Zbornik Refera Zbornik Referatov Xxiii. Simpozij O

ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

1 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

2 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

SLOVENSKO ZDRU@ENJE VETERINARJEV ZA MALE @IVALI SLOVENIAN SMALL ANIMAL VETERINARY ASSOCIATION

ZBORNIK REFERATOV

XXIII. SIMPOZIJA O AKTUALNIH BOLEZNIH MALIH @IVALI

http://www.zdruzenje-szvmz.si/

3 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

VSEBINA

Hackett T: The critical cat – Triage, vascular access and emergency treament ...... 7 Hackett T: Feline shock – The unique challenges of treating cats ...... 11 Romagnoli S: Feline pediatrics ...... 13 Romagnoli S: Techniques for neonatal resuscitation and critical care ...... 18 Hackett T: Managing the dyspneic cat – Case studies in feline respiratory distress ...... 23 Hackett T: Feline trauma ...... 26 Romagnoli S: Practical use of hormones in feline reproduction ...... 29 Romagnoli S: Ovarian remnant syndrome in the queen: Clinical approach to a surgeon’s dilemma ...... 38 Domanjko Petri~ A: Sr~no popuš~anje pri ma~ki ...... 41 Knez V: Zgodnja sterilizacija in kastracija ma~k ...... 43 Kogovšek J: Kirurško zdravljenje zlomov stegnenice pri ma~kah ...... 46 Bourdeau P: Fungal diseases of the skin in cats ...... 49 Bourdeau P: Skin condition in cats: parasitic or not? ...... 56 Brlo`nik M, Zaninovi} P, Zdovc I: Pristop k diagnostiki bolezni spodnjih se~il pri ma~ki ...... 60 Rejec A, Jeraj M, Butinar J, Fidel JL: Pospešeni protokol obsevanja pri zdravljenju ploš~atoceli~nega karcinoma smr~ka in ustne votline pri ma~kah ...... 61 Firm I, Rejec A, Butinar J: Sindrom »okna na kip« in akutne ledvi~ne odpovedi pri doma~i ma~ki ...... 62 Pogorevc E, Celinšek B: Diagnostika pankreatitisa pri ma~kah ...... 63 Zajc R: Dihalna stiska pri ma~ki – stabilizacija, diagnostika in pogosti vzroki ...... 65 Porenta K: Rehabilitacija in fizioterapija psa po operaciji kolka – klini~ni primeri ...... 67 Firm I: Osnove EKG za tehnike ...... 69 Lukanc B: Pooperacijska oskrba ma~ke ...... 71 Seliškar A: Ma~ka in analgetiki ...... 74 Celinšek B: Odvzem biološkega materiala pri ma~ki ...... 78 Nemec Svete A, Tozon N: Ravnanje z vzorci za izvajanje testov za ugotavljanje ku`nih bolezni ma~k ...... 80 Knez V: Krvne skupine ma~k ...... 84 Pavlin D: Rokovanje s katetri in sondami ...... 87 Erjavec V: Razlika med ma~jo in pasjo ustno votlino ...... 89 Suhadolc Scholten S: Majhne skrivnosti za boljše po~utje ma~k ...... 93 Izdalo: Krofi~ M, Mlakar N, Tomsi~ K, Pavlica Z, Seliškar A, Tozon N: Celostna obravnava Slovensko zdruènje geriatri~nega stomatološkega pacienta – klini~ni primer ...... 94 veterinarjev za male ìvali Nemec Svete A, Lukanc B, Tomsi~ K, Seliškar A: Kvantitativno dolo~anje Fotografija: koncentracije CRP pri psih z uporabo nove imunokemijske metode ...... 97 Arhiva Term Krka Ravnik U, Suhadolc Scholten S, Tozon N: Hemobartoneloza pri ma~ki – klini~ni primer ...... 100 Oblikovanje: Plavec T: Hiperaldosteronizem pri ma~kah – pogostejši kot si mislimo? ...... 102 AKTA DESIGN www.akta-sp.si Marhold C, Slavec B, Ra~nik J, Zadravec M, ôn~ M, Dov~ A: Diagnostika klamidijskih oku`b pri ma~kah ...... 104 Naklada: 250 izvodov Oman M, Dov~ A, Kvapil P, Kastelic M, Miheli~ B: Zdravstvena problematika zapuš~enih ma~k v mestni ob~ini Ljubljana...... 106

4 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

UPRAVNI ODBOR SLOVENSKEGA ZDRU@ENJA VETERINARJEV ZA MALE @IVALI SZVM@ ORGANIZACIJSKI IN UREDNI[KI ODBOR

Doc. dr. Alenka SELIŠKAR, dr. vet. med. (predsednica), Ljubljana Prof. dr. Nata{a TOZON, dr.vet. med. (podpredsednica – bodo~a predsednica), Ljubljana Igor FIRM, dr. vet. med. (blagajnik), Mozirje Sara SUHADOLC SCHOLTEN, dr. vet. med. (tajnica), Ljubljana Mag. Jure PIPP, dr. vet. med. (~lan), Ljubljana Mag. Iztok VALENTIN^I^, dr. vet. med. (~lan), Maribor

^ASTNA ^LANA ZDRU@ENJA:

Prof. dr. Vjekoslav SIM^I^, dr. vet. med., Ljubljana, Slovenija in Prof. dr. Jones R. BOYD, Dublin, Irska.

WORLD SMALL ANIMAL VETERINARY ASSOCIATION - WSAVA OFFICERS President: Dr. David WADSWORTH ( U.K. ) President elect: Dr. Jolle KIRPENSTEIJN ( The Netherlands ) Secretary: Dr. Walt INGWERSEN ( Canada ) Vice president: Dr. Peter J. Ihrke ( USA ) Treasurer: Dr. Diane SHEEHAN ( Australia ) Immediate past president: Dr. Brian ROMBERG ( South Africa )

FEDERATION OF EUROPEAN COMPANION ANIMAL VETERINARY ASSOCIATIONS - FECAVA OFFICERS President: Dr. Johan Van TILBURG ( Belgium ) Vice president: Dr. Simon ORR ( U.K. ) Past president: Dr. Andrew BYRNE ( Ireland ) Secretary: Dr. Monique MEGENS ( The Netherlands ) Treasurer: Dr. Jerzy GAWOR ( Poland ) EJCAP Editor: Dr. Keith A. DAVIS ( U.K. )

5 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Generalni pokrovitelj:

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Simpozij so omogo~ili še:

ABBOTT LABORATORIES D.O.O., PODRU@NICA LJUBLJANA, Dunajska 22, 1000 Ljubljana

BTL MARKETING D.O.O., Zalo`nikova ulica 43, 1351 Brezovica pri Ljubljani

DIPROS D.O.O., Gorenjesavska cesta 54, 4000 Kranj

FECAVA - THE FEDERATION OF EUROPEAN VETERINARY COMPANION ANIMAL ASSOCIATIONS

INTERVET INTERNATIONAL B.V., BOXMEER podru`nica Ljubljana, Kri`na ulica 10, 1000 Ljubljana

IRIS MEDNARODNA TRGOVINA D.O.O., Cesta v gorice 8, 1000 Ljubljana

KEMOFARMACIJA VELETRGOVINA ZA OSKRBO ZDRAVSTVA D.D., Cesta na Brdo 100, 1000 Ljubljana

KRKA, TOVARNA ZDRAVIL D.D., Šmarješka cesta 6, 8501 Novo mesto

MM SURGICAL DRU@BA ZA TRGOVINO IN ZASTOPANJE D.O.O., Galjevica 81, 1000 Ljubljana

NOVARTIS VETERINA D.O.O., Verovškova 57A, 1000 Ljubljana

SALUS d.d., Mašera Spasi}eva ulica 10, 1000 Ljubljana

SCHERING - PLOUGH CENTRAL EAST AG LUZERN, ŠVICA PREDSTAVNIŠTVO V SLOVENIJI, Dunajska 22, 1000 Ljubljana

SANOLABOR D.D., Leskoškova cesta 4, 1000 Ljubljana

TOSAMA TOVARNA SANITETNEGA MATERIALA D.D., Šaranovi~eva cesta 35, 1230 Dom`ale

UNIVERZA V LJUBLJANI VETERINARSKA FAKULTETA, Gerbi~eva 60, 1000 Ljubljana

VETCONSULT PHARMA TRGOVINA IN MARKETING D.O.O., Gerbi~eva 50, 1000 Ljubljana

VET PET TRGOVINA D.O.O., Letališka 29, 1000 Ljubljana

VETERINA PLUS D.O.O., Dunajska 51, 1000 Ljubljana

VETPROMET, ZASTOPANJE D.O.O., Cesta na Brdo 100, 1000 Ljubljana

ZOO MARKET PREIS MARKETING, TEHNOLOGIJA IN IN@ENIRING D.O.O., Eipprova 3, 1000 Ljubljana

6 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

XXIII. SIMPOZIJ SOBOTA, 24. april 2010, velika dvorana KKC Moderator: Kogovšek J 09.00 – 09.30 Domanjko Petri~ A: Sr~no popuš~anje pri ma~ki O AKTUALNIH BOLEZNIH 09.30 – 10.00 Knez V: Zgodnja sterilizacija in kastracija ma~k 10.00 – 10.30 Kogovšek J: Kirurško zdravljenje zlomov MALIH @IVALI stegnenice pri ma~kah rogram 10.30 – 11.00 ODMOR Moderator: Kotnik T 11.00 – 11.45 Bourdeau P: Fungal diseases of the skin in cats 11.45 – 12.30 Bourdeau P: Skin condition in cats: ÊTRTEK, 22. april 2010, velika dvorana KKC parasitic or not? PREDKONGRESNI DAN - DERMATOLOGIJA 12.30 – 14.00 KOSILO (dermatološke parazitoze) Moderator: Valentin~i~ I 08.00 – 09.00 PRIJAVA UDELE@ENCEV 14.00 – 14.15 Brlo`nik M, Zaninovi} P, Zdovc I: Pristop k 09.00 – 09.15 Kotnik T: Otvoritev diagnostiki bolezni spodnjih se~il pri ma~ki 09.15 – 10.00 Bordeau P: Differential diagnosis of the 14.15 – 14.30 Rejec A, Jeraj M, Butinar J, Fidel JL: Pospešeni alopecic dog protokol obsevanja pri zdravljenju 10.00 – 10.30 Bourdeau P: New aspects in canine ploš~atoceli~nega karcinoma smr~ka in ustne leishmaniosis votline pri ma~kah 10.30 – 11.15 ODMOR 14.30 – 14.45 Firm I, Rejec A, Butinar J: Sindrom »okna na 11.15 – 12.00 Predstavitev klini~nih primerov kip« in akutne ledvi~ne odpovedi pri doma~i ma~ki 12.00 – 12.30 Skupš~ina Dermatološke sekcije 14.45 – 15.00 Pogorevc E, Celinšek B: Diagnostika 12.30 – 14.00 KOSILO pankreatitisa pri ma~kah 14.00 – 14.15 Pipp J: Pozdravne besede 15.00 – 15.15 Zajc R: Dihalna stiska pri ma~ki – stabilizacija, 14.15 – 15.00 Convert G: Cat scratch disease, a diagnostika in pogosti vzroki dermatological issue? 15.15 – 15.30 Porenta K: Rehabilitacija in fizioterapija psa po 15.00 – 15.45 Bourdeau P: The variety of skin operaciji kolka – klini~ni primeri conditions due to mites (and ticks) in dogs 15.30 ZAKLJUÊK SIMPOZIJA 15.45 – 16.15 ODMOR 16.15 – 17.00 Bourdeau P: Dermatoses due to fleas or other SOBOTA, 24. april 2010, mala dvorana KKC insects: A challenge for the clinician PROGRAM ZA VETERINARSKE TEHNIKE 17.00 – 17.45 Bourdeau P: Internal parasites in dogs: How to control them? - some key points from 08.00 - 09.00 PRIJAVA UDELE@ENCEV Dirofilaria to Leishmania Moderator: Seliškar A 17.45 – 18.30 Razprava 09.00 – 09.30 Firm I: Osnove EKG za tehnike 20.00 VEÊRJA (Merial) 09.30 – 10.00 Lukanc B: Pooperacijska oskrba ma~ke 10.00 – 10.30 Seliškar A: Ma~ka in analgetiki PETEK, 23. april 2010, velika dvorana KKC 10.30 – 11.00 ODMOR 08.00 – 09.00 PRIJAVA UDELE@ENCEV Moderator: Knez V 09.00 OTVORITEV SIMPOZIJA 11.00 – 11.30 Celinšek B: Odvzem biološkega materiala pri ma~ki Moderator: Seliškar A 11.30 – 12.00 Nemec Svete A, Tozon N: Ravnanje z vzorci za 09.00 – 09.45 Hackett T: The critical cat – Triage, vascular izvajanje testov za ugotavljanje ku`nih bolezni access and emergency treament ma~k 09.45 – 10.30 Hackett T: Feline shock – The unique 12.00 – 12.30 Knez V: Krvne skupine ma~k challenges of treating cats 12.30 – 14.00 KOSILO 10.30 – 11.00 ODMOR Moderator: Pavlin D Moderator: Tozon N 14.00 – 14.30 Pavlin D: Rokovanje s katetri in sondami 11.00 – 11.45 Romagnoli S: Feline pediatrics 14.30 – 15.00 Erjavec V: Razlika med ma~jo in pasjo ustno 11.45 – 12.30 Romagnoli S: Techniques for neonatal votlino resuscitation and critical care 15.00 – 15.30 Suhadolc Scholten S: Majhne skrivnosti za boljše 12.30 – 14.00 KOSILO po~utje ma~k Moderator: Pipp J 15.30 ZAKLJUÊK SIMPOZIJA 14.00 – 14.45 Hackett T: Managing the dyspneic cat – Case studies in feline respiratory distress POSTERJI 14.45 – 15.30 Hackett T: Feline trauma Krofi~ M, Mlakar N, Tomsi~ K, Pavlica Z, Seliškar A, Tozon N: Celostna obravnava geriatri~nega 15.30 – 16.00 ODMOR stomatološkega pacienta – klini~ni primer Moderator: Knez V Nemec Svete A, Lukanc B, Tomsi~ K, Seliškar A: Kvantitativno dolo~anje koncentracije CRP pri psih z uporabo nove imunokemijske metode 16.00 – 16.45 Romagnoli S: Practical use of hormones in feline reproduction Ravnik U, Suhadolc Scholten S, Tozon N: Hemobartoneloza pri ma~ki – klini~ni primer 16.45 – 17.30 Romagnoli S: Ovarian remnant syndrome in the Plavec T: Hiperaldosteronizem pri ma~kah – pogostejši kot si mislimo? queen: Clinical approach to a surgeon’s dilemma Marhold C, Slavec B, Ra~nik J, Zadravec M, ôn~ M, Dov~ A: Diagnostika klamidijskih oku`b pri 17.30 – 19.00 SKUPŠÎNA SZVM@ ma~kah 20.00 VEÊRJA (Pfizer) Oman M, Dov~ A, Kvapil P, Kastelic M, Miheli~ B: Zdravstvena problematika zapuš~enih ma~k v mestni ob~ini Ljubljana

