Textbook of Small Animal Emergency Medicine

By Kenneth J. Drobatz, Kate Hopper and Elizabeth A. Rozanski

Textbook of Small Animal Emergency Medicine offers an in-depth understanding of emergency disease processes and the underlying rationale for the diagnosis, treatment, monitoring, and prognosis for these conditions in small animals.

• A comprehensive reference on a major topic in veterinary medicine
• The only book in this discipline to cover the pathophysiology of disease in depth
• Edited by four respected experts in veterinary emergency medicine
• A core text for those studying for specialty examinations
• Includes access to a website with video clips, additional figures, and the figures from the book in PowerPoint

Textbook of Small Animal Emergency Medicine offers an in-depth understanding of emergency disease processes and the underlying rationale for the diagnosis, treatment, monitoring, and prognosis for these conditions in small animals.

• Language: English
• Publisher: Wiley
• Release date: Oct 11, 2018
• ISBN: 9781119028956

Book preview

Textbook of Small Animal Emergency Medicine

VOLUME 1

Edited by

Kenneth J. Drobatz, DVM, MSCE, DACVIM (IM), DACVECC

Professor and Chief, Section of Critical Care

Department of Clinical Sciences and Advanced Medicine

University of Pennsylvania

Philadelphia, PA;

Senior Fellow of the Center for Public Health Initiatives

University of Pennsylvania

Philadelphia, PA

USA

Kate Hopper, BVSc, PhD, DACVECC

Associate Professor, Small Animal Emergency & Critical Care

Department of Veterinary Surgical and Radiological Sciences

School of Veterinary Medicine

University of California, Davis

Davis, CA

USA

Elizabeth Rozanski, DVM, DACVIM (SAIM), DACVECC

Associate Professor

Department of Clinical Sciences

Cummings School of Veterinary Medicine

Tufts University

North Grafton, MA

USA

Deborah C. Silverstein, DVM, DACVECC

Professor of Critical Care

Department of Clinical Sciences and Advanced Medicine

University of Pennsylvania

Philadelphia, PA;

Adjunct Professor

Temple University School of Pharmacy

Philadelphia, PA

USA

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The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Library of Congress Cataloging-in-Publication Data

Names: Drobatz, Kenneth J., editor. | Hopper, Kate, editor. | Rozanski, Elizabeth A., editor. |

   Silverstein, Deborah C., editor.

Title: Textbook of small animal emergency medicine / edited by Kenneth J. Drobatz, Kate Hopper,

   Elizabeth Rozanski, Deborah C. Silverstein.

Description: Hoboken, NJ : Wiley, 2019. | Includes bibliographical references and index.

Identifiers: LCCN 2018002995 (print) | LCCN 2018004342 (ebook) | ISBN

   9781119028949 (pdf) | ISBN 9781119028956 (epub) | ISBN 9781119028932

   (cloth)

Subjects: LCSH: Veterinary emergencies--Textbooks. | MESH:

   Emergencies--veterinary | Pets

Classification: LCC SF778 (ebook) | LCC SF778 .T49 2019 (print) | NLM SF 778

   | DDC 636.089/6025 – dc23

LC record available at https://lccn.loc.gov/2018002995

Cover Design: Wiley

Cover Images: (Top) © Jeffrey J Runge DVM, DACVS; (Bottom) © John Donges

CONTENTS

Contributors

Dedication

Preface

About the Companion Website

VOLUME 1

Section 1 Emergency Medicine Overview

1 Goals in Veterinary Emergency Medicine

The 40-Year Evolution of Goals in Veterinary Emergency Medicine

Principles of Primary Survey, Resuscitation, Secondary Survey and Definitive or Refined Diagnostics and Treatment of Veterinary Emergency Patients

References

2 Triage

Introduction

Telephone Triage

Waiting Room Triage

Investigation and Stabilization of the Patient

References

Section 2 Common Conditions in Emergency Medicine

3 Neurological Disorders

Initial Management of the Acute Neurological Patient

Neuroanatomic Localization

Initial Assessment

Neurolocalization

Approach to Differential Diagnoses

References

4 Respiratory Distress

Introduction

Does Oxygen Help?

Signalment

Any Relevant Past Medical History? What Has Happened Today?

Is There Hyperthermia or Hypothermia?

Is There Loud Breathing?

Is There Any Cough or Wheeze?

Are There Extra Lung Sounds?

What Does Point-of-Care Ultrasound Show You?

What Should I Tell the Owner?

References

5 Ventricular Ectopy

Introduction

Presentation

Diagnosis

Causes

Treatment

6 Acute Abdomen

History and Physical Examination

Clinical Pathology

Abdominal Imaging

Collection of Peritoneal Effusion

Analysis of Peritoneal Effusion

Abdominal Surgery

Nutritional Support

Conclusion

References

7 The Collapsed Patient

Introduction

Pathophysiology of Syncope

Causes of Syncope

Collapse or Syncope-Like Conditions

Patient Evaluation and Risk Stratification

References

8 Global Approach to the Trauma Patient

Introduction

Pathophysiology

Triage Evaluation and Intervention

Further Evaluation

Diagnostic Imaging

Conclusion

References

9 Reproductive Emergencies

Introduction

Female Reproductive Emergencies

Male Reproductive Emergencies

References

10 Anemia

Introduction

Etiology

Consequences of Anemia

Clinical Signs

Diagnosis

Decreased Erythropoiesis

Hemorrhagic Anemia

Hemolytic Anemia

References

11 Jaundice

Definition

Physiology

Pathophysiology

Evaluation of the Icteric Patient

Diagnostic Evaluation

Treatment

References

12 Ophthalmic Emergencies

Proptosis

Eyelid Lacerations

Corneal Lacerations

Deep Corneal Ulcers

Primary Glaucoma

Acute Anterior Uveitis

Anterior Lens Luxation

Acute Blindness

References

13 Vomiting, Regurgitation, and Diarrhea

Differentiation Between Vomiting and Regurgitation

Vomiting

Regurgitation

Diarrhea

References

14 Dysuria

Introduction

Alteration in Volume or Frequency of Urination

Alteration in Urine Consistency

Other Clinical Findings That May Be Associated With Lower Urinary Tract Disease

Physical Examination Findings in Patients with Lower Urinary Tract Signs

Additional Analytical Procedures in Patients with Dysuria

Management of Patients with Dysuria

References

15 Dermatological and Ear Disease

Dermatological Emergencies

Pyotraumatic Dermatitis

Pyoderma

Otitis Externa

Ectoparasites

Atopy

Conclusion

References

16 Toxin Exposure

Introduction

References

17 Epistaxis

Introduction

Pathophysiology

Further Laboratory Evaluation

Nasal Imaging

Nasal Biopsy

Emergency Management

Conclusion

References

18 Fever

Physiology of Normal Thermoregulation

What is Fever?

Is Fever Helpful or Harmful?

How to Differentiate Fever from Hyperthermia

Primary Differentials for Cause of Fever

Early Diagnostics to Consider for Febrile Patients

Treatments to Consider

References

Section 3 Emergency Conditions by System

A. Neurological Disorders

19 Traumatic Brain Injury:

Introduction

Pathophysiology

Physical Examination

Diagnostic Imaging

Treatment

Prognosis

References

20 Altered Mentation

Introduction

Initial Assessment (see Chapter 2)

Neuroanatomy

Neurological Examination

Differential Diagnoses and 
Diagnostic Approach

Diagnostic Approach

Treatment and Monitoring

Conclusion

References

21 Seizures

Introduction

History

Initial Patient Assessment (see Chapter 2)

Neurological Examination

Differential Diagnoses

Quick Assessment Tests

Extended Laboratory Tests and Diagnostic Images

Emergency Management

Long-term Management of Seizures

References

22 Intracranial Disease

Clinical Signs

Diagnostic Tests

Differential Diagnoses and Prognosis

Infectious

References

23 Vestibular Disease

Introduction

Clinical Signs (Table 23.1)

Common Causes of Vestibular Disease

Diagnostics

References

24 Spinal Trauma

Causes

Pathophysiology

Initial Approach

Neurological Assessment

Diagnosis

Treatment of Spinal Cord Injury

References

25 Intervertebral Disk Disease

Introduction

Applied Anatomy

Pathogenesis

Clinical Signs

Diagnostics

Treatment

References

26 Diskospondylitis

Introduction

Pathophysiology

Causative Agents

Signalment

Clinical Signs

Diagnosis

Treatment

Prognosis

Complications

References

27 Lower Motor Neuron Disease

Introduction

Clinical Signs

Diagnosis and Initial Approach

Causes of Generalized Lower Motor Neuron Paresis

References

B. Respiratory Disease

28 Brachycephalic Syndrome

Introduction

Systemic Consequences of the Brachycephalic Obstructive 
Airway Syndrome

Acute Upper Airway Obstruction: 
Current Concepts

Treatment of Brachycephalic Syndrome

Future Directions

References

29 Feline Upper Respiratory Complex

Introduction

Causes/Infectious Agents

Clinical Presentation

Risk Factors

Diagnosis

Treatment (Table 29.2)

Prevention

Prognosis

References

30 Laryngeal Paralysis

Introduction

Clinical Signs

Emergency Treatment

Emergency Diagnostic Tests

Long-Term Management

Prognosis

References

31 Tracheobronchial Injury and Collapse

Anatomy and Physiology of the Trachea

Emergency Management

Tracheobronchial Injury

Tracheal and Bronchial Collapse

References

32 Acute Airway Obstruction

Emergency Examination

Emergency Stabilization

Diagnostics

Complications of Upper Airway Obstruction

Diseases Causing Upper Airway Obstruction (Table 32.1)

References

33 Exacerbations of Chronic Bronchitis

Introduction

Disease Syndrome

Diagnosis

Treatment (Table 33.1)

