.2.1A Arrhythmogenic right ventricular cardiomyopathy (ARVC) 310

5.2.1b Dilated cardiomyopathy (DCM) 311

5.2.1C Heartworm disease/dirofilariasis 314

5.2.1D Myxomatous mitral valve disease 316

5.2.2 Congenital cardiac diseases 318

5.2.2A Aortic stenosis 318

5.2.2b Mitral valve dysplasia 319

5.2.2C Patent ductus arteriosus 321

5.2.2D Pulmonic stenosis 322

5.2.2e Tetralogy of fallot 324

5.2.2f Tricuspid dysplasia 325

5.2.2G Ventricular septal defect 326

5.2.3 Congestive heart failure (CHF) 328

5.2.3A Left-sided congestive heart failure 330

5.2.3b Right-sided congestive heart failure 331

5.2.4 Arrhythmias 332

5.2.4.1 Bradyarrhythmias 333

5.2.4.1A Atrial standstill 333

5.2.4.1b Atrioventricular (AV) block 333

5.2.4.1C Sinus bradycardia 336

5.2.4.1D Sinus arrest 336

5.2.4.1e Sick sinus syndrome 336

5.2.4.2 Tachyarrhythmias 337

5.2.4.2A Sinus tachycardia 337

5.2.4.2b Supraventricular tachyarrhythmias 338

5.2.4.2C Ventricular tachyarrhythmias 340

5.2.5 Pericardial diseases 343

5.2.5.A Pericardial effusion 343

5.2.5.B Peritoneal pericardial diaphragmatic hernia (PPDH) 346

5.3 Endocrine system 347

5.3.1 Diabetes insipidus (DI) 347

5.3.2 Diabetes mellitus (DM) 350

5.3.3 Growth hormone disorders 354

5.3.3A Acromegaly (hypersomatotropism) 354

5.3.3b Pituitary dwarfism 355

5.3.4 Adrenal gland disorders 356

5.3.4A Hyperadrenocorticism (HAC) 356

5.3.4b Hypoadrenocorticism (Addison’s disease) 360

5.3.5 Hypothyroidism 364

5.3.6 Insulinoma 367

5.3.7 Parathyroid diseases 368

5.3.7A Primary hyperparathyroidism (PHPT) 368

5.3.7b Hypoparathyroidism 369

5.4 Haemopoietic system 371

5.4.1 Anaemia of chronic kidney disease (CKD) 371

5.4.2 Immune-mediated haemolytic anaemia (IMHA) 373

5.4.3 Iron-deficiency anaemia 377

5.4.4 Lymphoid leukaemia 378

5.4.5 Other haemopoietic neoplasms 379

5.4.6 Leukopenia 380

5.4.7 Thrombosis 380

5.5 Haemostatic system 383

5.5.1 Anticoagulant rodenticide poisoning 386

5.5.2 Disseminated intravascular coagulation (DIC) 388

5.5.3 Factor VIII deficiency (haemophilia A) 390

5.5.4 Hyperfibrinolysis 391

5.5.5 Immune-mediated thrombocytopenia (IMTP) 392

5.5.6 von Willebrand disease 393

5.5.7 Vasculitis 395

5.6 Hepatobiliary system 397

5.6.1 Chronic hepatitis (CH)/cirrhosis 399

5.6.2 Cholangitis/cholangiohepatitis 400

5.6.3 Cholecystitis 401

5.6.4 Congenital porto-systemic shunt (PSS) 402

5.6.5 Copper-associated chronic hepatitis 404

5.6.6 Extra-hepatic bile duct obstruction (EHBDO) 404

5.6.7 Gall bladder mucocoele 405

5.6.8 Hepatic neoplasia 407

5.6.9 Infectious canine hepatitis 408

5.6.10 Nodular hyperplasia 408

5.6.11 Portal vein hypoplasia (PVH) 409

5.6.11A Microvascular dysplasia (MVD) 409

5.6.11b Non-cirrhotic portal hypertension/juvenile hepatic fibrosis 410

5.6.12 Steroid hepatopathy 410

5.6.13 Vacuolar/reactive hepatopathy 411

5.7 Immune system 413

5.7.1 (Auto)immune-mediated disorders 414

5.7.1.1 Immune-mediated polyarthritis (IMPA) 414

5.7.1.2 Immunodeficiency 415

5.7.1.2A Canine leukocyte adhesion deficiency (CLAD) 416

5.7.1.2B Cyclic haematopoiesis (cyclic neutropenia) 416

5.7.1.2C Hereditary selective cobalamin malabsorption (Imerslund-Gräsbeck syndrome) 417