7 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

8 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

The Critical Cat Triage, Vascular Access and Emergency Treatment

Tim Hackett

Triage Disability--Is there evidence of neurological injury? Sei zures? Subcutaneous emphysema over nasal sinus Veterinarians must understand the unique problems es? Broken teach? What is the posture of the animal? related to feline size and physiology that require special Is the animal bright, alert and responsive? Does the attention in emergencies. With a basic understanding of animal respond to painful stimuli? Are the pupils di feline emergency medicine these small patients that can lated, constricted, of equal size, and responsive to be managed in most veterinary hospitals. light? Is there an extremity fracture that might threaten Each new patient should be evaluated in an orderly a peripheral nerve? and systematic manner. Problems that interfere with vital physiological functions should receive the highest priority. These are generally disorders of the respiratory sys- Management of the life-threatening problems identi- tem, cardiovascular system, or neurological system. fied during the primary survey is continued as shock therapy begins. The secondary survey identifies all other problems related to the trauma. The entire animal's body is Initial Assessment examined again from head to toe. Necessary diagnostic Do an initial assessment of the critical feline to identi- samples are collected and submitted. Only when the pa- fy life-threatening physiological problems. Whenever a tient is stable are indicated radiographs taken. In-depth problem is identified immediate therapy is begun. This management of the patient's less life-threatening prob- "primary survey” follows the ABC (and D's) of triage and lems is undertaken in the definitive care phase. resuscitation: Cardiovascular System Airway--Is the cat having difficulty moving air? Is External blood loss is and a venous catheter is insert- there an airway obstruction? This can create a high- ed. Blood samples are collected for analysis of the packed pitched sound heard best over the obstruction. cell volume and serum total solids. The remainder of the Breathing--Is the cat dyspneic? What is the color of sample can be saved for a complete blood count and the mucous membranes? Pulmonary contusions, pneu biochemical analysis. The initial intravenous solution can monia, pulmonary edema, pneumothorax, diaphrag be any crystalloid fluid, such as normal saline, Hartmann's matic hernia, and broken ribs can all result in a rapid, lactate, or Normosol-R. Crystalloid fluids should be ti- shallow (restrictive) breathing pattern. trated to each patient. Cats are extremely sensitive to Circulation--Is there evidence of hemorrhage, fluid loss overhydration and aggressive fluids can easily create more or heart disease? Are the mucous membranes pale problems with pulmonary edema. Our technique is to and dry? Are the femoral pulses weak and rapid? administer one fourth of a shock volume (Shock volume Are the extremities cold? Is the abdomen distended? in cats is 45 ml/kg of crystalloid fluid) in the first 10 minutes. We give the dose in 10 ml/kg test doses to avoid iatrogenic fluid overload. Most case that are volume de- pleted will show improvement with only modest frac- tions of the total shock volume. Titration cannot be over- Tim Hackett D.V.M., M.S. emphasized. Serious problems can develop if too much Diplomate, American College of Veterinary Emergency & Critical Care fluid is given to quickly. Associate Professor and Small Animal Medical Chief of Staff After the initial bolus, we assess for evidence of shock James L. Voss Veterinary Medical Center (rapid heart rate, tachopnoea, weak pulses, cool extrem- Colorado State University ities, slow capillary refill time), and then give another Fort Collins, CO 80523 quarter shock volume over the next 20 minutes. At thir- [email protected]

9 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 ty minutes the patient is again assessed and a packed cell Other variables include fluid balance (body weight, cen- volume and total solids is evaluated. Packed cell volume tral venous pressure), serum electrolytes, urine produc- and total solids are rechecked thirty minutes after be- tion, coagulation function and patient comfort. ginning fluid therapy. If the packed cell volume drops below 25 to 30% and the patient is still showing signs of Fluid Balance. Because of increased capillary perme- shock, whole blood is given. If the serum total solids ability and decreased systemic vascular resistance, criti- drops below 45 gm/L a colloid should be used to main- cally ill cats can experience large fluid movement from tain intravascular volume. We tend to use hydroxyethyl the vasculature into the tissues. Crystalloid fluids can lower starch at doses of 5-10 ml/kg. Colloids like crystalloids protein levels causing a drop in the oncotic pressure. can cause volume overload. Take care when giving these With increased vascular permeability and abnormal dis- fluids quickly. tribution this may cause interstitial edema. If fluid accumulates in the lungs, gas exchange is impaired and oxy- Respiratory system gen delivery reduced. Cerebral edema will cause progres- Respiratory distress in cats is a therapeutic dilemma. sive changes in mentation. Frequent checks of the body Critical cats can be so compromised that diagnostics and weight, central venous pressure, mentation and urine treatment can cause respiratory and cardiac arrest. A di- production are vital. Respiratory rate and thoracic aus- agnosis should not come at the expense of the patient. cultation should be repeated listening for changes asso- An induction chamber for cats works well to give the cat ciated with pulmonary edema. Excessive fluid losses (vom- added oxygen while observing them in an attempt to lo- iting, diarrhea, polyuria) should be measured or estimat- calize the respiratory problem. Try to determine the na- ed and replaced with crystalloid fluids as they occur. ture of the problem first with observation. A rapid shallow respiratory pattern suggests restrictive disease while a slow deep inspiratory pattern is seen with airway ob- Vascular Access for the Critical Cat struction. With the restrictive pattern, auscultation can help differentiate pleural space disease (pneumothorax, hydrothorax) from parenchymal diseases (pneumonia, Since fluid therapy requires close attention to prevent pulmonary edema). overhydration, variables like packed cell volume, total Cats will become more and more distressed as they strug- protein, glucose, and electrolytes should be checked sev- gle for oxygen. A stressed animal will need more oxygen eral times a day. For this reason it is important to have so the problem can get worse. Mild sedation with very reliable vascular access. This is best accomplished with a low doses of a diazepam or a narcotic can allow the anx- jugular, or medial saphenous central intravenous. ious dyspneic cat to relax and breathe more efficiently. Veterinarians and veterinary technicians that can reli- Restraint for catheterization, radiographs and physical ably gain vascular access in the sickest cats are valuable examination should wait until the patient is relaxed and members of the patient care team. Often, the patients breathing easier. In the case of pleural effusion or pneu- most in need of vascular access are the hardest to cath- mothorax, a thoracocentesis can provide a diagnosis at eterize. the same time it is providing the life-saving treatment. Catheterization Basics Secondary Survey and Hospitalization Intravenous catheters are invasive devices and their Cats dealing with critical illness develop a variety of pre- use must be managed with potential complications in mind. dictable complications. These patients are at risk of or- Direct access can also allow infectious agents a means of gan failure. Hypothermia, acute respiratory distress (pul- bypassing defenses to colonize the host. These “foreign” monary edema), sepsis, disseminated intravascular co- materials can also cause a variety of inflammatory com- agulation, renal failure and liver disease are just some of plications from mild vasculitis to serious thrombosis and the problems seen regularly in our feline critical care prac- vascular occlusion. tice. By anticipating multiple organ dysfunction, moni- A surgical preparation of the skin over the catheter toring critical hemodynamic and respiratory variables and site, and sterile handling of catheter and connection tub- treating abnormalities that are identified, these patients ing will minimize infectious complications. Hair should may be supported throughout hospitalization. be clipped within 2 to 4 cm of the site. The area should Intensive, serial monitoring is the core of critical care then be cleaned and disinfected with antiseptic surgical medicine. Readily obtainable physiologic variables are used scrub for 3 minutes. While it is not necessary to wear for screening, early warning and hopefully, early correc- sterile gloves when placing intravenous catheters, the tion of life threatening problems. Packed cell volume, to- person handling the catheter should have clean hands. tal protein, oxygenation parameters (mucous membrane We recommend wearing disposable vinyl or latex gloves color, oxygen saturation) have already been discussed.

10 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 when scrubbing the skin, then drying or changing the travascular catheters, this procedure is easily mastered gloves when handling catheters and tubing. using fresh cadavers. People anticipating a need for this After the catheter is in place, the site should be cov- skill would be wise to learn it before they need it. Unfor- ered with a clean dressing. The catheter needs to be held tunately this route can only be used for giving fluids, not securely, however think about how you will remove or for drawing blood. change connections when you are applying the bandage. Incorporating “T-port” connectors in the final bandage will take the strain of movement off the catheter. These Hematologic and Physiologic Variables to connections are also easily replaced without having to replace the entire dressing. Monitor and Address in Critical Cats Catheters and the local site should be checked every 24 to 48 hours. The bandage should be removed, and Oncotic pressure. Serum albumin when low should the vessel palpated. The catheter should be removed and be addressed with appropriate nutrition and colloidal flu- a new one placed in another site if there is any evidence ids (blood or hetastarch). Total solids should be moni- of inflammation or thrombosis. tored and kept above 35 g/L. Persistent hypoalbumine- mia is associated with increased mortality in critically ill Central intravenous catheterization animals. A large-bore, teflon, jugular venous catheter can be maintained for days. Incorporated into a bandage around Electrolytes and glucose. Calcium, sodium, chloride the cat's neck, these catheters tend to stay dryer, cleaner and potassium should be maintained within normal lim- and can remain in longer than peripheral catheters. Cen- its. Potassium should be added to maintenance fluids to tral venous catheters are useful in obtaining a central avoid iatrogenic hypokalemia. Potassium containing flu- venous pressure (CVP). The CVP provides important in- ids should never exceed a rate of 0.5 mEq/kg body weight/ formation about fluid loading and the hearts ability to hour of additional potassium. Blood glucose should be pump the fluids forward. Large central catheters can also maintained between 100 and 200 gm/dL (5.5 11 mmol/ be useful for repeated blood sampling. By drawing 3 cc L). Hypokalemia that does not rapidly correct with high of blood back into a syringe pre-loaded with 0.5 cc-hep- levels of supplemental potassium may respond to mag- arinized saline (1 U heparin/ml 0.9% saline flush), any nesium supplementation. Hypomagnesemia is common volume of blood can then be sampled. The heparinized in the critically people and animals. Unfortunately, serum blood can then be returned to the patient and the line magnesium represents only a small fraction of whole body flushed. This “Three-syringe” technique will minimize magnesium and is not a reliable measure. Magnesium patient discomfort and iatrogenic blood loss. can be replaced at 0.75 - 1 mEq/kg/day by constant rate infusion in 5% dextrose in water. After 24 hours the dose Central venous catheters should be avoided in patients is lowered to 0.3 to 0.5 mEq/kg/day or the animal can be with bleeding disorders, seizures or hypercoagulable states switched to a magnesium containing maintenance crys- (hemolytic anemia, hyperadrenocorticism, DIC, protein talloid fluid. losing nephropathy).

Intraosseous catheterization Urine production. Urine output and urine specific gravity tells us about renal blood flow and function. Recum- The smallest and sickest cats are often the most diffi- bent and azotemic patients, and those at risk for multiple cult to catheterize although they may be the most in need organ dysfunction should have an indwelling urinary cath- of intravenous fluid therapy. Rather than struggle with a eter in place with a sterile closed collection system. Low small, peripheral catheter, or the trauma of a vascular urine output (< 1 ml/kg/hour) in a hydrated patient may cut-down procedure, an intraosseous catheter can pro- represent acute renal failure. A low urine output with vide short-term access. Placed in the medullary cavity of elevated urine specific gravity is an indication of inade- any long bone, the intraosseous space rapidly absorbs quate fluid intake (IV fluids or drinking). Quick interven- crystalloid fluids, colloids and drugs. Any needle with a tion with fluids, and diuretics (furosemide 1-2 mg/kg) stylet can be used. We will usually use an 18-gauge bone may start urine flow and prevent permanent renal dam- marrow needle or a 20 to 22-gauge 1” spinal needle. The age. It is important to withhold furosemide until dehy- needle is usually placed in medullary space of the femur dration is corrected. Patients that are hypotensive follow- in cats. ing fluids may benefit from a positive inotrope like dob- Intraosseous catheterization is a worthwhile skill for utamine to offset any drops in cardiac output as a result feline emergency and critical care practitioners. The in- of furosemide. traosseous space is always available regardless of the degree of hypovolemia or dehydration. Unlike other in-

11 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Coagulation. Disseminated intravascular coagulation (DIC) is a common component of systemic illness. Daily examination of a blood smear for decreased platelets and fragmented red blood cells is inexpensive and easy. Tests of factor function (prothrombin time) should be considered if bleeding is occurring with normal platelet numbers. The most important treatment for DIC is to remove/resolve the underlying cause. Specific therapy is directed toward decreasing microthrombi (heparin), providing missing factors (fresh frozen plasma) and improving perfusion (fluid/colloid support).

Pain control. Cats in constant stress will become immunosuppressed. It is vital to the care of the patient that it be made as comfortable as hospitalization will allow. The appropriate use of analgesics, padding, bandage changes and personal contact will have positive effects on the patients overall sense of well-being.

Physiologic Variable Optimal Values Intervention

Systemic arterial pressure >90 mmHg Fluids, inotropes Central venous pressure <3 cmH20 (5-10 cm H2O if loading) Diuretics, venodilators Urine output >1 ml/lb/hr Diuretics, dopamine Blood Glucose >3.9 mmol/L Nutrition, dextrose Packed Cell Volume 25-35% Transfusion Total Serum Solids >35 g/L, < 50 g/L Plasma, colloids Albumin >10 g/L Plasma Arterial blood gasses PaO2 > 70 mmHg Supplemental oxygen Sa02 > 92% Supplemental oxygen PaCO2 < 35 mmHg Ventilatory support HCO3 > 14, < 24 Fluids, perfusion pH > 7.3, < 7. 5 Fluids, perfusion Heart rate >70, <150 BPM Fluids, analgesics, anti-arrhythmics Prothrombin time Normal range varies with equipment Blood, plasma, heparin

12 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Feline Shock The unique challenges of treating cats

Tim Hackett

Introduction Baseline information Shock, in it's most basic form, is an inadequate deliv- When deciding on rates, volumes, and types of fluids ery of oxygen. If we look at oxygen delivery as an equa- for our sick feline patients, it is especially important to tion we can address all the variables involved can correct know about the electrolytes, and the cat's normal body those we can. weight. If there are acute decreases in body weight, most of these losses can be attributed to water loss. This will allow a more accurate assessment of dehydration. If ide- DO ml/min (oxygen delivery) = CaO2 (oxygen 2 al weight is not known and the animal is clinically dehy- content) x CO (cardiac output) drated (poor skin turgor, dry mucous membranes, sunken eyes) the degree of dehydration can be estimated at CO = Heart rate x Stroke volume approximately 10%. A thorough physical examination should be performed; assuming fluid losses are not life threatening. If howev- CaO2 = SaO2 (Oxygen saturation) x Hgb (hemoglobin er, your quick assessment suggests life-threatening com- concentration) x 1.34 + (PaO x 0.003) 2 plications (abnormal mucous membrane color, abnormal capillary refill times, tachycardia, tachopnoea, weak pulse, Circulatory shock is divided into 3 major classifica- cool extremities, obvious blood loss, etc.), then your first tions; hypovolemic shock, cardiogenic shock or pump goal of fluid therapy will be to save the life of the animal failure, and distributive shock. Though the mechanisms and your thorough physical examination will have to be for each are distinctly different, each results in reduced postponed and fluid therapy to stabilize the patient's con- oxygen delivery (DO2) to tissues through low blood flow dition must be started first. or uneven distribution of flow. In actual feline practice Third-space losses involve the accumulation of large we usually deal with issues of blood volume and poor fluid volumes in cavities such as the pleural or peritoneal cardiopulmonary function. A single patient may have sev- space and intestinal or gastric lumen, or in tissues around eral pathologic processes simultaneously resulting in re- fracture or trauma sites. These losses result relative hy- duced perfusion of tissues. povolemia without predictable changes in body weight. Cats are notoriously bad at shock. Instead of com- Mucous membranes are good indicators of hydration. pensating for low volume with a faster heart rate, the cat Color and refill time, as well as moistness, should be in shock is often bradycardic. Cats also have issues with assessed. The color of the mucous membranes will vary cardiopulmonary function leading to problems handling considerably. A septic patient often has red, injected, shock rates of fluids. Close attention is required to pre- mucous membranes, while a severely hypovolemic pa- vent iatrogenic pulmonary edema when giving large vol- tient may have pale to gray mucous membranes. Be- umes of fluid to feline patients. cause many factors will govern the color of mucous membranes, this feature alone cannot be used to assess hydration.