Causes of Exacerbation

Emergency Management of Disease Exacerbations

References

34 Feline Lower Airway Disease

Introduction

Patient History

Initial Assessment

Emergency Treatment

Differential Diagnosis

References

35 Puppy Pneumonia

Introduction

Clinical Approach

Diagnostic Testing

Treatment Options

Prognosis

Brachycephalic Dogs

References

36 Coughing and Hemoptysis

Introduction

Physiology

Differential Diagnosis

Diagnostic Approach

Treatment

References

37 Bronchopneumonia

Introduction

Types of Pneumonia

Physical Examination Findings

Diagnostics

Treatment

Prognosis

References

38 Cardiogenic Pulmonary Edema

Introduction

Diuretics

Vasodilators

Positive Inotropes

Vasopressors

Sedatives

Oxygen Therapy

Other Therapies

References

39 Neurogenic Pulmonary Edema

Introduction

Pathogenesis

Clinical Characteristics of Neurogenic Pulmonary Edema

Diagnosis

Initial Approach and Management

Monitoring the Effectiveness of Therapy

Prognosis

References

40 Submersion Injury

Introduction

Definitions

Precipitating Factors

Pathophysiology

Complications of Submersion Injury

Diagnosis and Treatment

Outcome

References

41 Pulmonary Hemorrhage

Etiology and Pathogenesis

Patient Evaluation

Diagnosis

Treatment

Outcome

References

42 Pulmonary Thromboembolism

Introduction

Risk Factors

Diseases associated with PTE

In-hospital risk factors

Other

Pathophysiology

Clinical Signs

Diagnosis

Management

References

43 Primary and Metastatic Pulmonary Neoplasia

Introduction

Diagnostic Tests

Treatment and Prognosis

Conclusion

References

44 Pneumothorax

Anatomy

Pathogenesis

Clinical Consequences of Pneumothorax

Physical Examination

Diagnosis

Treatment

References

45 Pleural Effusion

Introduction

Clinical Signs

Initial Treatment

Types of Effusions

Conclusion

References

46 Pyothorax

Introduction

Etiology

Microbiology

Signalment

Clinical Signs and Physical Examination Findings

Diagnosis

Treatment

Prognosis

References

47 Diaphragmatic Hernia

Anatomy

Types of Hernias

Clinical Signs

Diagnosis

Treatment

Complications and Prognosis

References

48 Penetrating Thoracic Trauma

Introduction

Etiology

Physical Examination and Diagnostics

Treatment

Prognosis

References

49 Blunt Thoracic Trauma

Introduction

Etiology

Pathophysiology

Physical Examination and Diagnostics

Treatment

Surgical Indications

Prognosis

References

50 Look-Alike Causes of Respiratory Distress

Introduction

Look-Alike Causes of Respiratory Distress

References

C. Cardiovascular Disease

51 Mechanisms of Heart Failure

What is Heart Failure?

Neuroendocrine Systems in Heart Failure

Maladaptive Responses in Heart Failure

Global Cardiac Function in Heart Failure

Treatment

Conclusion

References

52 Congenital Cardiovascular Disease

Introduction

Diagnosis

Cyanosis

Congestive Heart Failure

Syncope/Collapse

Conclusion

References

53 Arrhythmias

Introduction

Tachycardias

Bradycardias

References

54 Pericardial Effusion

Etiology

Pathophysiology

Clinical Presentation

Diagnostic Testing

Pericardiocentesis

Management and Prognosis

References

55 Dilated Cardiomyopathy

Introduction

Etiology

Signalment, Prevalence, and Incidence

Stages

Diagnosis

Diagnostic Tests

Treatment

Prognosis

References

Further Reading

56 Feline Hypertrophic Cardiomyopathy

Introduction and Definitions

Pathology and Pathophysiology

Presentation and Clinical Signs

Initial Stabilization

Diagnostic Tests

Chronic Therapy

Prognosis

References

57 Valvular Heart Disease

Introduction

Myxomatous Valvular Degeneration

Diagnosis (Table 57.1)

Pathophysiology of Congestive Heart Failure (see Chapter 51)

Treatment (Table 57.2)

Prognosis

References

58 Heartworm Disease

Introduction

Pathophysiology

Clinical Presentation and Physical Examination

Diagnosis (Table 58.1)

Treatment of Specific Syndromes

References

59 Pulmonary Hypertension

Pathophysiology

Classification of Pulmonary Hypertension

Cor Pulmonale

Clinical Presentation

Diagnosis

Treatment

Follow-Up and Prognosis

References

60 Bradyarrhythmias and Pacemakers

Introduction and Definitions

Physiological Bradyarrhythmias

Iatrogenic Bradyarrhythmias

Pathological Bradyarrhythmias

Clinical Management of Dogs and Cats with Bradyarrhythmias

References

61 Myocarditis

Introduction

Parvovirus

Chagas’ Disease

Lyme Disease

Bartonella

Toxoplasmosis

Traumatic Myocarditis

Diagnosis

Treatment

Further Reading

62 Thromboembolic Disease

Introduction

Pathophysiology of Thrombosis

Diagnosis of Thrombosis

General Aspects of the Treatment and Prevention of Thrombosis

Feline Aortic Thromboembolism

Canine Aortic Thrombosis

Portal Vein Thrombosis

Splenic Thrombosis

Mesenteric Thrombosis

Caval Thrombosis

Cerebral Infarction

Myocardial Thrombosis

References

63 Systemic Arterial Hypertension

Introduction

Pathophysiology of Systemic Hypertension

Target Organ Damage Caused by Systemic Hypertension

Conditions Associated with Systemic Hypertension

Clinical Recognition of Systemic Hypertension

Treatment of the Patient with Systemic Hypertension

Prognosis and Long-Term Management

References

D. Hematological and Oncological Disorders

64 Leukocytosis and Leukopenia

Introduction

Leukocytosis

Leukopenia

References

65 Non-Regenerative Anemia

Introduction

Erythropoiesis

Pathophysiological Response to Non-Regenerative Anemia

Diagnostic Approach

Primary Bone Marrow Disorders

Secondary Extramarrow Disorders

Therapies for Non-Regenerative Anemia

References

66 Hemolytic Anemia

Introduction

History and Physical Examination

Laboratory Assessment

Differential Diagnoses for Hemolytic Anemia

References

67 Thrombocytopenia

Platelets

Thrombocytopenia Etiology

Clinical Signs

Diagnosis

Treatment

References

68 Fibrinolysis and Antifibrinolytics

Introduction

Physiology of Fibrinolysis

Disorders of Fibrinolysis

Evaluation of the Fibrinolytic System

Management of Hyperfibrinolysis

Therapeutic Fibrinolysis

References

69 Congenital Coagulopathy

Introduction

Dogs

Cats

Animals Presenting with Unexplained Hemorrhage

Animals with Known Inherited Defects

Von Willebrand’s Disease

Hemophilia A

Hemophilia B

Conclusion

References

70 Acquired Coagulopathy

General Approach

Anticoagulant-Associated Coagulopathy

Disseminated Intravascular Coagulation

Acute Traumatic Coagulopathy

Hepatobiliary Disorders

Angiostrongylus vasorum

Neoplasia

References

71 Antithrombotics in the Emergency Room

Introduction

References

72 Sick Oncology Patients in the Emergency Room

Introduction

Febrile Neutropenia and Sepsis

Hypercalcemia

Acute Tumor Lysis Syndrome

Thromboembolism and Hemostatic Abnormalities

Hemangiosarcoma

Conclusion

References

73 Paraneoplastic Syndromes

Hypercalcemia of Malignancy

Hypoglycemia

Polycythemia

Anemia

Thrombocytopenia

Coagulopathies/Disseminated Intravascular Coagulation

Hypertrophic Osteopathy

Fever

Miscellaneous

References

E. Esophageal and Abdominal Disease

74 Vomiting and Regurgitation

Vomiting

Regurgitation

References

75 Esophageal Foreign Bodies

Introduction

Presentation

Diagnosis

Treatment

Outcome

References

76 Diarrhea

Introduction

Diagnostic Approach

Causes of Diarrhea (Table 76.1)

Treatment

References

77 Hematemesis and Gastrointestinal Hemorrhage

Introduction

Etiology and Pathophysiology

Clinical Signs and Physical Examination

Laboratory Evaluation

Diagnostic Imaging

Endoscopy

Exploratory Laparotomy

Treatment

Prognosis

References

78 Parvovirus Enteritis

Pathogenesis

Clinical Signs

Diagnostic Tests

Treatment and Monitoring

Prognosis

Husbandry Considerations

References

79 Hemorrhagic Gastroenteritis

Introduction

Investigation into the Underlying Etiology

Clinical Recognition and Diagnosis

Emergency Stabilization and Treatment

Prognosis

References

80 Protein-Losing Enteropathy

Introduction

Pathophysiology

Clinical Presentations and Laboratory Data

Treatment

Prognosis and Follow-Up Care

Protein-Losing Enteropathy in Feline Patients

References

81 Gastrointestinal Obstruction

Introduction

Etiology

Pathophysiology

Clinical Signs and Physical Exam

Diagnostics

Specific Conditions

Postoperative Complications and Care

Overview

References

82 Gastric Dilation-Volvulus

Introduction

Diagnosis and Treatment

Surgical Management

Outcome

References

83 Mesenteric Torsion

Introduction

Pathophysiology

History and Clinical Signs

Diagnostics

Treatment

References

84 Hemoperitoneum

Introduction

History and Signalment

Clinical Signs and Physical Examination Findings

Initial Treatment and Stabilization

Diagnostics

Definitive Care and Prognosis

References

85 Splenic Disease

Splenic Disease in the Emergent Patient

Splenic Masses in Dogs

Splenic Torsion

Splenic Trauma

Splenic Infarction

Splenic Abscesses

Miscellaneous Conditions Causing Diffuse Splenomegaly in Dogs

Feline Splenic Disease

References

86 Pancreatitis

Introduction

Pathophysiology

History, Signalment, and Clinical Signs

Diagnosis

Biopsy and FNA

Scoring Disease and Assessing Severity

Treatment

Prognosis and Owner Communication

References

87 Peritonitis

Introduction

Etiology

Immune Response

Signalment and History

Physical Examination

Diagnostics

Treatment

Prognosis

References

88 Postoperative Complications Presenting to the Emergency Service

Introduction

Surgical Site Complications

Associated Complications

Conclusion

References

89 Biliary Disease

Introduction

Overview of Anatomy and Physiology

Presenting Signs and Initial Physical Examination

Diagnostics

Stabilization

Acute Medical Therapy

Surgery

Prognosis

References

90 Acute Liver Failure

Introduction

Pathophysiology

Presenting Complaint and Clinical Signs

Causes

INFECTIOUS

TOXIN

OTHER

Diagnostic Tests

Initial evaluation:

Full work-up:

Emergency Stabilization and Treatment

Prognosis

Conclusion

References

91 Feeding Tube Complications

Introduction

Complications Associated with Placement of Feeding Tubes

Complications Associated with Feeding Tube Use

Complications Encountered After Placement of Feeding Tubes

Conclusion

References

92 Anorectal Disease

Introduction

Anatomy

Perforation

Rectal Prolapse

Other Diseases

References

93 Constipation

Introduction

History

Physical Examination

Diagnostics

Treatment

Prognosis

References

VOLUME 2

F. Urogenital Disorders

94 Acute Azotemia

Introduction

Diagnosis of Acute Azotemia

Treatment

References

95 Oliguria

Pathogenesis of Oligoanuria

Patient Assessment and Initial Diagnostics

Managing the Oligoanuric Patient

Converting Oligoanuria to Polyuria

Extracorporeal Renal Replacement Therapy

References

96 Urinary Tract Infections

Definition

Incidence and Pathogenesis

History and Physical Examination

Diagnosis

Therapy

Management of Particular Conditions

References

97 Urolithiasis

Introduction

Diagnosis of Uroliths

Management of Uroliths Associated with Urinary Obstruction

Management of Uroliths Unassociated with Urinary Obstruction

References

98 Feline Ureteral Obstruction: Diagnosis and Management

Introduction

Etiology

Treatment of Feline Ureteral Obstructions

Postoperative Management

Conclusion

References

99 Feline Lower Urinary Tract Obstruction

Pathogenesis of Obstruction

Predisposing Factors

Pathophysiology of Obstruction

History and Clinical Signs

Initial Stabilization

Urethral Catheterization

Diagnostic Evaluation

Postobstructive Care

Alternative Management Protocols

At-Home Care

Prognosis

References

100 Urethral Trauma

Incidence

Patient Evaluation

Diagnosis

Treatment

Complications

Outcome

References

101 Lyme Nephritis

Introduction

Transmission, Prevalence, and an Experimental Model of Canine 
Lyme Disease

Presentation of Field Cases with Presumptive Lyme Nephritis [1–4,15]

Diagnostic Work-Up to Stage Disease and Rule Out Other Differentials [1–4,9,10]

Treatment (Table 101.2)

Monitoring

Prevention, Tick Control and 
Lyme Vaccination

References

102 Chronic Kidney Disease

Introduction

Pathophysiology

Presentation

Diagnostics

Stabilization and Initial Therapy

Prognosis and Long-Term Management

Conclusion

References

103 Uroabdomen

Etiology and Pathogenesis

Clinical Signs and Physical Examination Findings

Diagnosis and Laboratory Evaluation

Emergent Stabilization

Treatment

Complications and Prognosis

References

104 Urethral Prolapse

Urethral Prolapse

Diagnosis

Treatment

References

105 Discolored Urine

Introduction

Examination of the Urine Specimen

Abnormal Urine Sediment Color

Abnormal Urine Supernatant Color

Pigment-Induced Renal Injury

Conclusion

References

106 Urinary Diversion in the Emergency Room

Urinary Catheterization

Percutaneous Nephrostomy Tube

Percutaneous Antegrade Urethral Catheterization

Cystoscopy and Urethroscopy

Cystostomy Tubes

Peritoneal Drainage

References

G. Acid-base, Electrolyte and Endocrine Disorders

107 Acid–Base Disorders

Introduction

Sample Considerations

Acid–Base Regulation

Acid–Base Analysis

Acid–Base Disorders

Acid–Base and Prognosis

Case Example 1

Case Example 2

Case Example 3

References

108 Sodium and Water Balance

Introduction

Hyponatremia

Hypernatremia

Acute (<48h) hypernatremia

Prognosis

References

109 Potassium Disorders

Introduction

Potassium Homeostasis

Hypokalemia

Hyperkalemia

References

110 Calcium, Magnesium, and Phosphorus Disorders

Introduction

Phosphorus Homeostasis

Calcium Homeostasis

Magnesium Homeostasis

References

111 Hypoglycemia

Introduction

Pathophysiology

Clinical Signs

Causes of Hypoglycemia

Diagnosis

Treatment of a Hypoglycemic Crisis

References

112 Hyperglycemia

Introduction

Stress Hyperglycemia

Diabetes Mellitus

Insulin Deficiency and Insulin Resistance

References

113 Complicated Diabetes Mellitus

Introduction

Pathogenesis

History and Physical Examination

Diagnostic Evaluation in the Emergency Room

Stabilization and Emergency Treatment

Post-crisis Therapy for Diabetes Mellitus

Outcome

References

114 Adrenal Gland Disorders

Introduction

Pheochromocytoma

Hyperaldosteronism

Hyperadrenocorticism

References

115 Hypoadrenocorticism

Etiology and Pathogenesis

Patient Evaluation

Diagnosis

Treatment

Complications

Outcome

References

116 Thyroid Disorders

Introduction

Thyroid Physiology

Thyroid Testing

Clinical Presentations

References

117 Diabetes Insipidus

Introduction

Pathophysiology

Recognizing Diabetes Insipidus in the Emergency Patient

Treatment

Prognosis

References

H. Reproductive Disorders

118 Dystocia

Female Reproductive Anatomy and the Physiology of Parturition

Dystocia

Postoperative Care and Management

References

119 Eclampsia

Introduction

Etiopathogenesis

Diagnosis

Treatment (Box 119.1)

Prevention

References

120 Neonatal Resuscitation

Physical Examination

Respiratory Concerns

Cardiac Concerns

Hypothermia

Dehydration and Fluid Therapy

Hypoglycemia

Sepsis

When to Stop Resuscitation Efforts

References

121 Diseases of the Neonate

Introduction

Epizootiology

Physiology

Neonatal Disorders in the Immediate Postpartum Period

Neonatal Disorders in the Later Postpartum Period

References

122 Metritis and Mastitis

Metritis

Mastitis

References

123 Pyometra

Signalment, Clinical Presentation, and Associated Disease

Diagnostics

Treatment

References

124 Prostatic Disease

Introduction

Anatomy

Diagnostics

Prostatic Disorders

References

125 Uterine and Vaginal Prolapse

Uterine Prolapse

Vaginal Prolapse

References

126 Penile, Preputial, and Testicular Disease

Priapism

Paraphimosis

Phimosis

Persistent Penile Frenulum

Balanoposthitis

Urethral Prolapse (see Chapter 104)

Penile Trauma

Infectious Orchitis and Epididymitis

Testicular Torsion

Scrotal Dermatitis

References

I. Common Toxins

127 Decontamination and Toxicological Analyses of the Poisoned Patient

Introduction

Gastrointestinal Decontamination

Emetic Agents

Gastric Lavage

Activated Charcoal

Toxicological Analyses

Conclusion

References

128 Lipid Rescue Therapy

Introduction

Available Formulations

Historical Use in Human Medicine

Use in Veterinary Medicine

Mechanism of Action

Recommended Dosing

Potential Complications

References

129 Blood Purification Techniques for Intoxications

Introduction

Intermittent Hemodialysis

Hemoperfusion

Combination Hemodialysis/Hemoperfusion

Apheresis

Indications for the Use of Extracorporeal Therapies in Treatment of Poisoning

Medical Management for Intoxications

Conclusion

References

130 Rodenticide Toxicity

Introduction

Decontamination

Anticoagulant Rodenticides

Neurotoxic Rodenticides

Cholecalciferol Rodenticides

Phosphide Rodenticides

Aldicarb Rodenticide

References

131 Ethylene Glycol Intoxication

Introduction

Clinical Signs

Diagnostic Testing

Treatment

Hemodialysis

References

132 Acetaminophen Intoxication

Introduction

Pharmacokinetics and Toxicokinetics

Clinical Signs

Gross and Histological Lesions

Diagnosis

Treatment

Prognosis

References

133 Non-Steroidal Anti-Inflammatory Drug Intoxications

Mechanism of Action

Pharmacokinetics

Adverse Effects

Treatment of NSAID Intoxication

References

134 Grape, Raisin, and Lily Ingestion

Grape, Raisin, and Currant Nephrotoxicity Pathogenesis

Lily Nephrotoxicity Pathogenesis

Physical Examination

Initial Diagnostics

Management of Non-Azotemic Animals Shortly After Exposure

Managing Patients with Established Acute Kidney Injury

Prognosis

References

135 Recreational Drug Intoxications

Cocaine

Methamphetamine

Marijuana

Conclusion

References

136 Household Toxins

Decontamination

Common Household Toxin Exposures

Conclusion

References

J. Skin and Soft Tissue Disease

137 Life-Threatening Dermatological Emergencies

Dermatological Emergencies

Methicillin-Resistant Staphylococcal Infections (MRSIs)