5.7.1.2D Immunoglobulin deficiency 417

5.7.1.2E Trapped neutrophil syndrome 418

5.7.1.3 Lymphadenitis 418

5.7.1.4 Systemic lupus erythematosus (SLE) 420

5.7.2 Neoplasia of immune cells 420

5.7.2.1 Lymphoma 420

5.7.2.2 Mast cell tumour (MCT) 422

5.7.2.3 Multiple myeloma 424

5.7.2.4 Thymoma 424

5.8 Neurological system 427

5.8.1 Cerebrovascular disease 429

5.8.2 Corticosteroid-responsive tremor syndrome 430

5.8.3 Hydrocephalus 431

5.8.4 Idiopathic epilepsy 431

5.8.5 Idiopathic head tremor 433

5.8.6 Idiopathic vestibular disease 434

5.8.7 Infectious diseases affecting the nervous system 435

5.8.8 Movement disorders 436

5.8.9 Meningoencephalitis of unknown origin (MUO) 437

5.8.10 Myasthenia gravis (MG) 438

5.8.11 Neoplasia of the neurological system 439

5.8.12 Polyradiculoneuritis 441

5.8.13 Steroid-responsive meningitis-arteritis (SRMA) 442

5.9 Reproductive system 445

5.9.1 Mammary gland disease 445

5.9.1a Mastitis 446

5.9.1b Mammary neoplasia 446

5.9.2 Ovarian remnant syndrome 447

5.9.3 Prostatic disease 448

5.9.4 Pseudocyesis (false pregnancy) 449

5.9.5 Pyometra 450

5.9.6 Testicular neoplasia 451

5.9.7 Vaginitis 452

5.10 Respiratory system 455

5.10.1 Nasal disorders 457

5.10.1A Chronic idiopathic rhinitis 457

5.10.1b Sinonasal aspergillosis (fungal rhinitis) 458

5.10.2 Upper-airway disorders 459

5.10.2A Brachycephalic obstructive airway syndrome (BOAS) 459

5.10.2b Infectious tracheobronchitis 460

5.10.2C Laryngeal paralysis 461

5.10.2D Tracheal collapse 462

5.10.2e Tracheobronchial foreign body 464

5.10.3 Lower-airway disorders 464

5.10.3A Chronic bronchitis 465

5.10.3b Eosinophilic bronchopneumopathy 465

5.10.3C Lungworm (Angiostronglylus vasorum)466 5.10.4 Pulmonary parenchymal disease 468

5.10.4A Pneumonia 468

5.10.4b Non-cardiogenic pulmonary oedema 469

5.10.4C Pulmonary fibrosis 470

5.10.4D Pulmonary neoplasia 471

5.10.5 Pleural space disease 473

5.10.5A Idiopathic chylothorax 473

5.10.5b Pneumothorax 474

5.10.5C Pyothorax 475

5.11 Systemic infections 477

5.11.1 Anaplasmosis 479

5.11.2 Babesiosis 480

5.11.3 Borreliosis (Lyme Disease) 481

5.11.4 Brucellosis 482

5.11.5 Distemper 484

5.11.6 Ehrlichiosis 485

5.11.7 Hepatozoonosis 486

5.11.8 Leishmaniosis 487

5.11.9 Leptospirosis 489

5.11.10 Neosporosis 491

5.11.11 Rabies 492

5.11.12 Toxoplasmosis 493

5.12 Urinary system 495

5.12.1 Kidney diseases 495

5.12.1A Acute kidney injury 497

5.12.1b Chronic kidney disease 499

5.12.1C Glomerular disorders 501

5.12.1D Pyelonephritis 503

5.12.1e Renal tubular disorders 504

5.12.2 Lower urinary tract diseases 506

5.12.2A Functional disorders of urination 507

5.12.2b Neoplasia of the urinary system 508

5.12.2C Urethritis 509

5.12.2D Urinary tract infection (UTI) 510

5.12.2e Urolithiasis 511

Abbreviations 513

Index 519