Tim Hackett D.V.M., M.S. Decreased skin turgor, sunken eyes, dry mucous mem- Diplomate, American College of Veterinary Emergency & Critical Care branes are other subjective observations that suggest clin- Associate Professor and Small Animal Medical Chief of Staff ical dehydration. James L. Voss Veterinary Medical Center Colorado State University Fort Collins, CO 80523 [email protected]

13 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

The Emergency Phase The Replacement Phase When a patient is excessively hypotensive and has clin- The volume of fluid administered during the rehydra- ical signs of shock, the blood volume must first be re- tion/replacement phase is based on an assessment of fluid stored. If there are no clinical signs of shock, one can needs for (1) returning the patient's status to normal (def- proceed to the second phase of fluid replacement. icit volume), (2) replacing normal ongoing losses (main- The volume of fluid required is based on the patient's tenance volume), and (3) replacing continuing abnormal weight, but you should be prepared to administer a plas- losses (continuing losses volume). ma volume each hour if crystalloid solutions are being Maintenance volumes are normal ongoing losses. used. In the cat this is 45-50 ml/Kg/hr. Ongoing losses are divided into sensible and insensible By dividing the total fluid volume into 1/8-1/4 test losses. Sensible losses can be measured and are water doses and titrating to effect (frequently monitoring of end- losses in the urine and feces. Insensible losses are nor- point variables), one may determine when it is appropri- mal but are not easily quantitated. These water losses ate to move to the second phase of fluid resuscitation occur with metabolism, and from the respiratory tract. (rehydration phase). If the clinical signs of shock resolve One-third of the maintenance volume is made up of the after the first bolus, there is no need to proceed with insensible volumes and two-thirds, sensible volumes. another bolus of fluid. Move on to the rehydration phase. Traditionally, maintenance volumes have been estimated at about 66 ml/kg/day. One must be cautious about overhydration and hemodilution. Overhydration during the emergency phase is most likely to occur when large volumes are adminis- The Maintenance Phase tered to cats with pulmonary contusions, preexisting The last phase of fluid therapy is the maintenance pulmonary edema, aspiration pneumonitis, hypoproteine- phase. At this point the patient has received enough mia, brain injuries, and underlying heart disease. fluid to compensate for shock (if necessary) and has had a partial replacement of any deficit volume. Chronologi- Hypovolemic Shock cally, this phase begins no sooner than 24 hours after fluids were begun. Objective signals that the patient is The primary defect in hypovolemic shock is an inade- ready to be placed in the maintenance phase are an ab- quate circulating volume. This can be from sudden mas- sence of clinical signs of shock or dehydration, and the sive blood loss as in surgery or trauma or fluid loss from body weight will have increased by at least the percent- vomiting, diarrhea or renal disease. Because cardiac out- age of dehydration already corrected. During the mainte- put relies on stroke volume and heart rate, the patient nance phase, you will be providing both maintenance with inadequate volume will be tachycardic in an attempt volumes and continuing losses volumes. to compensate. Neurohormonal pathways detecting a drop in blood pressure will lead to increased vascular Oxygen delivery to the tissues is one of the primary tone in an attempt to shunt circulation from the periph- functions of the cardiopulmonary system and of primary ery to vital tissue beds. This results in cool extremities, importance to the patient manifesting signs of circulato- tachycardia, prolonged capillary refill, oliguria and weak- ry failure. If the defect in the transport of oxygen to the ness. vital tissues can be identified and removed while the patient is supported, recovery is possible. Treatment should be directed at the primary source of fluid loss while correcting the fluid deficit. Crystalloid fluids can be used initially to restore circulating volume. Crystalloids will improve cardiac output and should not be withheld for fear of diluting the red blood cell mass. Oxygen delivery is a function not only of oxygen content but of cardiac output as well. With a treatment goal of improving oxygen delivery to the tissues we can increase cardiac output by increasing stroke volume (fluids). Oxygen content can be increased by increasing the hemoglobin concentration (Red cell transfusion) and increasing oxygen saturation (Oxygen supplementation).

14 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Feline pediatrics

Stefano Romagnoli

The success of neonatal care depends on normality of newborns that die within 12 weeks of age. Kitten losses pregnancy as well as parturition, as abnormal pregnancy up to 12 months of age are due to problems acquired in and/or dystocia may easily predispose neonates to devel- utero, at birth (birth to 2 weeks) or around weaning time op pathological conditions or transient hypoxia which may (5 to 12 weeks of age). Neonatal kittens may die sudden- threaten their survival during the first few hours/days of ly or “fade” within a few days. Unfortunately, the clinical life. Sadly, it is inevitable that some kittens will die, and a signs of many neonatal diseases are very similar and vague. low level of loss is to be expected, even in the best run While normal kittens tend to cuddle together and sleep breeding cattery. It is generally found that pedigree cats contentedly between feeds, sick kittens tend to lie sepa- have higher levels of neonatal mortality than non-pedi- rately, are generally more restless, are not keen to suck- gree. In one study, pedigree cats had an average kitten le, and cry frequently (if still strong enough to do so). mortality of 34.5% from birth to one year of age (range of 8-40%), compared to 10-17% in non-pedigree cats. Neonates are vulnerable because their thermoregulatory These higher levels of mortality may reflect inbreeding mechanisms are poorly developed, they are at increased within pedigree cats. However, there may also be bias in risk of dehydration and hypoglycaemia, and they are im- the non-pedigree data as it is difficult to get accurate munologically immature. Therefore, regardless of the figures for pet cats. initiating cause, neonates rapidly become hypothermic, Normal kittens eat or sleep 90% of the time for their first hypoglycaemic, dehydrated, hypoxic, and die. They are 2 weeks. Unfortunately, neonates tend to show limited predisposed to hypothermia because they cannot ther- responses to disease, so their presenting signs are rarely moregulate, lack insulating fat and thermogenic brown, indicative of a particular condition. Regardless of wheth- cannot induce peripheral vasoconstriction, cannot react er they are hungry or ill they typically cry excessively, to cold by shivering, and have a large surface area to and/or fail to suckle. The most common signs of illness volume ratio over which to loose body heat. Hypother- are weakness, hypothermia, lethargy, restlessness, and/ mia then triggers ileus and reduced intestinal absorption, or regurgitation of milk. Sick kittens respond poorly to increases susceptibility to infection, and eventually leads their environment, and typically have either very thin ab- to cardiopulmonary failure. Neonates are predisposed to domens from lack of food or very swollen abdomens hypoglycaemia because they have high energy require- from swallowing air. They often lay separated from the ments (2-3x the metabolic rate of adults/kg body weight), other kittens and are ignored by the queen. Sick kittens but have no energy reserves and their immature livers need to be treated immediately as they cope very poorly are inefficient at generating energy. This can then be ex- with anorexia or hypothermia. acerbated by hypothermia-induced reduction of intesti- Approximately 15-40% of kittens die between birth and nal absorption. The neonatal risk of dehydration is be- 3 months of life, with the majority of these losses occur- cause they have a higher percentage of body water (82%) ring at birth or within 4-5 weeks of age. Deaths occur- than adults, while incurring greater loses through their ring at birth or within the first 2 weeks in otherwise nor- immature kidneys, lungs and skin. The most important mal neonates are generally referred to as “fading syn- causes of “fading” or sick kittens are 1) birth/queen-re- drome”. The 2-week distinction is rather arbitrary, and lated factors, 2) Congenital abnormalities; 3) Low birth most clinicians will consider as fading kittens all those weight; 4) Inappropriate environment; 5) Inappropriate nutrition; 6) Neonatal isoerythrolysis; 7) Infection. Stefano Romagnoli, DVM, MS, PhD, Dipl. ECAR President, European Board of Veterinary Specialisation 1) Birth / queen-related factors - Kittens that suffer dys- Dept. of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Agripolis, Legnaro, 35020 (PD) tocia have a significantly increased risk of death within University of Padova, Italy the first few weeks of life. In fact, prolonged labour or [email protected] dystocia are probably the most significant causes of neo-

15 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 natal death. This results from the effects of hypoxia and/ supply. The average birth weight for most breeds of cat or trauma. Dystocia occurs in ~6% of pregnancies (range is 100g ± 10g. However, it is normal for some breeds to 0-18%). Studies have shown that cats with extremes of have significantly smaller kittens (Oriental; ave. 80g); while conformation, such as the Siamese and Persians, experi- others (Maine Coon) have significantly larger kittens ence much higher levels of dystocia (7-10%) than cats (ave.120 g). It is therefore very important to know what with normal conformation (generally <5%). Hypoxia the average weight for kittens of a particular breed is during birth can result in stillbirth, or the birth of weak, when trying to decide whether or not a particular kitten slow, kittens that fail to suckle. These kittens usually die is underweight. As a general guideline newborn kittens within the first week of life or, due to failing to ingest <75 g are likely to have very high death rates. sufficient colostrum, have an increased risk of infectious disease. Kitten mortality is usually highest in the first 4) Inappropriate environment Environmental factors, such litter born to a particular queen and after her fifth litter. as extremes of temperature and humidity, poor hygiene, The high death rates in kittens from first-time queens overcrowding, or over-handling, all result in increased probably relates to inexperience, trauma and cannibal- kitten mortality. Ideally, the kittening room should be well ism. Older queens tend to have smaller litters and tend to ventilated, draft free, and maintained at a fairly constant produce more kittens with congenital defects. The nega- 18-24oC temperature, 55-60% humidity. This will allow tive effect of extremes of litter size is seen as reduced the dam to be comfortable, and she can supply any addi- survival of single kittens, and of kittens from litters of 7 tional heat required by the offspring. Where kittens have or more. Kitten mortality also increases with increasing to be hand-reared it is necessary to supply additional maternal obesity, and with other queen-related causes, heating. Ideally the temperature in the box should be including a lack of milk, mastitis, or maternal neglect. maintained at 29-32oC, but the box should be large enough for the kittens to move away from the heat if they be- 2) Congenital abnormalities - Obvious physical defects come too hot. The temperature is gradually reduced to may be seen in 10-20% of stillborn kittens. However, the 27oC by 7-10 days and 22oC by the end of the first month. prevalence varies considerably; from 1-10% of kittens born Overcrowding will lead to increased infectious disease to research cats, to 1-31% of kittens born to pedigree and disease resulting from competition at the mother’s cats. Congenital disorders are present from birth, and nipples (which can in turn result in inadequate nutrition can affect any body system. They may result from genet- [see below]). Over-handling will not only limit the kitten’s ic disorders or teratogenic factors. Because inbreeding feeding time, but with nervous queens, may result in can- increases the risk of genetic disease, congenital disor- nibalism of her kittens. ders are seen more frequently in pedigree cats. In addition, certain defects are seen more frequently in some Providing kittens with a suitable environmental tempera- breeds than others. Congenital defects resulting from ture is essential. A kitten that has ceased to suckle regu- exposure to teratogenic substances may be seen in cats larly will quickly become cold and hypoglycaemic. Since of any breed. For example, cleft palates may result from neonates cannot shiver and are unable to control their treatment with griseofulvin, corticosteroids, or excessive own body temperature hypothermia will result, and this amounts of vitamin A; skeletal deformities may result will lead to a further reduction in activity and suckling. from the administration of organophosphate anti-flea The rectal temperature of new-born kittens ranges from products. It has also been suggested that overheating, in 35-37oC in the first week, to 36-38oC in the second and some pregnant cats, may result in an increased risk of third weeks, and reaches normal adult levels of 38-39oC skeletal deformity in their kittens. Severe defects usually by the fourth week. Hypothermia is particularly harmful result in stillbirth or early neonatal death. Milder disor- as it can initiate a number of other problems. For exam- ders may result in fading kittens, or only become appar- ple: a week-old kitten should have a temperature of 35- ent later in life. 37oC and a heart rate of 200-250 bpm. However, if its temperature falls to 30oC, its heart rate will fall to 40-50 3) Low birth weight - Underweight kittens have a signif- bpm. While this is initially a protective response, if sus- icantly increased risk of neonatal death. They are physio- tained, it can lead to a decrease in respiratory rate, which logically immature compared to normal-weight kittens, may in turn lead to cardiopulmonary failure. Also, a hy- and they may be too weak to nurse adequately. In addi- pothermic kitten will not suckle effectively, its gastrointes- tion, they lack insulating fat and thermogenic brown fat, tinal motility will become depressed, and it will have an and they have weak thoracic muscles and immature lung increased susceptibility to infection. It is therefore im- development. They are particularly susceptible to hypo- portant to check the temperature of any potentially weak thermia, dehydration, respiratory failure, and sepsis. Kit- or ill kittens. However, if their rectal temperature remains tens may be born underweight because of maternal mal- <34oC for prolonged periods of time the kitten is likely to nutrition or ill-health; congenital disease; in utero infec- die. tions; or any condition that results in poor placental blood