Burns

Frostbite

Drug Eruption

Vasculitis

Erythema Multiforme

Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome

References

138 Severe Soft Tissue Infections

Introduction

Etiology

Pathophysiology

Clinical Features (Table 138.1)

Diagnosis (see Table 138.1)

Treatment (see Table 138.1)

Prognosis

References

K. Environmental Emergencies

139 Smoke Inhalation Toxicity

Introduction

Pathophysiology of Smoke Inhalation

Carbon Monoxide and Cyanide Exposure

Physical Examination Findings

Diagnostics

Treatment

Prognosis

References

140 Porcupine Quilling

Introduction

Prehospital Care

Quill Removal

Discharge Instructions

Complicated Quillings

Conclusion

References

141 Crotalinae Snake Envenomation

Introduction

Crotalinae Envenomation

Clinical Signs of Envenomation

Patient Evaluation and Stabilization

Antivenoms

Additional Therapies

References

142 Elapid Snake Envenomation: North American Coral Snakes and Australian Elapids 
(Tiger Snakes, Brown Snakes, Taipans, Death Adders, and Black Snakes)

Introduction

Elapid Species Identification

Pathophysiology of Elapid Venoms

Clinical Signs of Envenomation

First Aid Advice for Owners

Treatment of Envenomation in Dogs 
and Cats

References

143 Spider and Scorpion Envenomation

Spider Envenomation

Theraphosidae Spiders

Scorpion Envenomation

References

144 Bufo Toad Toxicosis

Introduction

Incidence

Signalment

Clinical Signs of Envenomation

Diagnosis

Treatment and Monitoring

Prognosis

Acknowledgments

References

145 Hymenoptera Envenomation

Apoidea

Vespoidea

Formicidea

Venom

Lethal Dose

Clinical Manifestations of Envenomation

Diagnosis

Treatment

References

146 Hypersensitivity and Anaphylaxis

Incidence and Definitions

Classification and Pathophysiology of Hypersensitivity Reactions and Anaphylaxis

Etiologies and Clinical Manifestations

Diagnosis

Treatment

Prognosis

References

147 Canine Heat Stroke

Pathophysiology

Risk Factors for Developing Heat Stroke

Clinical Signs and Diagnosis

Hematological Disorders and Biochemical Abnormalities

Coagulation Disorders and Disseminated Intravascular Coagulation

Other Complications: Acute Kidney Injury, Central Nervous System Dysfunction, ARDS, Cardiac Arrhythmias, and Gastrointestinal Bacterial Translocation

Treatment Options

Monitoring

Prognosis

Conclusion

References

148 Cold Exposure

Introduction

Pathophysiology of Effects of Cold Exposure [1–3,6–10]

Management [1–3,7–10]

Frostbite

References

149 Electrical and Lightning Injuries

Introduction

Electrical Injury

Lightning Injury

References

Section 4 Trauma and Resuscitation

A. Cardiopulmonary Resuscitation

150 Cardiopulmonary Resuscitation in the Emergency Room

Recognition of Cardiopulmonary Arrest

Basic Life Support

Advanced Life Support

Prognosis

References

151 Small Animal Cardiopulmonary Resuscitation Initiatives

Strategically Advancing the Field 
of Veterinary CPR

Evidence-Based Consensus Small Animal CPR Guidelines

Knowledge Gaps

Glossary and Guidelines For Standardized Reporting

CPR Registry

Conclusion

References

B. Circulatory Shock

152 Pathophysiology of Shock

Introduction

Cellular Impact

Systemic Impact

Secondary Systemic Sequelae

Conclusion

References

153 Hypovolemic Shock

Pathophysiology of Hypovolemic Shock

Diagnosis of Hypovolemic Shock

Treatment of Hypovolemic Shock

Complications of Hypovolemic Shock

References

154 Cardiogenic Shock

Introduction

Pathophysiology (see Chapter 152)

Incidence and Etiology

Diagnosis

Treatment and Monitoring

Conclusion

References

155 Additional Mechanisms of Shock

Introduction

Distributive Shock

Obstructive Shock

Non-Circulatory Shock

References

156 Lactate Monitoring

Introduction

Lactate Physiology

Causes of Hyperlactatemia

Lactate Measurement

Normal Lactate Concentration

Assessment of Hyperlactatemia

Prognostic Implications

Lactate Measurement in Other Body Fluids

References

157 Emerging Monitoring Techniques

Introduction

Venous Oxygen Monitoring

Peripheral Hemodynamic Parameters

References

158 Ischemia-Reperfusion Injury

Pathophysiology

Disorders Associated with Ischemia-Reperfusion Injury

Identification of Ischemia-Reperfusion Injury

Management of Ischemia-Reperfusion Injury

Conclusions and Clinical Recommendations

References

159 Systemic Inflammatory Response Syndrome, Sepsis, and 
Multiple Organ Dysfunction Syndrome

Introduction

Definitions

Pathophysiology

Diagnostic Approach to SIRS and Sepsis

Treatment Approach to SIRS and Sepsis

Prognosis for SIRS, Sepsis, and MODS

References

C. Trauma

160 Trauma Overview

Introduction

Overview of the Pathophysiology of Trauma

Epidemiology of Small Animal Trauma

Trauma Scoring Systems

General Approach to the Polytrauma Patient

Considerations for Intravenous Fluid Resuscitation in Trauma

References

161 Trauma Center Registry

Veterinary Trauma Initiative

Trauma Registries: History and Purpose

Trauma Registry: The Future

References

162 High-Rise Syndrome

Definition and Pathophysiology

Clinical Signs

Diagnostics

Treatment

Prognosis

References

163 Trauma-Associated Coagulopathy

Introduction

Pathogenesis

Trauma-Associated Coagulopathy in Dogs

Hemostatic Testing for Trauma

Conclusion

References

164 Metabolic Consequences of Trauma

Introduction

Sympathoadrenal Activation

Neuroendocrine Activation

Hyperglycemia

Hyperlactatemia

Acid–Base Disorders

Body Temperature

Gastrointestinal Injury

Systemic Inflammation

Activation of the Coagulation Cascade

Conclusion

References

165 Traumatic Orthopedic Emergencies

General Considerations for the Trauma Patient

Fractures

Traumatic Joint Injuries

Skull and Maxillofacial Trauma

References

166 Wound Management Principles

Introduction

Phases of Wound Healing

Wound Closure

Management of Acute Traumatic Wounds and Deciding When and How to Close Them

Antibiotic Therapy in Wound Management

References

Section 5 Fluid and Blood Product Therapy

167 Crystalloid Fluid Therapy

Introduction

Physiology of Fluid Distribution

Patient Assessment

Types of Crystalloids

Crystalloid Fluids in Resuscitation

Crystalloid Fluids for Rehydration and Maintenance

Complications of Crystalloid Fluid Therapy

References

168 Colloid Fluid Therapy

Introduction

Colloid Osmotic Pressure

Types of Colloid Solutions

Conclusion

References

169 Crystalloids Versus Colloids

Introduction

Suitability

Fluid Prescription: Crystalloids (see Chapter 167)

Fluid Prescription: Colloids (see Chapter 168)

Fluids: Strategies, Dosages, and Endpoints

References

170 Management of Hemorrhagic Shock

Signalment/History

Physical Examination

Point-of-Care Diagnostics

Treatment

Additional Therapy for Specific Conditions

References

Supplemental Reading

171 Management of Dehydration

Introduction

Definition of Dehydration

Estimating Dehydration

Total Body Water

Mechanism of Thirst

Rehydration

Conclusion

References

172 Maintenance Fluid Therapy

Introduction

Estimation of a Patient’s Maintenance Fluid Requirement

Composition of a Maintenance Fluid

Use of Maintenance Fluids

Conclusion

References

173 Potassium Supplementation

Introduction

Potassium Physiology

Causes of Hypokalemia

Clinical Signs of Hypokalemia

Potassium Supplementation

Diabetic Ketoacidosis (see Chapter 113)

References

174 Administration of Sodium Bicarbonate

Introduction

Metabolic Acidosis (see Chapter 107)

Cardiopulmonary Cerebral Resuscitation (see Chapter 150)

Hyperkalemia (see Chapter 109)

Dosage and Administration

References

175 Continuous-Rate Infusion

Preparing Drug Solutions for Infusions

Fluid Bag Delivery

Drug Infusions Using a Burette

Preparation of Drug Infusions for Bag/Burette

Labeling the Drug Infusion

Standardized Concentration Infusions

Drug Infusions Using a Syringe Pump

176 Transfusion of Red Blood Cells and Plasma

Transfusion Therapy

Donor and Recipient Screening

Cross-Matching

Blood Product Administration

Transfusion Reactions

References

177 Massive Transfusion

Introduction

Common Conditions Requiring 
Massive Transfusion

Diagnosis/Prediction

Pre-Resuscitation Complications/Acute Traumatic Coagulopathy

Treatment

Complications

Prognosis

References

Section 6 Emergency Room Procedures

178 Vascular Access

Introduction

Venous Access

Intraosseous Access

Arterial Access

References

179 Intraosseous Catheters

Introduction

Physiology

Indications

Contraindications

Medications

Methods

Possible Complications

Intraosseous Catheter Care

References

180 Airway Management

Introduction

Healthy Dog or Cat

Upper Airway Obstruction (see Chapters 28 
and 30–32)

Difficult Intubation

Tracheostomy

Pharmacological Therapy

References

181 Oxygen Therapy

Introduction

Non-Invasive Oxygen Therapy

Advanced Oxygen Delivery Methods

Invasive Oxygen Delivery Methods

Hyperbaric Oxygen

Monitoring Response to Oxygen Therapy

Oxygen Toxicity

Conclusion

References

182 Sonography in the Emergency Room

Terminology

Abdominal Focused Assessment of Sonography for Trauma (FAST)