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5) Inappropriate nutrition - Care should be taken to feed 6) Neonatal isoerythrolysis - Neonatal isoerythrolysis (NI) the queen an appropriate diet. Incorrect nutrition of the is relatively common is certain purebred kittens. Cats queen can affect the quality of the milk she produces. have 3 blood groups; Type A, B, and AB. Type A is ge- Generally, when the queen is healthy and producing ade- netically dominant to Type B. Genetically, a Type A cat quate milk the kittens should have no problems with in- may therefore be A/A or A/B. The rare blood type AB is appropriate nutrition. Inadequate milk production may inherited slightly differently, and is recessive to Type A be associated with an inexperienced or overly nervous but dominant to Type B. AB cats are only found in breeds queen, old queens, sick or malnourished queens, dysto- in which the Type B has been identified, usually increas- cia, certain familial traits, systemic illness or mastitis. ing in frequency as the percentage of Type B cats in- Inadequate milk uptake by the kitten can also result from creases. The frequency of Type A, B and AB blood types anything causing kitten ill-heath or weakness, from com- varies between breeds (Table 1), and also, to some ex- petition and bullying by siblings, or any environmental tent, between countries. Generally, most domestic short factor that distracts or upsets the queen-kitten bond. and longhaired cats (DSH/DLH) are Type A (75-100% Normal kittens should suckle within 2 hours of birth as Type A; 0-25% Type B; 0-10% Type AB). Interestingly, they can only adsorb colostrum in the first 16-24 hours the Bengal breed appears to have a particularly high num- of life. Since any kitten not gaining sufficient weight has ber of AB cats, although actual prevalence data are not an increased risk of neonatal death it is important to weigh yet available. Unlike puppies, kittens have naturally oc- kittens regularly (at birth, daily for the first week, then at curring antibodies against the other blood types in their least twice weekly until after weaning). A loss of <10% plasma. Antibodies of the IgG class (and to a lesser may be expected in the first 24h, but after that there extent of the IgM class) are acquired by kittens with co- should be daily weight gain (~10-15g/day; 5-10%); they lostrum. Kittens with blood type A have weak anti-B should double their birth weight by 1-2 weeks of age and antibodies, while kittens with blood type B have strong weight gain should be steady and progressive. Failure to anti-A antibodies. Since these antibodies occur natural- gain weight over 24 hr requires attention and any weight ly, the queen does not need to be sensitized by previous loss should be investigated, as kittens losing more than pregnancies or blood transfusions. Since the highest pro- 10% body weight are unlikely to survive. It is essential portion of Type B cats are seen in British Short Hair (BSH) that kittens gain adequate nutrition as they have a greater cats, NI is seen most frequently in this breed of cats. risk of developing hypoglycaemia than adults. This is During the first 16 hours of life maternal antibodies are because they are metabolically less able to generate glu- transferred to the kitten through colostrum ingestion. If cose than adults, while having a much larger require- the kitten has blood type A or AB and the mother has ment for it. Any kitten that is ill or stressed may develop blood type B, colostral antibodies will lyse the kitten’s hypoglycaemia. This may be seen as weakness, hypoth- red blood cells. Haemolysis can be intravascular and/or ermia, crying, difficult breathing, seizures, coma and, extravascular, causing severe anemia, nephropathy, mul- eventually, death. tiple organ failures as well as disseminated intravascular coagulopathy. Since all blood type B cats have high antibody titers, even primiparous mothers can have litters Neonatal kittens are also very susceptible to dehydration. with NI. Clinical signs develop more often in blood type This may result from inadequate consumption of milk, A or AB kittens born to blood type B mothers. As the or excessive fluid losses (usually associated with over- fetus is protected from maternal antibodies, kittens at heating, excessively low humidity, or diarrhoea). Kittens risk are born healthy and nurse vigorously, but will start contain relatively more body water than adults and their showing clinical signs within hours to days after colos- water turnover rate is twice that of adults. Neonatal kit- trum ingestion. Clinical signs will include either a) sud- ten maintenance fluid requirements are ~130-220ml/kg/ den death; b) progressive failure to nurse and to thrive 24h, compared to 50-65ml/kg/24h for a mature cat. This during the first 3 days (with presence of dark, brown- is because kittens have greater fluid losses through their red urine caused by haemoglobinuria, icterus, anemia) skin, lungs and kidneys, which are all immature. Since with death occurring during the first week; some kittens the kittens derive all of their food and water in the form may survive and develop a tail-tip necrosis between the of milk, when the supply is inadequate, supplemental feed- first and second week of life, which may then slough ing is needed. Where the kittens have been orphaned or between 3 days and 2 weeks of age. or c) no clinical sign the queen is unable to feed them they will need total re- except for presence of tail-tip necrosis, positive direct placement feeding. Weaning should begin at 3-4 weeks Coombs’ test and moderate anemia. of age. It is important to ensure that all of the kittens gain sufficient food at this time. In large litters competition at the food bowl can lead to weaker kittens being bullied and so eat less.

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100% Type A ~80% Type A 75-100% Type A 60% Type A 40% Type A Siamese Somali Domestic Short-Hair Devon Rex British Short Hair Domestic Long-Hair Burmese Abyssinian Persian Tonkinese Birman Oriental Maine Coon Norwegian Forest Cat Table 1: Breed prevalence of feline blood types

Where NI is seen, all sexually active cats should be blood- bodies against its resident infectious organisms. The pro- typed to prevent further inappropriate mating. In addi- tective effect of systemically absorbed MDA usually be- tion, it is recommended that all BSH cats should be blood- gins to wane from 3-4 weeks of age. The kittens’ natural typed prior to breeding. This can be done using a simple immunity is still developing at this time, and since most in-house test card (Rapid Vet-H, dms laboratories). It is vaccine regimens do not start until ~8 weeks of age, this important to ensure that Type B queens do not mate with can leave a period of time when the kittens are particular- Type A toms. Where an unknown mating has occurred, ly at risk from these infectious diseases. placental blood can be used to determine a kitten’s blood A healthy kitten should be able to cope with a low level of type. If the queen’s blood-type is known to be Type B, infectious organisms within its environment. It will gen- and a kitten is found to be a Type A, it can be prevented erally experience no more than occasional mild and brief from suckling the queen, at least until it is >24h old. clinical signs. However, if the kitten’s immune system While this procedure will prevent the occurrence of NI, becomes suppressed serious disease or fatal infections the lack of colostrum will leave the kitten at risk of infec- may occur. Factors which may contribute to an inade- tious disease. quate immune response include inadequate colostrum Kittens showing signs of NI, if <24h old, should be im- intake, inadequate nutrition, low birth weight, peri-natal mediately removed from their mother to prevent further hypoxia, congenital disorders (especially of the immune absorption of anti-A antibodies. In kittens, most colos- system), previous trauma or infection, a low environ- tral antibodies are absorbed by 12-24h of age. Once re- mental temperature, or an unhygienic environment lead- moved, the kittens can either be fostered to a Type-A ing to a build up of contamination with infectious agents. queen, or fed milk replaced formula for 24 hours. After Respiratory and gastrointestinal infections are seen most this time it is generally safe for them to be returned to frequently. their dam. If the anaemia is severe a blood transfusion will need to be performed. However, despite removing Viruses the kittens as soon as clinical signs are noted, most affected kittens die within their first week of life. • The cat flu viruses (feline calicivirus [FCV] and feline herpes virus [FHV-1]) are perhaps the most commonly seen viral infections of kittens. While in healthy kittens 7) Infection - In general, infections are involved in rela- infection may be mild and brief, weak kittens may de- tively few early neonatal deaths. However, they can re- velop more severe clinical signs or secondary bacteri- sult in significant mortality from 3-4 weeks of age on- al infections. FHV-1 infection may also be associated wards. Since neonatal kittens have immature immune with abortion. systems, and gain <5% of their maternally derived antibodies (MDA) transplacentally, they need to gain protec- • Feline coronavirus infection (FCoV), like the cat flu tion from infectious disease via transfer of MDA in the viruses, is hard to eliminate from breeding catteries. colostrum. The passive protection of the intestines by When present, infection may be associated with an MDA continues for the entire duration of suckling as IgA increased incidence of reproduction failure, abortions antibodies resist gastric degradation and can bind poten- and stillbirths. Affected kittens may show signs of tial pathogens in the gut lumen, preventing them from diarrhoea, malaise, or “fading”, and occasional cases attaching to or penetrating the intestinal mucosa. The of more classical effusive feline infectious peritonitis ability of neonates to absorb MDA begins to decline 6h (FIP). after birth, and is no longer possible after ~48h. The • Feline panleukopenia virus (FPV) is usually seen in cat- majority of neonatal infections are caused by agents to teries that fail to vaccinate properly. It is occasionally which vaccines are not available; it is therefore important seen in kittens from vaccinated queens, possibly re- that neonates are born into the same environment as their sulting from severe environmental contamination. In- dam has been living since she will then have raised anti-

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fection may result in abortions, stillbirths, fading kit- propensity to develop hypoglycaemia and intestinal ileus tens, diarrhoea, panleukopenia, septicaemia, cerebel- (especially when cold), significantly increases the risk of lar ataxia, and/or death. translocation of enteric bacteria into the blood stream. This is exacerbated by sepsis further predisposing to • Feline leukaemia virus (FeLV) has been almost elimi- hypothermia and hypoglycaemia (possibly resulting from nated from the pedigree breeding population in many impaired liver function, depletion of glycogen, and pe- countries. Neonatal disease caused by this infection is ripheral utilisation of glucose by bacteria and leucocytes). therefore seen mainly in rescue catteries. In this situ- Disease may be very sudden or may run a more protract- ation it may result in reproductive failure, abortions, ed course. While the clinical signs are varied, they fre- stillbirths, fading kittens, a panleukopenia-like syn- quently result in bradycardia, dyspnoea, dehydration, drome, septicaemia or death. weakness, crying, seizures, coma and death. Sepsis of- • (In puppies canine herpes virus is a common cause of ten occurs as the final stage of other conditions, and is puppy loss, and can result in abortion, or neonatal particularly associated with systemic viral infections. The death associated with abdominal distension and pain most common cause of sepsis are gram-negative bacte- at <3weeks of age. Other common viral infections of ria, but can include; Streptococcus, E. coli, Staphylococ- puppies include canine distemper virus, canine par- cus, Klebsiella, Enterobacter, Enterococcus, Pseudomo- vovirus, canine coronavirus [which appears to be nas, Clostridium, Bacteroides, Fusobacterium, Pasteurella changing in significance], canine adenovirus-2, and and Salmonella. parainfluenza). Parasites - In well-run catteries parasite infestation should not be a problem. Where queens are not dewormed, heavy Where infectious disease is suspected it is important to kitten infestations can result in a poor body condition, ensure that the queens’ vaccination programme is up to soft or bloody stools, lack of appetite, a pot-bellied ap- date. Since kittens gain some protection from infectious pearance, weight loss, and occasionally death. A severe disease in the form of MDA passed in the colostrum, it flea, tick or hookworm infestation can result in signifi- may help to give booster vaccines prior to mating. In cant anaemia. Gut parasites, such as Giardia, Tritrichomo- some cases it may be appropriate to instigate an isolation nas foetus, Isospora or Cryptosporidia may cause diar- breeding and early weaning programme. rhoea and a failure to thrive. Toxoplasma infection may result in abortion, stillbirths and fading kittens. Bacteria - In kittens, bacterial infections are often seen secondary to viral infection. However, bacterial infections can also be seen without prior viral infection. In most cases the bacteria originate from the queen’s birth canal (beta haemolytic Streptococcus sp. [Strep. G infection]), gastrointestinal tract (E. coli, Salmonella sp., Campylo- bacter sp., many normal enteric bacteria), or respiratory tract (Bordetella sp., Pasturella sp., Mycoplasma sp.). Clinical signs depend on the site, nature, and severity of the infection. They may include diarrhoea, coughing, dyspnoea, polyarthritis, omphalophlebitis, or dermatitis, as well as the less specific signs more typical of fading kittens. Ultimately, many of these infections may result in septicaemia and death. The increased risk of sepsis in neonates results from the factors listed above, especially failure of passive transfer of MDA. In addition, neonatal

References and suggested readings · Blunden AS (1998) The Neonate: Congenital Defects and Fading Puppies. BSAVA Manual of Small Animal Reproduction & Periparturient Care, p 143-152 · Feline Advisory Bureau Manual of Cat Breeding (2006), FAB Publications, Tisbury. · Feldman DC and Nelson RW (1987) Feline reproduction. In: Canine and Feline Endocrinology and Reproduction. Ed. Feldman DC and Nelson RW, WB. Saunders, Philadelphia. pp. 525-548 (or the 2004 edition). · Hoskins JD (1995) Fading puppy and kitten syndrome. Kirk’s Current Veterinary Therapy XII, eds. RW Kirk and JD Bonagura, WB. Saunders, Philadelphia. pp. 30-33 · Hotston Moore P and Sturgess CP (1998) Care of Neonates and Young Animals. BSAVA Manual of Small Animal Reproduction & Periparturient Care, p 153-169 · Little S (2004). Breed Specific Reproduction Projects; Heritable Aspects of Cat Breeding; Feline Reproduction: A Manual for Cat Breeders and Veterinarians (CD ROM); www.catvet.homestead.com , [email protected] · Sturgess CP (2006) Feline paediatric medicine. Eur J Comp An Pract 16(1): 83-94

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Techniques for Neonatal Resuscitation and Critical Care

Stefano Romagnoli

When a neonate is in critical condtions treatment must dark pink or red gums. However, sick neonates often be instituted immediately, after which the clinician may have pale, grey or bluish gums. Umbilical cord – This concentrate on the kitten, the rest of its litter, their moth- should be dry and free of discharges, and normally falls ers health, and the overall health and management of the off between 3-7 days of age. It is of concern if it is still other cats in the cattery. In fact, it is only through a moist, painful, inflamed or discharging. Defaecation and complete history that the true nature of the problem can urination – Since stimulation of the perineal area in kit- be determined. If sick kittens are not to die, they must tens of <3 weeks of age results in defaecation and urina- be detected and treated early as their health status can tion this technique can be used to look for the presence deteriorate rapidly. This paper will focus on perinatal of diarrhoea or constipation (present in ~60% of sick kit- reviival as wel as on some of the most common health tens), and to check urine colour (see below). problems in young kittens such as hypothermia, hypogly- Blood sampling: The small size of kittens makes collec- caemia and dehydration and their clinical approach in a tion difficult. It is usually only possible to take very small practice situation. The following protocol should be adopt- volumes of blood (0.3-0.5 ml, rarely up to 1.5 ml). Total ed and the following information collected for each criti- blood volume is ~75ml/kg, so at 1 week a kitten of 200g cal neonatal patient: only has ~15ml total). Blood should be collected from Physical exam - Weight and body condition should be the jugular vein. Care should be taken not to induce a assessed, presence of signs of trauma, congenital de- large haematoma. This can result in significant loss of fects, or disease should be carefully investigated. While circulating volume, and can, if severe, obstruct the air- some congenital defects, such as cleft palate or atresia way. Collect samples into 0.5 ml EDTA and heparin tubes, ani are readily evident, others, like congenital heart de- run glucose on a single drop using a glucometer, and run fects, are only evident on a post mortem examination. It packed cell volume (PCV) and total protein (TP) on a mi- is important to be aware of normal age-related changes cro-haematocrit tube. It is often only possible to assess and not over-interpret normal findings e.g. neonatal joint PCV, TP, urea, glucose, and blood smear cytology. In instability or cardiac murmurs. The coat should be order to correctly interpret the results it is important to checked for quality, cleanness and parasites. The thorax know what is normal for kittens of that age (Chandler and head should be checked for normal shape and feel; 1992; Hotston Moore and Sturgess 1998). For example, normal heart rate is ~200-220 beats per minute; normal normal neonatal kittens have mild normochromic nor- respiration is ~15-35 breaths per minute. The abdomen mocytic anaemia, and blood urea and creatinine levels in should feel gently full, not swollen, tight or empty. The kittens are considerably lower than adults. Few biochem- intestines and bladder should feel soft, mobile and non- ical and haematological results are specific for a particu- painful. The extremities should be pale pink (extremity lar disease. Severe anaemia may be seen with NI, or a erythaemia is often associated with sepsis). Eyes and nose heavy flea or hookworm infestation. Panleukopenia may – Kittens should open their eyes between days 5-14; a be seen with FPV, FeLV, or sepsis. Hypoglycaemia is com- mild cloudiness is normal and should resolve quickly. While mon, regardless of the cause of illness. Hyperbilirubi- a small amount of sticky discharge is not of major con- naemia may be seen in NI or liver disease. Hyperammo- cern, closed eyelids that are swollen or matted with pus naemia may occur with hepatic encephalopathy and a is. Gums - Until about a week old healthy neonates have congenital portosystemic shunt. Urine collection: Stimulating the kitten’s perineum with a Stefano Romagnoli, DVM, MS, PhD, Dipl. ECAR warm moist cotton ball is a useful method for collecting President, European Board of Veterinary Specialisation a urine sample. Urinalysis can be helpful in the diagnosis Dept. of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Agripolis, Legnaro, of NI, where brown-staining urine results from haemo- 35020 (PD) globinuria. Pyuria is suggestive of a urinary tract infec- University of Padova, Italy tion, while a specific gravity of >1.017 indicates dehy- [email protected] dration. Glucosuria is not abnormal in neonates.

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Further investigations: More specific tests include serol- wards your palm and neck between your forefinger and ogy (e.g. FeLV, FIV), slide agglutination or Coombs’ test third finger, its head protruding between your fingers. for NI, pharyngeal swabs for the cat flu viruses, or ocu- Enclose the kitten in your fingers and, turning your hand lar swabs for chlamydophila felis. If a bacterial infection palm downwards with your arm extended, give a gentle is suspected swabs, blood or urine can be taken for cul- swing several times; make quite sure first that you are ture and sensitivity. In cases of septicaemia, it is difficult not too near any protruding edges or disaster will follow. to obtain sufficient blood to perform blood culture. It is The swing will have the effect of forcing fluids out of the usually more rewarding to sacrifice a moribund kitten, kitten’s airway and a further wipe of its nose and mouth and then send fresh samples of heart blood, heart tissue, will clear any debris away. Keeping some absorbant pa- liver, lungs, etc. for culture. Survey radiography or ultra- per on the nostrils of the kitten during the procedure will sound examination may be considered, but there is little allow to detect minute quantities of liquid coming out. radiographic contrast in kittens (so reduce the kV by half The swing will also serve to stimulate respiration. Take of that used in an adult of the same body thickness), and care; if performed too vigorously this method can result ultrasound examination may require a “stand-off” for the in brain haemorrhage. probe. Faecal cultures can be examined for the presence • Stimulate respiration: If the kitten is still not breath- of pathogenic bacteria, Giardia spp., Tritrichomonas foe- ing, some form of artificial respiration may be necessary. tus, coccidia, and intestinal parasites. Mouth-to-mouth respiration can be useful, but only if very carefully performed. There are several points to re- Peri-natal kitten revival member. It is of no use blowing fluids and debris further Hypoxia related to dystocia is probably the single most down the airway; these must be cleared away first (see significant factor in neonatal mortality. Since the healthy above). Secondly, the capacity of kitten lungs compared mother cat will generally make a good job of nursing her to humans is minute. Blow very gently and allow a pause kittens, it is important not to interfere unless necessary. for expiration. Repeat this cycle every 3-5 seconds. Breath- However, intervention is recommended when a kitten is ing into the kitten’s airway through a small endotracheal not breathing, or on the few occasions when maternal tube or drinking straw may help to reduce the risk of instinct appears to be lacking. The aim is to imitate the over-inflating the kitten’s lungs, and be more hygienic cat’s own methods; she ensures that the kitten’s nose than direct mouth-to-mouth. Various methods have been and mouth are clear, then, with a nipping/licking action, used to make the new-born animal gasp, including the she chews through the umbilical cord. This, and more administration of brandy or other spirits to the kitten’s vigorous licking of this area, provides stimulation of res- tongue, flicking its chest sharply but gently with a finger- piration. The cat then gives the kitten a more general tip, alternate warm and cold water applications, or the drying lick, then concentrates on the perineal area in or- insertion of a 25-g needle into the nasal philtrum. How- der initiate bowel and bladder functions. If something ever, it is more reliable to apply a drop of doxopram goes wrong of the mother does not have any maternal hydrochloride (20 mg/ml) sublingually. A strong regular instinct, the following intervention should be put in place: heart beat should be easily palpable; if not, external cardiac massage can be attempted. It is important to note • Severe the umbilical cord - If the umbilical cord has that unlike adults neonatal heart rates fall in a protective not broken on delivery, separate it using 2 haemostats response to hypoxia, and this should not be misinter- >2 cm from the kitten’s abdominal wall. Complicated preted. If the dam was given opioids prior to delivery cutting and tying are not usually necessary. Dipping the naloxone hydrochloride (0.4 mg/ml) can be administered stump in chlorhexidine is a common procedure, although to the offspring (1 drop sublingually) to reverse respira- there is no need for disinfection if the kitten is born in a tory depression. If in doubt persist with stimulating the clean environment. kitten; some can still be revived after >30 minutes from • Clear the airways: Tear the membranes from the nose, birth. That said, the longer the duration before breathing wipe the nose and open the mouth, tilt the kitten’s head the higher the risk of hypoxia causing brain damage or down and clear away any fluid. If the kitten is not breath- blindness. Hypoxic bradycardic puppies may respond to ing, or if it has come tail first and possibly inhaled fluid, the administration of atropine into the umbilical vein. While it is necessary to clear debris and fluid from the airway. If no information is available on the use of this method in suction equipment is available this can be done by suck- kittens, it may be worth considering. Since premature ing the debris out of the airway. This can also be achieved kittens often have very poor pulmonary development the using a Jackson cat urinary catheter attached to a 5-10 administration of dexamethasone (0.1mg) may help to ml syringe as a gentle suction apparatus. The catheter stimulate surfactant production. Supplementary oxygen can also be used to induce the kitten to sneeze and cough should be given until the kitten is breathing regularly and by stimulating its nose/throat. One of the traditionally is obviously vigorous. This can be done using a small used methods involves swinging the kitten. To do this, face mask, an oxygen box, or using a fine urinary cathe- place the kitten in the palm of your hand, its back to- ter to administer intranasal oxygen (the adapter to a 3

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French endotracheal tube can be used to connect the sions and death. If a kitten refuses to feed, prompt action oxygen supply to the catheter). The kittens tongue is a is required. Kittens have no energy reserves and will de- reliable indicator of respiration. If the kitten is receiving teriorate rapidly. If a kitten is showing signs of hypogly- sufficient oxygen its tongue will be pink, if not it will have caemia, a few drops of glucose syrup placed on its gums a bluish tint. can be life saving. However, if the kitten is cold, glucose solution should not be given by mouth as it will not be Critical Care of Neonatal Kittens adsorbed from hypothermic intestines. More severe cases can be corrected by the parenteral administration of Sick kittens need to be treated immediately. Supportive isotonic glucose solutions. It is important to correct any therapy is aimed at re-warming, maintaining blood glu- hypothermia at the same time. When giving supplemen- cose levels, correcting dehydration and, when required, tal glucose it is important to monitor glucose blood con- supplying additional oxygen. centrations as kittens can easily become hyperglycaemic. Once recovering the kitten can be fed a small amount of Hypothermia - Neonatal kittens cannot thermo-regulate, glucose solution, and either the amount and/or frequen- they lack insulating fat and thermogenic brown, and they cy of routine feeding should be increased. Note: the nu- cannot react to cold by shivering. They loose heat rapid- tritional requirements of a septic kitten are increased ly, especially if left wet. Body temperature generally falls (~1.5x maintenance) so in these cases it may be neces- from ~36oC at birth, to 30oC within a few hours, then sary to provide nutritional support by tube feeding (see increases to 38oC over the first week. It is important that later). these temperatures are maintained as hypothermia can Tube feeding: If kittens are too weak to suckle for them- initiate a number of other problems: e.g. a week-old kit- selves, then tube feeding is perhaps the cleanest and most ten should have a temperature of 35-37oC and a heart efficient method by which to deliver nutrition. However, rate of 200-250 bpm, but if its temperature temporarily it requires proper equipment and good technical skills. falls to 30oC, its HR will fall to 40-50 bpm. While this is a Also, as the kittens have no control over how much they protective mechanism, if persistent, it can results in a are fed, they can easily be given too much (or too little). decrease in respiratory rate that may in turn leads to car- Stomach tubes must be soft, flexible, blunt-ended and diopulmonary failure. Also, a hypothermic kitten will not generally not more than 2-3 mm wide. A premature hu- suckle effectively; it may develop gastrointestinal ileus, man infant feeding tube is ideal (6-10 French feeding tube and will have an increased susceptibility to infection. It is for neonates and 8-10 French for kittens over 300g), or a important to check the temperature of any potentially weak soft rubber canine urethral catheter may also be used. or ill kittens, however, if their temperature is maintained The tube must be measured to the correct length (from at <34oC for a prolonged period of time they are likely to the kitten’s nose to the last rib), and an indelible mark die. should be made on the tube at this point. The tube should be lubricated with K-Y jelly before it is used. To place the tube the kitten’s mouth must be opened by pressing gen- The kitten should then be rubbed all over with a clean tly at the corners, and, keeping the head flexed down- towel. This further stimulates respiration and dries the wards, the tube is then slid along the roof of the mouth kitten. It should then be kept warm. If the mother is ill or and down the back of the kitten’s throat into the oesoph- uncooperative, place the kittens in contact with a warm, agus. The tube is passed down the oesophagus until the well-covered hot water bottle and conserve the heat by mark on the tube is level with the kitten’s nose. The other covering the bed with a blanket. Great care must be tak- end of the tube will then be in its stomach. A syringe en not to inflict contact burns on the kittens by having containing pre-warmed milk can then be attached, and the bottle too hot. When attempting to re-warm hypoth- the milk can be delivered slowly, directly into the stom- ermic kittens it is important to do so gradually, ideally ach. If the kitten’s head is kept flexed forward, it is quite over 1-4h, depending on the severity of chilling. Rapid difficult to miss the oesophagus and so pass the tube re-warming can lead to cardiovascular collapse and death. into the airway by mistake. Many kittens mew loudly Importantly, overheating can also be detrimental, and can throughout the whole procedure, and it is useful to note quickly lead to dehydration and death. Because hypoth- that they cannot do this if the tube is in the airway. If the ermia can markedly reduce the absorptive ability of the tube does not pass easily or if coughing occurs withdraw intestines concurrent hypoglycaemia and dehydration the tube from the kitten’s mouth and try again. cannot be corrected using oral solutions; parenteral fluids are needed. Frequency of feeding: 0-2 weeks: 6-10 feeds/24h at 2-4h intervals. Hypoglycaemia - This results from inadequate or infre- 2-4 weeks: 4-8 feeds/24h at 3-6h intervals. quent feeding and if protracted can cause severe depres- 4-5 weeks: 3-5 feeds/24h at 5-8h intervals. sion, muscle twitching and occasionally lead to convul-

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Diarrhoea and dehydration - Diarrhoea is common in kittens, particularly those fed milk replacement formula. It may also be caused by over feeding; giving too con- centrated a solution of milk replacement formula; or as a result of infection (usually caused by poor hygiene). Treat- ment must be prompt as dehydration can develop rapidly, followed by collapse, hypothermia, and death. Look- ing for skin tenting is an unreliable method of assessing dehydration in neonates. Instead, dehydration should be assessed by weight loss, dryness of mucus membranes, and urine specific gravity (>1.017). • Mild cases respond well to dilution of the milk replacement formula 50:50 with boiled water, which can then be given until the diarrhea stops. Treatment with SQ fluids may be required (see below, but starting with ~1ml/30g is reasonable). B • Severe cases should be given no milk at all. Instead they can be given oral support with 5-10% glucose solution, glucose-saline, or isotonic electrolyte solution until the diarrhoea stops. While oral supplemen- Figure 1. Placement of the IO needle in the bone mar- tation may help, it is generally better to give parenter- row. A) The proximal femur is preferred in the cat while al fluids. If the neonate is cold, do not give any oral the wing of the ileum can be useful in dogs. Picture: medication/fluid. Slatter D, Textbook of Small Animal Surgery, third Edi- • Intravenous (IV) or intraosseous (IO) routes are used tion, 2000, WB Saunders, Philidelphia. B) Detail of the most frequently for parenteral access. IV access can placement of the IO needle within the bone marrow of often be gained using a 23-25-g catheter placed in the the proximal femur. IO needles can be left in place for up cephalic or jugular vein. However, kittens’ short legs to 72 hours, although their use is often limited by clot- can make catheter placement difficult and flow hard ting within the needle. To try to reduce this risk, the nee- to maintain. IO access can be easily gained using the dle should be flushed regularly with heparinised saline, proximal femur (Figure 1). Subcutaneous (SQ), intra- usually every 6 hours. muscular and intraperitoneal (IP) routes are less ad- Picture: http://courses.vetmed.wsu.edu/samdx/bm.asp. visable as the absorption is slower and less reliable than in adults, especially if dehydration or shock is present. In addition, the IP route requires strict asep- • Use fluid pumps, syringe pumps, or a burette with a sis, and carries a small risk of puncturing viscera. If paediatric giving set (60 drops/ml) to reduce the risk the IP route is to be used the daily fluid requirement is of over-hydration to which all neonates are particu- calculated (see below) then the volume is divided, and larly susceptible (in part because of their immature given 2-3x daily. kidneys). • Fluid requirements per kg are higher in neonates than • While sick neonates are often acidotic their reduced adults but total volumes required are low. Immature hepatic ability to metabolise lactate to bicarbonate kidneys lack the ability to concentrate urine so fluid means that lactated Ringer’s should not be given. Sa- losses cannot be controlled, especially if there is con- line or Ringer’s are better choices in kittens <7 weeks current vomiting and/or diarrhoea. Maintenance fluid of age. In severe acidosis bicarbonate can be given as rates in kittens <2 weeks of age are 130-220ml/kg/ per known acid-base status, or ~2mmol/kg can be 24h (ave. 180ml/kg/24h), by weaning ~120ml/kg/24h, given over 10-15 mins. Hypoglycaemic kittens should and adult levels of ~50-65ml/kg/24h from 6 months. be given 5% dextrose solution mixed 50:50 with saline, or 1-2 ml of 10-25% glucose in very severe cases. All fluids should be carefully warmed prior to ad- Example: 1 week old kitten, 200g, needs 36ml fluid/24h ministration and kittens should be closely observed maintenance; 1.5ml/h (~1 drop/40 seconds using a pae- for signs of over-hydration. diatric giving set). If 7% dehydrated, the estimated deficit is 14ml. Therefore, the fluid rate should be ~2.5ml/h • Once the kitten has been warmed up and given fluid over 6h (1 drop/20sec), then reduce to ~2ml/h (1 drop/ therapy it must be allowed to recover quietly. Feeding 30sec); but always monitor for over-hydration. can only begin once the kitten is warm and able to suck. Stomach tubing is not helpful here, since when

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a kitten is cold and collapsed its intestines stop functioning, so stomach contents can be easily regurgitat- ed and then aspirated. As soon as the kitten is able to suck, it should be given isotonic glucose or Lectade solution (~1.0 ml/100 g body weight) given every 15 minutes until it is rehydrated and can urinate when massaged. If all goes well, diluted milk replacement formula can then be introduced after 24 hours, and full strength milk 24 hours after that. • The administration of antibiotics is not recommended, particularly for the treatment of diarrhoea. Antibi- otics severely disrupt the process of normal colonisa- tion of the gut by harmless bacteria, and can therefore make the situation worse. Antibiotics cannot be used as a substitute for colostrums and good hygiene.