Thoracic FAST

Vet BLUE

Global FAST

References

183 Thoracocentesis

Introduction

Indications

Contraindications

Preparation and Considerations

Procedure

Identify Anatomical Landmarks

Complications

Postprocedure Monitoring

References

184 Thoracostomy Tube Placement

Indications for Thoracostomy Tubes

Preparation for Placement

Tube Types

Tube Placement Techniques

Thoracostomy Tube Maintenance and Care

Complications

References

185 Pericardiocentesis

Etiology and Indications for Pericardiocentesis

Contraindications

Sedation (see Chapter 192)

Equipment

Procedure

Complications

Pearls of Wisdom

References

186 Abdominocentesis

Introduction

Indications

Technique

Focused Assessment with Sonography 
for Trauma (see Chapter 182)

Preparation of the Patient

Diagnostic Peritoneal Lavage

Abdominal Fluid Analysis

Conclusion

References

187 Urethral Catheterization (Including Urohydropulsion)

Introduction

Indications for Urethral Catheterization

Risks of Urethral Catheterization

Catheter Considerations

Placement Technique

Retrograde Urohydropropulsion

Indwelling Catheter Care

References

188 Mechanical Ventilation in the Emergency Room

Introduction

Supplies Required

Personnel

Transport

Owner Communication

Respiratory Distress (Hypoxemia)

Intoxications/Envenomation

Post Cardiopulmonary Resuscitation

Tetraparesis

Ventilation

Conclusion

References

189 Damage Control Surgery

Introduction

Damage Control Surgery Stage 1: 
Initial Laparotomy

Damage Control Surgery Stage 2: 
ICU Resuscitation

Damage Control Surgery Stage 3: 
Definitive Reconstruction

References

Section 7 Anesthesia and Analgesia for the Emergency Room Patient

190 Anesthesia and Analgesia in the Emergency Room: An Overview

Introduction

Origins and Sequelae of Pain

General Approach to the Painful Patient

Treating the Painful Emergent Patient

Analgesic Agents and Tranquilizers

(Figure 190.1)

Induction Agents (see Figure 190.1)

Inhalant Anesthetics (see Figure 190.1)

Conclusion

References

191 Anesthetic Concerns and Protocols for Common Conditions

Introduction

Dystocia/Cesarean Section 
(see Chapter 118)

Enucleation/Proptosis

Foreign Body (Esophageal, Gastric, Intestinal)

Gastric Dilation-Volvulus (see Chapter 82)

Hemoabdomen (see Chapter 84)

Major Wounds (see Chapter 166)

Pacemaker

Urethral Obstruction (Canine)

References

192 Sedation for the Emergency Room Patient

Introduction

Healthy Dog/Cat Emergencies

Geriatric, Debilitated, or Hemodynamically Unstable Cat or Dog Emergencies

Sedation Agents

Induction Agents Used for Sedation

References

193 Pain Management in Critical Patients

Pain in the Emergency Patient: Concerns and Goals

How Much Pain and How to Approach It

Drug Interactions

Dose Titration, Timing, and Duration

Breakthrough and Unexpected Pain

Pharmacological Methods for Treating Acute Pain

Cryotherapy

References

194 Opioids

Introduction

Mechanism of Action

Duration of Action and Administration Techniques

Advantages and Side-Effects

Patient Management Recommendations

References

195 Alpha-2 Adrenergic Agonists

Introduction

References

196 Non-Steroidal Anti-Inflammatory Drugs

Introduction

Mechanisms of Action

Pharmacokinetics

Adverse Effects

Drug–Drug Interactions

Clinical Usage

References

197 Regional Anesthesia Techniques

Introduction

Selected Regional Anesthetic Techniques

Potential Complications

References

198 Go Home Analgesics

Pain Assessment

Pathophysiology of Pain

Go Home Analgesics

Adjunctive or Alternative Analgesics

References

199 Approach to the Aggressive or Fearful Emergency Room Patient

Introduction

Patient Fear and Aggression

Recognizing Fear and Aggression 
in Dogs and Cats

Techniques for Patient Handling and Physical Restraint

Pharmacologic Restraint of the Aggressive or Fearful Patient

References

Section 8 Unique Emergency Medicine Topics

200 Antimicrobial Therapy in the Emergency Patient

Introduction

General Considerations for Antimicrobial Selection

Approach to Antimicrobial Selection for Patients with Sepsis

Duration of Antimicrobial Administration

Source Control

Conclusion

References

201 Disaster Medicine

What is a Disaster?

The Human–Animal Bond During a Disaster

Organizational Structure

Veterinary Disaster Response Programs

Phases of Disaster Management

Conclusion

References

202 Working Dogs in the Emergency Room

Occupations

Occupational Hazards

Client Education

References

203 Approach to Unowned and Shelter/Rescue Animals in the Emergency Room

Introduction

References

204 Euthanasia Considerations

Introduction

Emotional Aspects of Euthanasia in the Emergency Setting

Technical Aspects of Euthanasia in the Emergency Setting

Current Concepts in Veterinary End-of-Life Care

Conclusion

References

205 Emergency Room Design and Staffing Models

Introduction

General Design Concepts

Entrance

Reception

Waiting Room

Exam Rooms

Visitation, Consulting, and Grieving Rooms

Emergency Room

Other Hospital Space

Other Design Considerations for the Emergency Room

Design Summary

Staffing the Emergency Room

206 Conflict in the Emergency Room

Introduction

Interpersonal Conflict

Enhancing Constructive Conflict

Conclusion

References

207 Maximizing Communication

Core Communication Skills

Breaking the News/Presenting the Diagnosis

Offering Options

Specific Pointers

Conclusion

References

208 Basics of Clinical Study Design

Introduction

The Research Question

Choosing the Appropriate Subjects

Planning and Recording the Measurements

Choosing the Study Design

Analysis

Presenting the Results

Further Reading

209 Designing and Participating in Clinical Trials

Clinical Trial Design

Controlled Clinical Trial Design

Clinical Trial Implementation

Good Clinical Practice

References

Index

End User License Agreement

List of Tables

2

Table 2.1

Table 2.2

Table 2.3

3

Table 3.1

Table 3.2

Table 3.3

Table 3.4

7

Table 7.1

Table 7.2

Table 7.3

Table 7.4

Table 7.5

10

Table 10.1

13

Table 13.1

Table 13.2

15

Table 15.1

Table 15.2

Table 15.3

Table 15.4

Table 15.5

Table 15.6

Table 15.7

Table 15.8

Table 15.9

Table 15.10

16

Table 16.1

18

Table 18.1

Table 18.2

20

Table 20.1

21

Table 21.1

Table 21.2

22

Table 22.1

23

Table 23.1

Table 23.2

24

Table 24.1

25

Table 25.1

Table 25.2

27

Table 27.1

Table 27.2

28

Table 28.1

29

Table 29.1

Table 29.2

31

Table 31.1

32

Table 32.1

33

Table 33.1

35

Table 35.1

37

Table 37.1

38

Table 38.1

44

Table 44.1

45

Table 45.1

46

Table 46.1

49

Table 49.1

Table 49.2

52

Table 52.1

53

Table 53.1

Table 53.2

55

Table 55.1

Table 55.2

57

Table 57.1

Table 57.2

58

Table 58.1

63

Table 63.1

Table 63.2

65

Table 65.1

68

Table 68.1

Table 68.2

70

Table 70.1

Table 70.2

73

Table 73.1

74

Table 74.1

76

Table 76.1

78

Table 78.1

80

Table 80.1

Table 80.2

86

Table 86.1

87

Table 87.1

90

Table 90.1

93

Table 93.1

94

Table 94.1

Table 94.2

Table 94.3

95

Table 95.1

96

Table 96.1

Table 96.2

99

Table 99.1

101

Table 101.1

Table 101.2

102

Table 102.1

Table 102.2

103

Table 103.1

105

Table 105.1

107

Table 107.1

Table 107.2

109

Table 109.1

Table 109.2

Table 109.3

110

Table 110.1

111

Table 111.1

113

Table 113.1

Table 113.2

Table 113.3

115

Table 115.1

Table 115.2

Table 115.3

116

Table 116.1

117

Table 117.1

118

Table 118.1

Table 118.2

119

Table 119.1

120

Table 120.1

Table 120.2

123

Table 123.1

125

Table 125.1

126

Table 126.1

127

Table 127.1

Table 127.2

Table 127.3

Table 127.4

129

Table 129.1

133

Table 133.1

135

Table 135.1

Table 135.2

Table 135.3

137

Table 137.1

Table 137.2

Table 137.3

Table 137.4

138

Table 138.1

141

Table 141.1

142

Table 142.1

143

Table 143.1

Table 143.2

144

Table 144.1

145

Table 145.1

146

Table 146.1

147

Table 147.1

151

Table 151.1

153

Table 153.1

158

Table 158.1

Table 158.2

159

Table 159.1

Table 159.2

Table 159.3

160

Table 160.1

165

Table 165.1

167

Table 167.1

Table 167.2

Table 167.3

168

Table 168.1

Table 168.2

169

Table 169.1

Table 169.2

Table 169.3

170

Table 170.1

Table 170.2

Table 170.3

Table 170.4

171

Table 171.1

Table 171.2

172

Table 172.1

173

Table 173.1

174

Table 174.1

Table 174.2

175

Table 175.1

176

Table 176.1

Table 176.2

179

Table 179.1

182

Table 182.1

Table 182.2

Table 182.3

Table 182.4

Table 182.5

183

Table 183.1

188

Table 188.1

191

Table 191.1

192

Table 192.1

194

Table 194.1

195

Table 195.1

197

Table 197.1

198

Table 198.1

Table 198.2

199

Table 199.1

Table 199.2

Table 199.3

200

Table 200.1

202

Table 202.1

Table 202.2

204

Table 204.1

206

Table 206.1

Table 206.2

List of Illustrations

5

Figure 5.1 Single lead II ECG of a Doberman pinscher displaying paroxysms of ventricular tachycardia and multiform ventricular premature contractions. The ventricular premature contractions have prominent S waves, indicating a right bundle branch block pattern suggesting a left ventricular origin.