References · Cave TA, Thompson H, Reid SWJ, Hodgson DR and Addie D (2002) Kitten mortality in the UK: histopathological examinations (1986-2000). Vet Rec 151: 497-501 · Chandler LM (1992) Pediatric normal blood values. Kirk’s Current Veterinary Therapy XI, eds. RW Kirk and JD Bonagura, WB. Saunders, Philadelphia. pp. 981-984 · Hoskins JD (1995) Fluid therapy in the puppy and kitten. Kirk’s Current Veterinary Therapy XII, eds. RW Kirk and JD Bonagura, WB. Saunders, Philadelphia. pp. 34-37 · Hotston Moore P and Sturgess CP (1998) Care of Neonates and Young Animals. BSAVA Manual of Small Animal Reproduction & Periparturient Care, p 153-169 · Sturgess CP (2006) Feline paediatric medicine. EJCAP 16(1): 83-94

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Managing the Dyspneic Cat Case studies in feline respiratory distress

Tim Hackett

Introduction Airway resistance is the pressure difference between the alveoli and the mouth divided by flow rate and is deter- As we discussed in the first lecture on triage, respiratory mined Poiseuille's law: distress in cats is a therapeutic dilemma. Critical cats can be so compromised that diagnostics and treatment can cause respiratory and cardiac arrest. Try to determine the nature of the problem first with observation. A rapid shallow respiratory pattern suggests restrictive disease Where R = airway resistance, n = viscosity, l = length while a slow deep inspiratory pattern is seen with airway and r = radius. Note the critical importance of tube radi- obstruction. With the restrictive pattern, auscultation can us; if the radius is halved, the resistance increases 16- help differentiate pleural space disease (pneumothorax, fold. However doubling the length only doubles resis- hydrothorax) from parenchymal diseases (pneumonia, tance. pulmonary edema). With an understanding of the factors that increase the work of breathing we can narrow our Airways resistance is determined by lung volume, bron- list of possible problems. chial smooth muscle tone and dynamic airway compres- sion. At reduced lung volumes (expiration), radial trac- Work of breathing tion supporting the bronchi is lost and airway caliber is For gas exchange, fresh air must be brought into the reduced. Dynamic airway collapse is seen with forceful alveoli through the process of alveolar ventilation. The respiration. Sudden changes in intrathoracic pressure can O2 cost of quiet breathing is extremely small, being less affect the large airways. than 3% of total resting O2 consumption. With voluntary hyperventilation it is possible to increase this to 30%, Minimizing the work of breathing probably greater with respiratory disease. For animals Cats will adopt respirations to minimize the work of with obstructive or restrictive lung disease, the O2 cost breathing. Those with upper airway obstruction will have of breathing can limit their exercise ability. a slower, deeper inspiratory effort with stridor (whistling Muscles of the respiratory system must overcome sever- sounds) heard loudest over the point of narrowing. By al forces: Elastic recoil and airways resistance. The elas- decreasing the speed of airflow past an obstruction this tic forces opposing inhalation are a combination of elas- breathing pattern will favor maximal flow through nar- tic properties of the lung and alveolar surface tension. rowed airways with minimal energy expenditure. It's easy Elastic forces were described above as they effect pul- to understand the problems of airway obstruction by try- monary compliance. ing to breathe through a straw. Intrathoracic airway collapse (thoracic trachea and bronchi) will have increased expiratory effort. Tracheal collapse will often have a loud snap, bronchitis/asthma patients will have pronounced expiratory wheezes. Animals with pleural effusions, pulmonary edema or pul- Tim Hackett D.V.M., M.S. monary fibrosis will adopt a restrictive breathing pattern. Diplomate, American College of Veterinary Emergency & Critical Care By minimizing the change in volume while increasing the Associate Professor and Small Animal Medical Chief of Staff respiratory rate they can maintain alveolar minute venti- James L. Voss Veterinary Medical Center lation despite decreased pulmonary compliance. Colorado State University Fort Collins, CO 80523 [email protected]

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Observation The clinical signs and physical examination abnormalities associated with near drowning, smoke inhalation, Try to determine the nature of the respiratory prob- are similar with electric cord bites with the exception of lem first with observation. A rapid shallow respiratory oral burns and can usually be ruled in or out with the pattern suggests restrictive disease while a slow deep history. inspiratory pattern is seen with airway obstruction. With the restrictive pattern, auscultation can help differentiate Adult respiratory distress syndrome (ARDS) results from pleural space disease (pneumothorax, hydrothorax) from a variety of pulmonary insults and can be thought of as parenchymal diseases (pneumonia, pulmonary edema). organ failure of the lung. The clinical criteria for a diagnosis of ARDS include hypoxemia, pulmonary infiltrates (fluid accumulation in the lung tissue) without evidence Imaging of heart failure and decreased pulmonary compliance. The Cats presenting with upper or lower respiratory signs primary pathogenesis of this edema is an increased alve- should have a thoracic radiographs when it is safe to olar capillary permeability. Problems associated with the restrain. Bronchial patterns develop as the peribronchi- development of ARDS include aspiration of stomach con- olar tissues become inflamed (as would be seen with bron- tents, traumatic pulmonary contusion, inhalation of nox- chitis or bronchial asthma). Interstitial patterns develop ious gases, oxygen toxicity and a variety of infectious with thickening of the fibrous structures of the lung. Al- diseases. Secondary lung diseases associated with the veolar patterns characterized by “Air bronchograms” are development of ARDS include gram-negative sepsis, trau- caused by fluid accumulation in the alveoli (pulmonary ma (not just chest trauma), pancreatitis, transfusion re- edema or pneumonia). Thoracic and cervical radiographs actions and toxins. Removal of the primary causes and can be used to diagnose collapsing trachea, tracheal or administration of oxygen support preferable with posi- laryngeal foreign bodies, and tracheal or laryngeal mass- tive end expiratory pressure are the principle treatments. es. Pulmonary Thromboembolism Pulmonary Edema Pulmonary thromboembolism (PTE) is the occlusion of Noncardiogenic pulmonary edema occurs occasionally in the pulmonary vasculature by products of the coagula- cats secondary to electric cord bites, sepsis, following tion cascade. Thrombosis of pulmonary vasculature re- near drowning or choking, uremia, smoke inhalation, and sults in an ischemic condition. This commonly results in the acute respiratory distress syndrome (ARDS). tachopnoea, dyspnea, and potentially, cyanosis. PTE oc- Most cats that chew on electric cords are presented with curs through 3 major mechanisms, damage to vascular acute onset of dyspnea and oral burns, which may or endothelium, altered pulmonary blood flow, and hyper- may not be associated with dysphagia or ptyalism. The coagulability. Diseases commonly associated with dam- syndrome occurs most commonly in the young. Pulmo- age to vascular endothelium include dirofilariasis, neo- nary edema develops rapidly, generally within hours. plasia, valvular heart disease, endotoxemia, and any cause Common physical examination abnormalities include oral of vasculitis including pancreatitis and immune mediated burns, dyspnea, and pulmonary crackles. Thoracic ra- disease. Altered pulmonary blood flow occurs most com- diographs show mixed interstitial and alveolar patterns monly with cardiomyopathy, partial venous occlusion by that are most prominent in the dorsal portions of the granulomatous disease or neoplasia, valvular heart dis- caudal lung lobes. The pathogenesis of edema is thought ease, vascular tumors, any form of shock, polycythemia, to be increased pulmonary capillary hydrostatic pressure and hyperviscosity syndromes. Syndromes of hyperco- and increased alveolar-capillary permeability. Increased agulability can be either primary or secondary. People pulmonary capillary hydrostatic pressure is likely due to develop primary antithrombin III (ATIII), protein C, plas- a centrally mediated burst of sympathetic activity, which minogen, and plasminogen activator deficiency as well causes constriction of resistance and capacitance vessels as dysfibrinogenemia that predisposes to thrombus for- leading to a shift of blood from the splanchnic viscera mation. Acquired hypercoagulability occurs with many into the circulation. This ultimately results in overcircula- diseases resulting in decreased production of ATIII, lost tion of the pulmonary vasculature. Increased peripheral of ATIII, increased concentration of some coagulation vascular resistance increases pulmonary capillary hydro- factors, platelet hypersensitivity, or thrombocytosis. static pressure and pulmonary venous pressures increase The most common clinical signs associated with PTE in- as the left ventricle pumps against increased outflow re- clude acute onset dyspnea or tachopnoea with or with- sistance. Treatment includes supplemental oxygen, mor- out cough and hemoptysis. Auscultation generally reveals phine (0.05 mg/kg by subcutaneous injection) to reverse increased bronchial sounds; crackles are rare. Split sec- the sympathetic tone. If morphine is unavailable, other ond heart sound may occur due to pulmonary arterial narcotic agonists and agonist/antagonists may also be hypertension. beneficial.

26 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Diagnosis can be difficult. Thoracic radiographic find- Cats presenting dyspneic as an emergency are often ings are dependent on the primary disease but can in- to distressed to handle. Physical examination, intrave- clude increased interstitial densities, increased size of the nous catheterization and diagnostics could prove fatal. pulmonary arteries, mild right heart enlargement, alveo- The best approach is to place them in an oxygen cage lar lung disease, and pleural effusion. Occasionally, tho- while obtaining a history and observing their respiratory racic radiographs are completely normal. These cases efforts. are often oxygen dependent but respond well to supplemental oxygen (noticeably better oxygenation, reduced Pleural Cavity respiratory rate, and decreased anxiety). Diagnosis is often by compatible underlying disease and a positive re- Diseases of the pleural space cause a decreased tidal vol- sponse to oxygen. ume and a restrictive breathing pattern. Characterized by the rapid, shallow respirations and dull lung sounds, fluid and air in the pleural space can be diagnosed and treated Feline Bronchial disease by rapid thoracocentesis. Once removed, fluid can be There is no clear terminology for the bronchial ob- examined to determine the likely cause. Thoracocentesis structive diseases in the cat. Bronchitis is inflammation is performed using a 20 or 21g needle attached to a short of the airways. Asthma generally implies a reversible piece of extension tubing. Alternatively a larger (19g) bronchoconstriction related to hypertrophy of smooth butterfly catheter may be used. The needle and tubing muscle in airways, hypertrophy of mucous glands, and are attached to a 20-60 cc syringe through a 3-way stop- infiltrates of eosinophils. Asthma in cats is a Type I hy- cock. A 2x2 cm area over the lateral chest wall between persensitivity reaction, often without an obvious cause. the 6th and 10th intercostal spaces is surgically prepared. Cats with bronchitis not due to asthma generally have With the animal comfortable in either sternal or lateral infiltrates of neutrophils or macrophages as well as hy- recumbency, the needle is advanced into the thoracic cav- pertrophy of mucous glands, hyperplasia of goblet cells, ity. It is helpful to mark the location of the needle's bevel excessive mucous, and ultimately fibrosis secondary to before advancing into the chest. Once either air or fluid chronic inflammation. Causes include bacterial infection, start flowing, the needle can be laid flat against the chest (including mycoplasmosis) viral infection and parasitic wall with the bevel facing in toward the lungs. This will infections. allow complete re-inflation without lacerating the lung Cats with bronchitis can be of any age. There is no on the needle. obvious breed or gender predilection. Primary present- A negative thoracocentesis may be due to fibrous adhe- ing complaints include cough, dyspnea, and wheezing. sions and small pockets of fluid. It is usually not neces- Physical examination abnormalities include cough, dysp- sary to evacuate all fluid or air so a negative tap should nea, and crackles, and wheezes in the pulmonary tis- not be pursued by re-directing the needle or repeated sues. Increased bronchovesicular sounds may be the only attempts. Radiographs may be helpful to decide if further abnormality noted on auscultation. If dyspnea occurs, it attempts are warranted. Diaphragmatic hernias may also commonly has a pronounced expiratory component. Open cause significant pleural restriction but yield a negative mouth breathing or panting commonly occurs during tap. These patients should be given supplemental oxy- periods of stress. gen while radiographs are taken. Thoracic radiographs reveal primarily a bronchial pattern. Overinflation and air trapping is seen in some dyspneic cats with chronic disease. Cytology of transoral airway wash samples reveals increased mucus with variable numbers of eosinophils, neutrophils, and macrophages. Bacteria may or may not be visualized. Aerobic and Mycoplasma culture as well as antibiotic susceptibility testing should be performed regardless of the type of inflammatory cell and whether or not bacteria are seen. Cats with eosinophilic airway cytology should be assessed for dirofilariasis using adult antigen detection tests or newly developed antibody tests. Fecal flotation (Toxo- cara and Toxascaris in kittens), Baermann examination of feces (Aelurostrongylus), and fecal sedimentation (Par- agonimus) should be performed in cats with eosinophilic airway cytology particularly if indoor-outdoor and from parasite endemic areas.

27 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Feline Trauma

Tim Hackett

Introduction lated portions of lung. With time, pulmonary contusions appear radiographically as a diffuse interstitial to alveolar As we learned in the first seminar, each emergent lung pattern. The location varies with the injury. It is im- patient should be evaluated in an orderly and systematic portant to note that contusions may not be evident on manner. This is especially true in trauma. It is the job of radiographs for several hours after the injury so a radio- the triage team to evaluate and treat injuries interfering graph taken on admission may not reveal the severity of with vital physiological functions. While trauma by its very the injury. nature is a polysystemic disease, pulmonary complications present one of the most common, and life-threat- Complicating trauma management is evidence that res- ening aspects of trauma triage. It is the purpose of this piratory insufficiency following pulmonary contusion may lecture not to review trauma triage, but to concentrate be iatrogenic. The use of large volumes of rapidly ad- on the pathophysiology, diagnosis, and treatment of trau- ministered crystalloid solutions can exacerbate the fluid matic injury to the respiratory tract. These injuries re- loss into damaged tissues worsening the hypoxemia as- quire immediate recognition and treatment, as aggres- sociated with the contusions. Maintaining plasma colloid sive fluid therapy can make some of these injuries worse. oncotic pressure with the use of plasma or other colloid It is important to assume some degree of thoracic and solutions may lessen the occurrence of respiratory insuf- pulmonary injury in all veterinary trauma patients. In a ficiency by preventing water loss into the injured lung. canine study, thoracic injuries were present in 58% of We use even more conservative fluid replacement in trau- patients presented for treatment of orthopedic injures. ma patients with pulmonary contusions. Using a combi- Pulmonary contusions, pneumothorax, and fractured ribs nation of crystalloid fluids (5-10 ml/kg, 1/8 to 1/4 of a were most commonly observed. These findings have also typical shock volume) and colloid solutions (whole blood, been noted in cats falling from great heights and suffer- or hydroxyethyl starch) we strive to maintain a minimally ing other forms of trauma. acceptable blood pressure (mean pressure of 60 mmHg) while avoiding iatrogenic pulmonary fluid overload. Pa- tients with severe contusions may present with or devel- Pulmonary Contusions op hemoptysis. Blood from the mouth, agitation and res- Lung contusion is the most common acute pulmo- piratory distress are all indications that pulmonary pa- nary complication of blunt chest trauma. Due to the com- renchymal hemorrhage is ongoing and aggressive treat- pliant nature of the feline thorax, severe injury may be ment is necessary. These patients are quickly restrained present without external signs of trauma. Such a contu- (fast acting anesthetic or a paralytic) and intubated. Ven- sion may occur under the site of a flail chest or indepen- tilating with 100% oxygen and 5-10 cm H20 positive end- dent of obvious external injury. A large bruise in a very expiratory ventilation will help keep remaining alveoli bad place, the contused alveoli fill with blood, and fluid open, and open catalectic lung units. Patient tidal volume resulting in atelectasis. Hypoxemia will result from pul- should be monitored closely as positive pressure ventila- monary shunt as blood flows through these non-venti- tion and damaged lungs can lead to a tension pneumothorax.