Figure 5.2 Lead I, II, and III ECG of a boxer with paroxysms of ventricular tachycardia followed by ventricular bigeminy. The ventricular premature contractions are wide and upright in lead II, suggesting left bundle branch block pattern indicating a right ventricular origin which is classic for boxer dogs with ARVC.

Figure 5.3 Lead II ECG of rapid ventricular tachycardia, approximate rate of 300 beats per minute, terminated and converted to normal sinus rhythm with lidocaine.

7

Figure 7.1 Causes of transient loss of consciousness (TLOC) in animals.

8

Figure 8.1 Formula for oxygen content (CaO2) in arterial blood.

Figure 8.2 Algorithm for evaluation and stabilization of the small animal trauma patient. aFAST, abdominal focused assessment with sonography for trauma; CT, computed tomography; MRI, magnetic resonance imaging; TBI, traumatic brain injury; tFAST, thoracic focused assessment with sonography for trauma; US, ultrasound.

11

Figure 11.1 Very yellow mucous membranes and sclera in a dog with immune hemolytic anemia with a PCV of 9%.

Figure 11.2 Yellow sclera and pinna in another dog with immune-mediated hemolytic anemia.

Figure 11.3 Orange-colored mucous membranes in a dog that has a hepatopathy with icterus and a PCV >30%.

12

Figure 12.1 Proptosis repair. (a) Globe proptosis. (b) Placement traction sutures of 2/0 to 4/0 nylon. Sutures should enter and exit at the lid margin and not on the conjunctival surface. (c) Placement of scalpel handle on a cornea lubricated with an artificial tear ointment. 
(d) Traction on the sutures and replacement of eyelids in front of the globe. (e) Completion of the sutures. Reproduced with permission of Elsevier.

Figure 12.2 Partial- and full-thickness corneal lacerations (a). Note the blood and fibrin in the full-thickness laceration (b). 
Source: Courtesy of the Ophthalmology Service, School of Veterinary Medicine, University of California-Davis.

Figure 12.3 Corneal foreign body, before (a) and after (b) removal. Source: Courtesy of the Ophthalmology Service, School of Veterinary Medicine, University of California-Davis.

Figure 12.4 (a) Slit beam transversing normal anterior chamber. (b) Slit beam transversing anterior chamber with aqueous flare. Source: Courtesy of the Ophthalmology Service, School of Veterinary Medicine, University of California-Davis.

15

Figure 15.1 Pyotraumatic dermatitis in a dog. Reproduced with permission of Kimberly Coyner.

Figure 15.2 Superficial pyoderma along the dorsum of a dog caused by Staphylococcus pseudintermedius. Reproduced with permission of Kimberly Coyner.

Figure 15.3 Close-up of superficial pyoderma from the dog in Figure 15.2. Reproduced with permission of Kimberly Coyner.

Figure 15.4 Deep pyoderma in a dog. Reproduced with permission of Kimberly Coyner.

Figure 15.5 Severe otitis externa in a dog. Reproduced with permission of Kimberly Coyner.

Figure 15.6 Demodecosis with secondary deep pyoderma in a dog. Reproduced with permission of Kimberly Coyner.

Figure 15.7 Fine dander noted in a cat with atopy. Reproduced with permission of Kimberly Coyner.

Figure 15.8 Alopecia, hyperpigmentation, and erythema affecting the ventrum and inguinal regions of a dog with atopy. Reproduced with permission of Kimberly Coyner.

Figure 15.9 Ventral neck and thorax of the same dog as shown in Figure 15.8. Reproduced with permission of Kimberly Coyner.

17

Figure 17.1 An example of an MRI showing a normal nasal anatomy.

Figure 17.2 An example of a CT from the same dog showing normal nasal anatomy. Note the difference in resolution between an MRI and a CT image.

Figure 17.3 Carotid ligation is performed under general anesthesia. The area is clipped and surgically prepped on the side of the hemorrhage. The carotid artery is identified through palpation and gentle dissection. Recall that it runs in close proximity to the vagosymphatic trunk. The artery is isolated and two circumferental ligatures are tied using 3-0 monofilament non-absorbable suture. The artery is not divided.

19

Figure 19.1 Intracranial compliance curve.

Figure 19.2 Modified Glasgow Coma Scale [12].

20

Figure 20.1 Head pressing in an older poodle secondary to a brain tumor.

24

Figure 24.1 How to immobilize a patient with suspected spinal instability. The animal should be strapped down in lateral recumbency to a rigid board. If instability of the thoracolumbar spine is suspected, the animal should be strapped cranial and caudal to the shoulder and the hip (green). If instability of the cervical spine is suspected, the head should also be strapped down (red).

Figure 24.2 The aims of surgical management of vertebral fracture/luxation are to stabilize the vertebral column and decompress the spinal cord. This dog had intact nociception despite the degree of vertebral displacement seen on survey radiographs.

26

Figure 26.1 Lateral radiograph of the thoracolumbar junction of an 8yo SF Belgian malinois presented for evaluation of waxing and waning fever and intermittent spinal hyperesthesia. No neurological deficits were noted on examination. There is diskospondylitis with moderate subluxation at L1–2 with pathological fracture of L2.

Figure 26.2 Sagittal postcontrast computed tomographic image from a 5yo CM rottweiler that presented for evaluation of progressive spinal hyperesthesia and non-ambulatory status. The patient was paraplegic with intact pain perception. There is diskospondylitis at L3–4 with mild subluxation and moderate ventral spinal cord compression.

28

Figure 28.1 Laryngeal examination of an English bulldog with severe brachycephalic syndrome showing an elongated soft palate and everted laryngeal saccules. The dog is anesthetized with orotracheal intubation prior to corrective surgery.

Figure 28.2 Laryngeal examination of the dog shown in Figure 28.1, following soft palate and laryngeal saccule resection.

30

Figure 30.1 Lateral neck radiograph of a dog presenting for signs of upper airway respiratory distress. Increased soft tissue opacity in the region of the larynx is evident, suggestive of a laryngeal mass that was later confirmed on laryngeal evaluation.

31

Figure 31.1 Picture (a) and lateral cervical radiograph (b) of a dog with a tracheal perforation secondary to ventral cervical bite wounds.

Figure 31.2 Lateral cervical radiograph of a dog with avulsion of the cricoid cartilage secondary to bite wounds and airway trauma.

Figure 31.3 CT volume rendering reconstruction showing the tracheal defect created by the bite wounds in the dog in Figure 31.1.

Figure 31.4 Cranial lung lobe herniation and kinking of the thoracic inlet trachea during coughing induced during fluoroscopy in a dog with severe bronchial collapse and intrathoracic tracheal collapse.

Figure 31.5 Lateral radiographs showing pre- (a) and post-tracheal (b) stent placement in a dog.

32

Figure 32.1 Retroflexed rhinoscopy appearance of nasopharyngeal stenosis (NPS) (a). Balloon dilation of NPS as seen on retroflexed rhinoscopy (b). Post-balloon dilation appearance of NPS (c).

Figure 32.2 Grade 3 laryngeal collapse seen during airway examination of a 10-year-old Yorkshire terrier presenting for stridor and respiratory distress.

Figure 32.3 Radiograph of a tracheal foreign body in a French bulldog with a 2-month history of intermittent respiratory distress (a). Endoscopic visualization of the cherry pit bronchial foreign body (b). Retrieval of the cherry pit using a stone basket used for cystic calculi retrieval (c).

33

Figure 33.1 Lateral radiograph of a dog with bronchitis that demonstrates diffuse thickening of airway walls and lack of tapering to the bronchi, indicative of bronchiectasis, particularly in the cranial lung lobe (arrows).

34

Figure 34.1 A spacer and mask for delivery of a bronchodilator (albuterol metered-dose inhaler) to cats.

35

Figure 35.1 A lateral thoracic radiograph from a Gordon setter puppy with respiratory distress associated with heart failure from a patent ductus arteriosus.

Figure 35.2 A lateral thoracic radiograph from a 5-month-old giant schnauzer- standard poodle X with metastatic disease from a nephroblastoma. Note the nodular pattern.

Figure 35.3 A lateral thoracic radiograph from a mixed breed puppy with non-cardiogenic pulmonary edema. Note the dorsal caudal infiltrates.

Figure 35.4 A lateral thoracic radiograph from a puppy with severe community-acquired pneumonia.

37

Figure 37.1 Lateral thoracic radiographs displayed. (a) Dog diagnosed with fungal pneumonia. Note the miliary bronchointerstitial pattern with tracheobronchial lymphadenopathy. (b) Cat diagnosed with toxoplasmosis. Note the multilobar patchy interstitial to nodular alveolar patterns throughout all lung lobes. (c) Dog diagnosed with aspiration pneumonia. Note the multilobar ventral alveolar pattern.

38

Figure 38.1 Algorithm for treatment of acute cardiogenic pulmonary edema. CRI, constant rate infusion. See text for details. Reproduced with permission of John Wiley & Sons.

39

Figure 39.1 Proposed pathophysiology of neurogenic pulmonary edema.

Figure 39.2 Lateral thoracic radiograph of a dog with congestive heart failure. Note the enlarged left atrium and perihilar distribution of pulmonary infiltrates.

Figure 39.3 Lateral thoracic radiograph of a dog with NPE due to a transient upper airway obstruction. Note diffuse pulmonary parenchymal infiltrates with the most severe changes in the caudodorsal lung fields.

40

Figure 40.1 Thoracic radiograph of a dog which suffered from submersion injury. Note the presence of pulmonary infiltrates in the diaphragmatic lung lobes (caudodorsal lung fields).

Figure 40.2 Management of patients with submersion injury at arrival to the emergency department. Patients are divided into six groups according to initial clinical findings at presentation. This approach is adapted from a scoring system described in humans where patients are allocated to one of six groups, with each group being associated with a specific percentage of survival [30]; patients belonging to groups 1, 2, 3, 4, 5, and 6 have 100%, 99%, 95%, 80%, 56% and 7% percentage of survival, respectively. ABG, arterial blood gas; CBC, complete blood count; CPR, cardiopulmonary resuscitation; ECG, electrocardiogram; ICU, intensive care unit; MV, mechanical ventilation; ROSC, return of spontaneous circulation.

Figure 40.3 The same dog as in Figure 40.1 receiving oxygen through a nasal catheter. Submersion injury victims frequently need oxygen supplementation to correct hypoxemia.

Figure 40.4 Management of patients with submersion injury according to the degree of hypothermia. ALS, Advanced Life Support; CPB, cardiopulmonary bypass; CPR, cardiopulmonary resuscitation; ECMO, extracorporeal membrane oxygenation; ED, emergency department; ICU, intensive care unit; IV, intravenous.

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Figure 41.1 Photomicrograph of the lung. Free red blood cells in the alveolar spaces (*) consistent with pulmonary hemorrhage in a dog with metastatic hemangiosarcoma. Erythrophagocytosis (white arrow) and hemosiderin-laden macrophages (black arrow) indicate chronicity. Reproduced with permission of Jennifer Davis, Diagnostic Services Unit, University of Calgary.

Figure 41.2 The lungs are diffusely dark red to black consistent with pulmonary hemorrhage in a dog with metastatic hemangiosarcoma. Reproduced with permission of Jennifer Davis, Diagnostic Services Unit, University of Calgary.

Figure 41.3 Tracheal bifurcation. Blood-tinged froth in the distal trachea and mainstem bronchi indicating pulmonary hemorrhage in a dog with metastatic hemangiosarcoma. Reproduced with permission of Jennifer Davis, Diagnostic Services Unit, University of Calgary.

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Figure 42.1 Diagnostic algorithm of pulmonary thromboembolism in dogs and cats.

Figure 42.2 (a) Thoracic radiograph obtained from a dog with multiple pulmonary emboli. Note the hyperlucency (oligemia) of the left hemithorax while the vasculature of the right hemithorax remains normal. A mild, focal interstitial opacity is seen at the left 8th intercostal space. (b) Positive computed tomography pulmonary angiography (CPTA) study from a dog with IMHA demonstrating intraluminal filling defect in the left main pulmonary artery (white arrow). (c) Echocardiographic image (right parasternal short axis view) of the heart base from a dog. Large thrombus within the lumen of the right branch of the main pulmonary artery (white arrowheads). (d) Echocardiography (right parasternal four-chamber view) showing a thrombus at the cranial vena cava and right atrial (RA) junction.

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Figure 45.1 Ventral-dorsal and left lateral radiographs from a 12-year-old MC DSH who presented for difficulty breathing. On auscultation, his lung and heart sounds were muffled and a gallop rhythm was heard. Thoracocentesis removed 105 mL of a red-tinged fluid that on cytology was classified as a neoplastic effusion with carcinoma cells present. On radiographs taken after thoracocentesis (not pictured), a moderate pleural effusion was still present bilaterally, and a mineralized pulmonary mass could be seen in the right middle or ventral part of the right caudal lobe.

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Figure 47.1 Ventrodorsal radiographic view of the thorax of a dog with a peritoneal pericardial diaphragmatic hernia (PPDH). Gas-filled intestinal loops can be visualized superimposed over an enlarged cardiac silhouette.

Figure 47.2 Ventrodorsal radiographic view of the thorax of a dog with a traumatic diaphragmatic hernia. The food-filled stomach can be visualized in the left hemithorax.

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Figure 51.1 Pathophysiology of heart failure. Cardiac injury results in neurohormonal activation and maladaptive responses, such as cardiac remodeling and abnormal calcium handling. These responses further cardiac injury, resulting in a vicious cycle. See text for more details.

Figure 51.2 (a) Normal left ventricular pressure–volume relationship during systole (s) and diastole (d). The cardiac cycle proceeds around the pressure–volume loop in a counterclockwise fashion (arrows). (b) Left ventricular pressure–volume relationship in heart disease (dotted line). The end-systolic point (x) is shifted downward and rightward, causing lower pressure and reduced stroke volume. The end-diastolic point (y) is shifted upward and rightward, resulting in higher diastolic pressures and congestion. (c) Positive inotropes shift the end-systolic point upward and leftward by improving contractility, thereby increasing stroke volume and arterial pressure (a). Diuretics and venous vasodilators shift the end-diastolic point downward and leftward, thereby improving diastolic filling and reducing pressures (b). In this way, the abnormal cardiac function is restored closer to normal function (solid line).

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Figure 52.1 A proposed calculation for palliative phlebotomy in patients with congenital heart disease and polycythemia.

Figure 52.2 (a) Right lateral and dorsoventral thoracic radiographs demonstrate severe right ventricular enlargement with a bulging main pulmonary artery and distended caudal lobar arteries in a patient with reverse PDA. (b) A two-dimensional short axis image demonstrates the massive right ventricular concentric hypertrophy (asterisks) secondary to severe pulmonary hypertension in a patient with reverse PDA and polycythemia. Note the negative QRS complexes on the ECG tracing consistent with the patient’s right axis deviation.

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Figure 55.1 ECG showing atrial fibrillation in a dog with dilated cardiomyopathy. Note the rapid, irregularly irregular rhythm and lack of P-waves. 25 mm/sec; 1 cm = 1 mV.

Figure 55.2 Two-dimensional (a) and M-mode (b) right parasternal short axis echocardiographic images of the left ventricle of a dog with dilated cardiomyopathy. The left ventricular cavity is dilated in both diastole and systole and the fractional shortening is markedly reduced.

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Figure 56.1 A right parasternal short-axis two-dimensional echocardiographic image obtained from a cat with hypertrophic cardiomyopathy and congestive heart failure. Left atrial size is commonly assessed by indexing its maximum dimension to that of the aorta (just after aortic valve closure) as shown. LA:Ao greater than 1.5 indicates enlargement. Ao, aorta; LA, left atrium; RA, right atrium; RV, right ventricle.

Figure 56.2 Right lateral (a) and ventrodorsal (b) radiographic projections of the thorax of a cat with congestive heart failure caused by hypertrophic cardiomyopathy. Note the enlargement of the cardiac silhouette as determined by dorsal deviation of the trachea on the lateral projection and the base-wide appearance or valentine shape on the ventrodorsal projection. Patchy interstitial densities are distributed throughout the lungs. Mild pleural effusion is also evident.

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Figure 58.1 (a) Left lateral and ventrodorsal thoracic radiographs from a 2-year-old female dog with HWI. She was presented for cough. There is mild-moderate right heart enlargement, as well as main pulmonary artery and right caudal lobar artery enlargement. There is also a diffuse interstitial infiltrate. (b) left lateral and dorsoventral thoracic radiographs from a 2-year-old male Labrador retriever with HWD, that was presented for cough, tachypnea, and severe exercise intolerance. There is right heart and main pulmonary artery enlargement and peripheral pulmonary arteries are enlarged and tortuous. There is a diffuse, mixed bronchial and nodular-interstitial pattern. The loss of abdominal serosal detail is due to ascites. This dog demonstrates the combined HWD sequelae of right heart failure, active pulmonary disease, pulmonary hypertension, and (likely) chronic and acute pulmonary arterial embolism.

Figure 58.2 Right parasternal short axis echocardiographic view (at the level of the mitral valve) from a 3-year-old female dachshund. A mass of heartworms is seen within the dilated right ventricle. Heartworms appear as echogenic parallel lines.

Figure 58.3 (a) Right parasternal axis echocardiographic view from a 6-year-old female domestic short-hair cat presented for cough and syncope. There is a heartworm (arrow) traversing the tricuspid valve. There is right atrial dilation. (b) Fluoroscopic image from the same cat shown in (a). A Nitinol Gooseneck® snare is open within the right atrium. A single worm was retrieved.

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Figure 59.1 Thoracic radiographs obtained from a dog with chronic pulmonary interstitial disease and class 3 PH. (a) Right lateral thoracic radiograph and (b) ventrodorsal radiograph. The patient has a patchy bronchointerstitial pulmonary pattern consistent with lower airway disease. There is right ventricular hypertrophy and main pulmonary artery dilation. Hepatomegaly and mild pulmonary effusion are present, consistent with cor pulmonale and subsequent hepatic congestion and right-sided congestive heart failure.

Figure 59.2 The echocardiographic images were obtained from a dog with severe chronic degenerative valvular disease and class 2 pulmonary hypertension. Note that the left atrium and ventricle are severely dilated consistent with left-sided cardiac disease. (a) Right parasternal long axis view demonstrating dilated LA, LV, and thickened MV. (b) Right parasternal short axis basilar view confirming severe LA dilation in relation to the Ao. (c) Left parasternal long axis view depicting dilated LA and LV and thickened MV with prolapse. (d) Left parasternal long axis view demonstrating Doppler interrogation of TR. The TR velocity is elevated at 4.25 m/sec; using the modified Bernoulli equation, the estimated pulmonary artery pressure is 72.5 mmHg, indicating moderate pulmonary hypertension. Ao, aorta; LA, left atrium; LV, left ventricle; MV, mitral valve; PA, pulmonary artery; RA, right atrium; RV, right ventricle; TR, tricuspid regurgitation.