Tim Hackett D.V.M., M.S. Pneumothorax Diplomate, American College of Veterinary Emergency & Critical Care Simple pneumothorax occurs when gas accumulates Associate Professor and Small Animal Medical Chief of Staff in the pleural space but pleural pressure does not signif- James L. Voss Veterinary Medical Center icantly exceed atmospheric pressure. Gas can enter the Colorado State University space either from outside the chest wall, as occurs with Fort Collins, CO 80523 bite wounds, sharp objects, or weapons, or via the lung [email protected] through a tear in the lung parenchyma. Small amounts

28 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 of gas cause pleural pressure to increase slightly, but it flail segment, therapy is aimed at relieving pain through remains sub atmospheric during inspiration because it is analgesics and local blocks, supplemental oxygen, and in equilibrium with the negative alveolar pressure. Al- supportive measures while the contused lung heals. though pleural and alveolar pressures become positive As we saw in the last seminar, each trauma patient should during forced expiration, slight separation of the pleural be evaluated in an orderly and systematic manner. Inju- spaces does not compromise ventilation. If the pneu- ries that interfere with vital physiological functions should mothorax is small and the pleural leak seals itself, the receive the highest priority. These are injuries that in- gas will be absorbed as a result of partial pressure differ- volve the respiratory system, cardiovascular system, or ences between gas in the pleural space and in the blood. neurological system. Serious injuries that are not imme- Tension pneumothorax is characterized by a progressive diately life threatening includes: fractures, luxations, and increase in pleural pressure sufficient to impair circula- intra-abdominal injuries (ruptured spleen, liver or dam- tion. This occurs as gas enters the pleural space and age to the urological system). Minor injuries may merely remains there during expiration because tissue or fluid require observation, monitoring, and serial evaluations occludes the pulmonary parenchyma. While tension pneu- to assure they do not slip to a more serious status. mothorax can occur during spontaneous negative pressure inspiration, it is more likely with intubated patients receiving positive pressure ventilation. The accumulating Initial Assessment gas not only collapses the lungs but also interferes with Using our standard triage scheme, the initial assess- venous return to the right atrium. Thoracocentesis is ment of the trauma patient identifies life-threatening phys- preferred in the initial evaluation of thoracic injury. With iological injuries. Whenever a problem is identified im- a 20-gauge needle attached to an intravenous extension mediate therapy is begun. This "primary survey” follows set, 3-way stopcock, and 60 ml syringe, one will aspirate the ABC (and D's) of triage and resuscitation (see the air, fluid, or both. It is advisable to aspirate from both first lecture “The Critical Cat”) right and left sides of the thorax. Management of the life-threatening problems identi- A thoracostomy tube allows rapid, continuous evacu- fied during the primary survey is continued as shock ther- ation of air or fluid from the pleural space. If it becomes apy begins. The secondary survey identifies all other prob- necessary to use needle thoracocentesis more than twice lems related to the trauma. The entire animal's body is to alleviate dyspnea, placement of the thoracostomy tube examined again from head to toe. Necessary diagnostic is necessary. Before placing the tube, a sterile prepara- samples are collected and submitted. Only when the pa- tion of the thorax is provided. Insertion is best accom- tient is stable are indicated radiographs taken. In-depth plished with a stylet enclosed in the tube in order to avoid management of the patient's less life-threatening injuries unnecessary dissection of subcutaneous tissues the tho- is undertaken in the definitive care phase. The fractures racostomy tube can be either intermittently drained with are stabilized, and careful inspection for "hidden" injuries a syringe, or continuously evacuated using controlled is begun. suction. Intermittent syringe evacuation is the only way to quantify the volume of air removed. Abdominal Trauma The thoracostomy tube is removed when the pleural Abdominal injuries are occult. Injuries caused by blunt leak has sealed and the lungs have re-expanded and/or trauma include lacerations of the liver and/or spleen, uro- when fluid drainage has decreased in blunt trauma this is logical trauma, infarcted bowel, or reproductive organ usually one to three days. Physical examination and chest damage during pregnancy. Penetrating injuries from gun- roentgenograms are used to determine suitability of drain shot, impalement injuries, and bite wounds are more removal. Additionally, daily cytological evaluation of the obvious. The wounding potential of missiles is related thoracic effluent should be monitored for incidence of both to velocity and mass of the bullet. High velocity infection. missiles produce cavitation within the abdomen that is sufficiently energetic to disrupt hollow organs, break Fractured Ribs bones and spread contamination. Physical examination Rib fractures are painful and limit diaphragmatic and findings and diagnostic studies are required in deciding chest wall motion. Failure to adequately expand the lungs which abdomen should be surgically explored following results in atelectasis of the underlying lung and hypox- penetrating injury. This decision is generally based upon emia. Flail chest occurs when three or more ribs, or the signs of peritoneal penetration, unexplained shock, ileus, junction of ribs and the sternum, are each fractured at organ evisceration, free gas on radiographic examination two points. This results in paradoxical inward move- or evidence of bacteria or plant debris following abdom- ment of the flail segment during inspiration when the inocentesis or peritoneal lavage. Blunt abdominal trau- rest of the thoracic cage expands. Because the hypox- ma cases are challenging diagnostic problems because emia associated with flail chest results from atelectasis the clinical manifestations may be delayed for hours or due to pain and contusions of the lung underlying the days. Abdominal tenderness is an important clinical signs

29 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 of peritoneal irritation by blood or intestinal contents. Less life-threatening emergencies Ultrasound is the most sensitive means to identify and Fractures and luxations of the bony pelvis and ex- locate peritoneal fluid. If unavailable, a four quadrant ab- tremities are not considered life-threatening emergencies. dominocentesis is our preferred means for confirming Of greater importance is the damage to associated neu- blunt abdominal injury. From the fluid obtained, a packed ral, vascular, and soft tissues surrounding these bony cell volume, total solids, cytology, billirubin, and creati- injuries. In fractures of long bones, blood loss may ex- nine can be evaluated. If the packed cell volume of cen- ceed 25% of the total blood volume. This blood is often tesis fluid exceeds the peripheral packed cell volume, very not obviously lost but rather sequestered about a frac- likely there is either a splenic, hepatic or renal parenchy- ture site. mal laceration. In the dog or cat our approach is to treat Fractures are classified as either open or closed. Most these patients as conservatively as possible. With an ab- closed fractures pose no immediate threat should remain dominal pressure bandage and individualized fluids ther- partially exposed for assessment of color, pain, swelling, apy, it is unusual to require surgery for a splenic or he- discharge, odor, and temperature. Open fractures require patic laceration. Caution should be employed in applying a thorough cleansing and covering of the wound along an excessively tight bandage when thoracic injuries are with appropriate antimicrobial therapy. Contaminated also present. wounds should be cultured to life and definitive repair is With major biliary tree or common bile duct injury, generally delayed at least 24 hours. Application of a splint the clinical signs of icterus are often delayed 4 to 6 weeks. will relieve pain, lessen additional swelling of the limb, If the abdominal fluid bilirubin is approximately 30 times and prevent a closed fracture from becoming an open greater than peripheral bilirubin, then surgical explorato- fracture. The principle of immobilization of the joint above ry will be required to close the lacerated organ and lav- and the joint below the fracture decreases the usefulness age the abdomen. This surgery is not considered an of splints in animals. In splinting, the toes with antimi- emergency procedure. With urological injury, the packed crobial sensitivity performed. The last step in the emer- cell volume of the abdominal fluid will be lower than the gency management of the open fracture is the applica- peripheral packed cell volume due to hemodilution with tion of sterile gauze and immobilization if possible. urine. The diagnosis is confirmed by comparison of ab- Bite wounds, gunshot wounds, and wounds with dominal fluid urine nitrogen or creatinine to peripheral massive contusions should not be closed. Early closure blood values collected at the time of the abdominocente- of these wounds generally results in disruption and pro- sis. longed convalescence. Definitive fracture treatment is Emergency management of intraperitoneal rupture of undertaken after the animal is stabilized. the bladder, urethra, and/or ureters involves drainage of Luxation of joints requires use of principles described the abdominal fluid via an indwelling catheter until the for fractures. Most joint luxations are closed and are patient is sufficiently stable to undergo anesthesia and easily managed. Following resolution of shock, the lux- surgical repair. Prior to surgery, contrast studies of the ation is reduced and ligamentous damage investigated to kidneys, ureter, and bladder should be performed to as- ascertain the necessity for open repair. sess the severity of injury using an excretory urogram. If there is evidence of lower urinary tract injury, positive contrast urethrography and cystography may be necessary. If plant debris or significant numbers of mixed bacteria be found with centesis of the abdominal fluid, a ruptured viscus is likely and exploratory surgery is indicated. Use of peritoneal lavage for diagnosis of abdominal injury should be considered if abdominocentesis is negative. If no blood, bile, urine or intestinal fluid can be aspirated, the abdominal fluid is irrigated with 10 to 20 ml/kg of warmed crystalloid fluid. If feasible, the patient is moved from side to side to assure the fluid reaches all areas of the abdominal cavity. The fluid is then allowed to drain via gravity.

30 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Practical use of hormones in feline reproduction

Stefano Romagnoli

As with other species, the use of hormonal compounds in cats requires a thorough understanding of the physiology of reproduction, which will be briefly reviewed here. The onset of puberty in the cat occurs from 4 to 12 months of age depending on season, day length, body weight and breed. However, onset of puberty as late as 18-21 months of age is reported for Persian and long haired queens (Table 1). In cats, there is a critical weight which has to be reached (2/3 of the adult body weight, or 2.3-2.5 kg) before puberty is attained. Furthermore, if the critical age and weight are reached during the period of decreased day-length, the onset of puberty will be further delayed.

Breed N° of queens Mean Range Abissinian 8 11.3 7.0-14.0 Birman 7 11.3 10.0-18.0 Burmese 45 7.7 4.0-19.0 Colourpoint 6 13.0 9.0-18.0 Hymalaian 33 9.6 4.0-16.0 Manx 7 12.4 9.0-18.0 Persian 40 11.2 6.0-21.0 Siamese 20 9.3 4.0-20.0 Other breeds (long –haired) 17 11.0 6.0-18.0 Other breeds (short -haired) 19 9.4 4.5-15.0

Table 1 – Breed, number of females considered, age at puberty in months and range for some breeds of queens (modified from Jemmet & Evans, 1977, and Povey, 1978)

The feline reproductive cycle is divided into proestrus, estrus, postestrus, diestrus and anestrus. Proestrus is indicated by continuous rubbing of the head and neck against any object, some vocalization but refusal of mating, and it is reported to be very short and often not observed (Shille et al., 1979). It lasts an average of 1.2+0.8 days. Estrus behaviour in the queen, as in other mammals, is indicative of receptivity to mating, and is characterized by signs which are similar to those of proestrus but more intense, more frequent vocalizing, Stefano Romagnoli, DVM, MS, PhD, Dipl. ECAR crouching with the forequarters pressed to the ground President, European Board of Veterinary Specialisation and hyperextension of the back which causes lordosis, so that the vulva is presented for mating. Unlike canine Dept. of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Agripolis, Legnaro, 35020 (PD) estrus which begins with decreasing serum estradiol con- University of Padova, Italy centrations, estrus in the queen occurs at peak follicular [email protected] activity. Feline ovulation is induced by LH released from

31 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 the pituitary in response to a neural reflex originating when the queen mates), but rather to look for vaginal from the vagina stimulated by the Tom’s penis. Occur- epithelial cornification in cases of silent or prolonged heat. rence of ovulation does not shorten duration of estrus During the follicular phase estradiol concentration in- which averages 8.5+4.2 days (range 2-19 days) in bred creases rapidly from 12-15 pg/ml during proestrus to 25 queens (regardless of whether or not follicle(s) ovulat- pg/ml on the first day of estrus, then up to >70 pg/ml ed). Instead, absence of coitus is associated with a shorter within the following 4-6 days, then down to 20-25 pg/ml duration of estrual behaviour (6.2+2.9 days). The length on the following 1-2 days and finally reaches 10-15 pg/ of estrus may vary depending on the season, with longer ml (a concentration typical of postestrus) between 7 and duration in the Spring (5-14 days) as opposed to other 10 days after the onset of estrus. seasons (1-6 days). The number of follicles ovulating has been related to the number of matings, with one Induction of oestrus and ovulation mating/estrus not being sufficient to cause ovulation in up to 50% of bred females, and >4 matings/estrus being Oestrus induction in the queen is commonly achieved associated with high numbers of follicles ovulating (Con- using PMSG. A variety of different treatments have been cannon et al., 1980; Romagnoli, 2005). used as shown in Table 2, but PMSG at the dose of 100- 150 IU a single time followed by 50-100 IU of hCG 5-7 days later is the protocol that consistently has given the The term Postestrus has been used to indicate the stage best results. Some efficacy of the antiprolactinics has which follows one estrus and precede the next in queens been claimed, but not substantiated so far. Although which did not ovulate (Lofstedt, 1982). The term me- prolactin does not seem to play a role in determining testrus is sometime used, but may be a source of confu- feline anestrus, clinical evidence indicates that in previ- sion as it indicates a phase of corpus luteum develop- ously fertile queens prolonged use of cabergoline results ment which does not occur in non-ovulating queens. in oestrus induction. This is in line with the observation Queens that ovulate show evidence of corpus luteum that in the bitch the lowering of prolactin due to the use development, therefore going through a normal Diestrus of antiprolactinic drugs is not always followed by induc- whose length varies depending on occurrence of con- tion of oestrus (Okkens et al., 1997). No information is ception. Diestrus lasts approximately 35-45 days in non- available on the use of cabergoline in queens with prima- pregnant queens, and approximately 60 days in pregnant ry anoestrus. queens. Following luteolysis, cyclicity resumes with a 7- 10 days delay both in pregnant and non-pregnant females, although lactation and suckling may inhibit resumption On day 2 of induced oestrus, hCG (100 IU) or GnRH (50 of cyclicity for 2-3 weeks post-weaning. Queens exposed mcg gonadorelin, or 0.8 µg buserelin) should be injected to natural photoperiod undergo Anestrus, a phase of re- intramuscularly (IM) before mating. However, patholog- productive quiescence, during late Fall and early Winter ical conditions like illness (progesterone-producing ova- (October-December). rian cysts), inadequate animal husbandry and feeding as well as too young age have to be excluded before medical induction of oestrus and ovulation. Induction of ovu- As in the canine, the feline estrus cycle can be easily lation may be necessary in case of permanent oestrus, staged with vaginal cytology. Exfoliated vaginal epithelial for induction of pseudopregnancy to prolong the inte- cells can be collected with a saline-moistened cotton- roestrus interval or in case of artificial insemination. In tipped swab gently inserted for approximately 2 cm into these cases, ovulation can be induced by IM or SC injec- the vagina and then rolled onto a glass slide; or by flush- tion of hCG or GnRH (at the above dosages) when the ing 0.5 cc of saline into the vagina with a Papanicolau- queen is in oestrus or also by slightly rubbing a cotton type pipette, placing a drop of vaginal fluid on glass slide swab at the vaginal mucosa to achieve vaginal stimula- and then smearing it. Any of the Romanowsky-type stains tion and to induce a LH surge mimicking the mating of a can be used satisfactorily (Giemsa, Wright’s, New me- tom. It may be necessary to repeat this procedure sever- htylene blue, Leishman blue, Diff-Quik) to stain feline al times to get sufficient LH concentrations to induce vaginal smears whose patters do not differ greatly from ovulation. those of the bitch. Percentage of anuclear squames is reported to be 10% on the first day of estrus, and to increase to 40% on the fourth day of estrus, with the percentage of intermediate cells falling from 40% to 10% during the same period (Shille et al., 1979). Although easy to perform also in felines, vaginal cytology is not routinely used in queens to stage the estrous cycle (ovulation does not need to be identified as it generally occurs

32 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Protocol Dosage Reference PMSG 100-1000 IU, 5-7 d Cline et al., Lab An Sci 1003, 1980 PMSG+hCG 100-150 IU on day 1 + 50-100 IU on day 5-7 Cline et al., Lab An Sci 1003, 1980; Donoghue et al., Biol Reprod 46:972, 1992; Swanson et al., Biol Reprod 57:295, 1997 FSH+hCG 2 mg/day 4-5 days + 50-250 IU Dresser et al., Therio 28:915, 1987 FSHp+hCG 2 mg on day 1, 0.5-1.0 mg days 2-5 + 50-250 IU Tsutsui et al., Jap J Vet Sci 51:677, 1989 huFSH + hCG 7.5 or 15 IU days 1-4 + 100 IU on day 4.5 Orosz et al., Therio 37:993,1992 hMG + hCG 15 IU days 1-5, + 100 IU on day 6.5 Orosz et al., Therio 37:993,1992 FSHp (ultra pure) 2.5-10 mg total dose, in 5 days Verstegen et al., J Reprod Fert Suppl 47:209, 1993 Antiprolactin drugs Cabergoline 5 mg/kg, max 15 days Verstegen, unpublished

Table 2 – Oestrus induction protocols in the queen.