Figure 59.3 The echocardiographic images were obtained from a dog with severe chronic pulmonary interstitial disease and class 3 pulmonary hypertension. Note that the left atrium and ventricle appear normal, with no evidence of left-sided cardiac disease. (a) Right parasternal long axis view demonstrating dilated RA, RV, and RPA. (b) Right parasternal short axis apical view demonstrated RV dilation and septal flattening due to high right-sided pressures. (c) Right parasternal short axis basilar view depicting PA dilation. (d) Right parasternal short axis basilar view demonstrating Doppler interrogation of TR. The TR velocity is elevated at 5.8 m/sec; using the modified Bernoulli equation, the estimated pulmonary artery pressure is 134.5 mmHg, indicating severe pulmonary hypertension. Ao, aorta; LA, left atrium; LV, left ventricle; PA, pulmonary artery; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle; TR, tricuspid regurgitation.

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Figure 60.1 Common pathological bradyarrhythmias in small animal patients. (a) High-grade Mobitz type II second-degree atrioventricular block and left bundle branch block (QRS duration > 40 ms) in a cat. Note the abrupt lack of sufficient escape activity in this cat (lead II, 50 mm/sec, 10 mm/mV). (b) Third-degree atrioventricular block in a dog. Note the upright and narrow QRS complexes suggesting a junctional escape rhythm depolarizing at 50 bpm (lead II, 50 mm/sec, 10 mm/mV). (c) Sick sinus syndrome in dog. A supraventricular tachycardia is followed by an abrupt sinus pause lasting approximately 7 seconds. Escape activity of a subsidiary pacemaker is lacking and a motion artifact is apparent during the pause (lead II, 25 mm/sec, 10 mm/mV). (d) Persistent atrial standstill in a dog. Note the bradycardia (36 bpm) and lack of P-waves (lead II, 50 mm/sec, 10 mm/mV).

Figure 60.2 Temporary transvenous pacing system. Note the inflatable balloon at the tip of this lead.

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Figure 63.1 Photograph of the left eye from a hypertensive (systolic blood pressure 270 mmHg), 11-year-old cat that was presented for acute lethargy, ataxia, and altered mentation. Complete, bullous retinal detachment was noted bilaterally. Reproduced with permission of Dr. Kate Myrna.

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Figure 65.1 A blood smear from a dog illustrating key characteristics of regenerative anemia, including anisocytosis, polychromasia (arrow indicates polychromatophil) and a nucleated red cell (arrowhead).

Figure 65.2 A peripheral blood smear from a dog with non-regenerative IMHA with evidence of erythophagocytosis (arrow).

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Figure 66.1 Feline heinz bodies on a peripheral blood smear. 


Figure 66.2 Mycoplasma haemofelis on a peripheral blood smear. 


Figure 66.3 Babesia gibsoni, as visualized on a peripheral blood smear. 

Figure 66.4 Schistocytes on a canine peripheral blood smear. 


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Figure 68.1 A schematic representation of the fibrinolytic system and the sites of action of endogenous and exogenous inhibitors of the fibrinolytic pathway. Plasminogen binds to fibrin. Plasminogen activator catalyzes the transformation of plasminogen to plasmin. Plasmin cleaves the fibrin thrombus and this leads to the formation of fibrin degradation products and D-dimers. Plasmin is inhibited by alpha-2-antiplasmin. Plasminogen activator (PA) is inactivated by plasminogen activator inhibitor-1 (PAI-1). The lysine analogues epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) block the lysine binding sites for tPA on plasminogen, thus inhibiting plasmin generation.

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Figure 70.1 Basic principles of emergency management of acquired coagulopathy. aPTT, activated partial thromboplastin time; PCV, packed cell volume; PT, prothrombin time; tFAST, thoracic-focused assessment with sonography for trauma.

Figure 70.2 Algorithmic approach to patients with anticoagulant-associated coagulopathy. aPTT, activated partial thromboplastin time; BMBT, buccal mucosal bleeding time; LMWH, low molecular weight heparin; NOAC, novel oral anticoagulants; PT, prothrombin time; UFH, unfractionated heparin.

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Figure 75.1 Right lateral cervical and thoracic radiograph of a dog with an esophageal foreign body obstruction at the level of the heart base. The foreign body (a rawhide chew treat in this case) is represented by the soft tissue density containing irregular gas opacities (black arrows). The esophagus is dilated with gas cranial to the foreign body (white arrowheads). Source: Courtesy of Dr Jennifer Reetz, Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Figure 75.2 Endoscopic view of the cervical esophagus of a dog before (a) and after (b) removal of a bone esophageal foreign body. Extensive circumferential necrosis of the esophageal mucosa is present following removal. This dog went on to develop an esophageal stricture at the site of foreign body removal.

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Figure 76.1 A fecal smear at 1000× magnification showing many clostridial spores (black arrow).

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Figure 77.1 Hematemesis.

Figure 77.2 Hematochezia.

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Figure 79.1 A dog with hemorrhagic gastroenteritis.

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Figure 81.1 A right lateral radiographic projection of an obstructive duodenal foreign body with confirmatory sagittal ultrasound image of a thickened duodenum extending aboral into a hard shadowing partially obstructive duodenal foreign body.

Figure 81.2 A transverse image of a jejunal intussusception with central string foreign body. The central hard shadowing string has joined the intussusceptum (inner intestine), becoming telescoped into the intussuscipiens (outer intestine), resulting in intestinal obstruction.

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Figure 82.1 Trocarization for gastric decompression of a dog with gastric dilation-volvulus. An area over the region of tympany has been clipped and prepared in an aseptic manner and a 14 G catheter passed into the lumen of the stomach to allow expulsion of gas and fluid.

Figure 82.2 A right lateral radiograph of the cranial abdomen of a dog with gastric dilation-volvulus. This radiograph demonstrates the classic double-bubble or Popeye arm appearance of the gas-distended stomach. The pylorus is evident craniodorsal to the stomach, separated from the stomach by soft tissue. This abnormal positioning of the pylorus confirms the diagnosis of GDV.

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Figure 83.1 Intraoperative appearance of small intestines with ischemic necrosis.

Figure 83.2 Lateral abdominal radiographs of the patient in Figure 83.1 prior to surgery. Dilated intestinal loops and poor serosal detail are present. Image courtesy of Dr. Kenneth J. Drobatz.

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Figure 85.1 Ultrasound image of a splenic mass with multiple areas of cavitation. Reproduced with permission of Trisha Oura, DVM DACVR, Cummings School of Veterinary Medicine at Tufts University.

Figure 85.2 Necropsy image showing demarcation between areas of normal small intestine and ischemic intestine following the development of a portal system thrombus 24 hours after splenectomy in a dog.

Figure 85.3 Ultrasound image of the speckled starry sky appearance of the spleen in a dog with splenic torsion. 
Reproduced with permission of Trisha Oura, DVM DACVR, Cummings School of Veterinary Medicine at Tufts University.

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Figure 86.1 Abdominal ultrasonographic image of a dog with pancreatitis. The pancreas is hypoechoic to the surrounding hyperechoic peri-pancreatic fat. Reproduced with permission of Cathy Beck.

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Figure 88.1 A pit bull who was presented to the emergency service after being found dead after an ovariohysterectomy.

Figure 88.2 An ultrasound image of a hydronephrotic kidney that developed following inadvertent ligation of the ureter during a cystotomy.

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Figure 89.1 A 5-year-old female spayed whippet sustained penetrating trauma to the abdomen (ran onto a stick), resulting in a laceration to the common bile duct. Primary repair was attempted but was unsuccessful and the patient presented to the referral clinic with septic bile peritonitis. At that time, the patient was not stable enough for definitive biliary diversion so a temporary tube cholecystotomy was placed (locking loop catheter) and the abdomen was left open. Cholecystoduodenostomy was performed 48 hours later and the abdomen was closed. Source: Courtesy of Richard Coe.

Figure 89.2 A 3-year-old female spayed Labrador recovering from abdominal exploratory after being hit by a car 8 days earlier. Six days post trauma, she presented to an emergency clinic for vomiting, abdominal pain, and icterus and was diagnosed with septic bile peritonitis. An abdominal exploratory was performed, the ruptured gall bladder was removed, the abdomen lavaged, and multiple closed suction abdominal drains were placed for continued removal of abdominal fluid and contaminants and for postoperative peritoneal fluid evaluation. The patient made a complete recovery after being discharged 4 days after surgery.

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Figure 90.1 Normal liver – white arrow points to central vein or centrilobular area, black lined arrow points to portal tract (portal vein, hepatic artery, bile duct). Reproduced with permission of Bradley Turek.

Figure 90.2 (a,b) Same patient, different magnification. Acute hepatic necrosis showing centrilobular hepatocellular degeneration (white arrow). Thin black lined arrow shows portal tract. Reproduced with permission of Bradley Turek.

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Figure 91.1 A complication seen with esophagostomy tubes includes complete displacement of the tube following vomiting, in which the tube tip exits through the mouth. In these cases, the tube should be removed and a new tube placed. Simply flipping the tube back into the esophagus is not recommended as the stoma becomes contaminated with manipulation of the tube. A new stoma is required.

Figure 91.2 The tube stoma site should be checked every few days to ensure no infection is present. The picture shows purulent discharge from the stoma site of an esophagostomy tube. This tube should be removed and the wound area cleaned. If a feeding tube is still required, a different site should be used.

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Figure 92.1 Pneumoperitoneum from colonic perforation secondary to colonoscopy in a dog.

Figure 92.2 Rectal prolapse secondary to parasitism in a young dog. The rectal segment is healthy and does not require resection.

Figure 92.3 Colopexy performed to treat recurrent rectal prolapse in a dog. The colon is gently pulled cranially while the rectal prolapse is reduced by a non-sterile assistant. The descending colon is sutured to the left body wall.

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Figure 94.1 Image of a uremic oral ulcer (red arrow)