Unwanted pregnancy the blockade of its receptors with antiprogestins, allows opening of the cervix and spontaneous contractions of Unwanted mating in privately owned sexually mature the myometrium. Aglepristone treatment has been prov- outdoor cats is common and detection of pregnancy in en to be safe and effective for early, midterm and late these cats is usually quite late in gestation. Fetal parame- pregnancy termination in the queen. Success rates in ters can be measured by ultrasound to estimate the date queens vary from 100% for early treatment (days 5/6 of parturition.5 However, if a cat is presented immediate- after mating), to ~ 85 % for mid-pregnancy treatment ly after unwanted mating, it should be checked for evi- (days 25 to 33) to <70% for late treatment (days 45). dence of mating (signs of scratching and biting, sperma- Two injections (10-15 mg/kg BW) on consecutive days tozoa in a vaginal smear) first. The use of estrogens caus- are recommended; due to variable success rates following closure of the utero-tubal junction and therefore in- ing midterm or late termination of pregnancy, an ultra- hibiting the transport of the embryo is very effective, but sound examination should be performed to make sure due to the risk of side effects (especially pyometra), in- that abortion is complete. Currently, many authors con- jections are not recommended. Repeated injections of sider the use of aglepristone as the method of choice for prostaglandin F2 alpha (PGF ) for induction of abortion 2α prevention of nidation and mid-term termination of preg- after day 30 have been described with significant side nancy in the queen. effects (salivation, vomiting, diarrhea) and variable success rates (25-75 %, n=4). Dopamine-agonists have been used occasionally in cats for induction of abortion from In cats, antiprogestins can also be used for: day 30 onward, although the available information on 1) open and closed-cervix pyometra – Conservative this drug in the feline is scant. Production of litters by medical treatment of bitches with pyometra can be feral cats was prevented by addition of cabergoline to the achieved with the administration of 10 mg/kg of agle- diet of pregnant females at a dose of 5-15 ug/kg/day for pristone on days 1, 2, 8 and then also 15 and 28 depend- 4-12 days. In a controlled laboratory study, cabergoline ing on the clinical situation in bitches with both open at doses of 1.7 ug/kg given i.m. daily for 5 days, starting cervix and closed-cervix pyometra (Romagnoli et al., at day 30 of pregnancy, induced luteolysis and terminat- 2006). The use of aglepristone should be associated with ed pregnancy in 4 of 5 cats, with negligible side effects. antibiotics if necessary, and can also be associated with In another study, the oral cabergoline formulation, (Ga- PGF provided that cervical opening has occurred. Un- lastopä Ceva-Vetem, Italy) administered per os at a dose published information indicates that the effect of agle- of 15 µg/kg for 4 to 7 days terminated pregnancy in 8 pristone on pyometra in the queen (using the 15 mg/kg cats when started between day 30 and 42, but failed in 2 dose) is probably the same as in dogs. cats when started at day 45. This failure of abortifacient efficacy in late pregnancy is perhaps not surprising, since 2) treatment of feline mammary hypertrophy - Be- the feline placenta is thought to produce progesterone nign mammary hypertrophy is a benign fibroglandular during the last 3 weeks of pregnancy. Emesis was a side proliferation of one or more mammary glands which typ- effect in some animals. ically occurs in young queens at their first luteal phase. The proliferation of the mammary gland is due to an excessive response to the action of progesterone which is The use of antiprogestins was recently proposed for ter- present in presumably normal concentrations in affected mination of the feline pregnancy. As progesterone is nec- animals. Mammary glands will start swelling rapidly and essary for maintenance of pregnancy, its withdrawal or within 2-3 days all glands become very swollen, firm and

33 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 nodular. If left untreated, the problem may disappear on of oestrus, or for suppression of oestrus (starting the its own without any complication in most cases. Treat- treatment after proestrus onset). The following com- ment with prostaglandins or antiprolactinic is not effec- pounds are currently available in various parts of the tive, while removal of ovaries or administration of agle- world: medroxyprogesterone acetate (MPA), megestrol pristone can be curative. When mammary hypertrophy acetate (MA), proligestone (PR), chlormadinone acetate occurs following progestogen administration, signs typ- (CMA) and delmadinone acetate (DMA). From the clinical ically do not subside immediately following neutering or point of view all these products act in the same way withdrawal of progestin therapy (Gorlinger et al 2002). through a block of the production and/or release of GnRH In such cases, surgical removal of persisting nodules from the hypothalamus (Romagnoli and Concannon, should be considered in order to perform histology and 2003). rule out presence of neoplasia. Recently, it was shown that the condition is responsive to aglepristone (Wehrend Medroxyprogesterone acetate (MPA) is a long-acting et al 2001, Gorlinger et al 2002, Meisl et al., 2003), which progestin, developed for human use in the 1960’s and may be an option also for cats treated with long-acting widely available in most countries of the world as a vet- progestogens. Although dose regimens for aglepristone erinary drug for use in dogs and cats (oral formulation) in cats have not been reported, anecdotal treatments with or mostly dogs (depot formulation). As MPA is slowly 15 mg/kg are known to be effective as abortifacients or metabolized by the liver, its effective circulating levels can in case of a pyometra. Dosages for mammary hypertro- be maintained for 3 to 6 months after a single intramus- phy may need to be higher or prolonged in time depend- cular injection. Various treatment regimens have been ing on whether it is a spontaneous disease or if it is due recommended for small animals with the minimum ef- to progestogen administration. Recently, Muphung et al fective dose being approximately 2.0 mg/kg for queens (2009) studied the effect of aglepristone in a group of (Table 3). Higher dosages have been suggested and are queens treated with a high dose of medroxyprogester- occasionally found on drug leaflets in some countries, one acetate (MPA - 50 mg) followed by 2 injections of 10 but their use should be discouraged because of the in- mg/kg aglepristone 3 weeks later. Based on histology creasing risk of side effects at MPA doses > 3.0 mg/kg and immunohistochemistry, no evidence of an effect of in both bitches and queens. MPA should be administered aglepristone on the mammary gland of treated queens in anoestrus, and treatment length should not exceed 2 was present. Lack of effect might be due to the very high years (or 4 injections at 6 month-intervals). The interval dose of MPA used, to the rather low dose of aglepristone from treatment to the first spontaneous oestrus ranges (10 mg/kg instead of 15 mg/kg), to the short treatment from 1.5 to 26 months after the last injection. In some with aglepristone (only 2 injections) or to the long inter- countries MPA is not recommended for use in cats (Jack- val between MPA and aglepristone treatments. son, 1984) 3) Aglepristone has recently been successfully used also for induction of parturition in term bitches. There is no information on such use in queens. Megoestrol acetate (MA) is a short-acting progestin, which is better suited than MPA for temporary postponement and suppression. MA is typically available as an oral for- Control of Reproduction mulation (although parenteral formulations are marketed Surgical contraception is not any longer the only approach in some countries) with dosages varying in the bitch de- requested by owners, as an increasing part of them would pending on the cycle stage: from 0.55 mg/kg/day for 32 appreciate to preserve a cat’s future reproductive poten- days in anoestrus up to a maximum dosage of 2.2 mg/ tial. Furthermore, restrictions are being imposed on sur- kg/day for 8 days in early prooestrus. In anoestrus queens gical castration in an increasing number of countries for it should be given at the dose of 5.0 mg/cat every 2 weeks, ethical reasons and animal welfare legislation. Alterna- while this dosage can be increased to 5.0 mg/cat/day for tive approaches are based on interference with endocrine up to 4 days in case of a breakthrough heat. Dosing of regulatory mechanisms and may include the use of a) injectable MA formulations should be done carefully based progestins causing a negative feedback on the pituitary, on body weight, keeping in mind that no dose response b) GnRH agonist implants leading to a down-regulation data are available to demonstrate what is the most ap- of the hypothalamo-pituitary-gonadal axis and c) melato- propriate protocol for injectable MA in small animals. nin implants. Delmadinone acetate (DA) and Chlormadinone acetate Progestins - Synthetic analogues of progesterone, also (CA) are synthetic progestins whose action on the repro- termed progestins or progestogens, are pharmaceutical ductive and endocrine system is similar to that of MPA compounds commonly used in (dogs and) cats for tem- (they are derivatives of MPA): effectiveness is reportedly porary (starting the treatment shortly before prooestrus good for prolonged postponement of cycle in cats at the onset) or prolonged (starting in anoestrus) postponement dose of 2 mg/cat. Published information on both drugs

34 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 is scant. Post-treatment fertility is reportedly normal for Androgens – Like for progestins, administration of an- both. DA is currently available as a veterinary drug in drogens in the female will suppress gonadotrophin re- some European countries. lease thanks to a negative feedback upon the hypothalamic-pituitary axis. Furthermore, androgen receptors have been identified in oestrogen target tissues and androgen Proligestone (PGS) is the most recent type of progestin administration may cause a decrease in the response of available for use in (dogs and) cats, which has been de- oestrogen function. Natural and synthetic androgens have veloped to selectively act on the hypothalamic-pituitary- been used for the control of oestrus in bitches and queens. gonadal axis with less progestational activity compared These drugs are commonly employed in racing Grey- to other synthetic progestogens. However, based on stud- hound bitches, not only because of their suppressive ef- ies performed in The Netherlands a range of side effects fect on oestrus, but also because of their anabolic ef- has been reported also for this compound (at least in fects. As with progestins, treatment with androgens dogs). The recommended dosage regimen in queens is should be started when the animal is in the first half of 10 mg/kg repeated after 3 and 4 months, and then every anestrus, as delaying its administration until late anoestrus 5 months. Breakthrough heats may occur during treat- may prove ineffective (Kutzler, 2006). In cats, the use of ment, although their incidence has not been studied in androgens is not currently advised due to the incidence bitches or queens. Table 3 shows the suggested dosag- of side effects (on which, however, there is little if any es of the most commonly used progestogen-based com- scientific data available). There is no information on the pounds in the queen. efficacy and safety of testosterone in cats, and mibolerone is not recommended in this species due to the fact that the effective dose (50 µg/day) is close to the toxic dose (60 µg/day).

Suggested Dosage Cat MPA 2.0 mg/kg IM every 5 months MA in anestrus: 5 mg/cat every 2 wk or 2.5 mg/cat/wk PO (better if divided into 2 administrations every 3.5 days) in proestrus: 5 mg/cat/day for 4 days, then 5 mg every 2 wk, PO DA PO: 0.25-0.7 mg/kg, once a week. SC: 2.5-5.0 mg/kg, every 6 months. For oestrus suppression, SC: 0.5-1.0 mg/kg, for 6 days or 2.5-6.75 mg/kg, one or two injections 24 hours apart PGS 10 mg/kg SC every 3, 4, 5, 5 months

Table 3 – Suggested dosages of the 4 most commonly used progestogen compounds in queen for the control of reproduction: MPA = medroxyprogesterone acetate; MA = megestrol acetate; DA = delmadinone acetate; PGS = proligestone

GnRH agonists - A recent development in the field of the Melatonin - The cat is a seasonal breeder (long-day breed- control of reproduction in the queen is the use of longer) influenced by day light with increasing melatonin con- acting GnRH agonists, which have become commercially centrations and decreasing sexual activity following de- available as veterinary drugs in Europe during 2008. Both creasing photoperiod. Exogenous melatonin may mimic deslorelin (Suprelorin, Virbac) and azagly-nafarelin (Go- this effect and has therefore been described in cats for nazon®, Intervet) have proven effective in controlling eline intravenous, subcutaneous and oral administration. Oral reproduction in preliminary trials. Based on ongoing stud- administration of melatonin for 30 to 35 days (given 3 h ies at the University of Padova in adult queens, the 4.7 before lights-off) effectively and reversibly suppressed mg deslorelin implant seems to be effective in inhibiting oestrus without any side effects. Because permanent oral reproductive cyclicity for >12 months, and good efficacy administration is impractical in daily routine and clinical has also been observed in delaying puberty in male and practice, melatonin implants were tested for their effica- female cats implanted at 2-4 months of age. Deslorelin cy in controlling feline reproduction. Whereas melatonin (Suprelorin®, Virbac is currently marketed in Europe for implants containing 12 mg suppressed oestrus in 3 of 4 use in male dogs, therefore its use in queens should be cats only, Gimenez et al showed that 18 g implants (Melo- regarded as extra-label. Azagly-nafarelin is not market- vine®, CEVA Sante Animal, Libourne, France) were highly ed yet anywhere in the world. effective (9/9 cats). Treatment in interoestrus resulted in

35 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 a prolonged duration of efficacy compared to treatment SIDE EFFECTS OF REPRODUCTIVE DRUGS in oestrus (113.3 ± 6.1 days vs. 61.1 ± 6.8 days). Initial The incidence of progestin and androgen side effects oestrus induction for 2-3 days was observed in 3/9 cats appears to be associated with overdosing, a wrong choice (interoestrus) and 7/9 cats (oestrus). Whereas in the of patients and/or administration during stages of the former study one cat suffered from uterine pathology cycle other than anoestrus. For instance, while a dose of after treatment, no side effects were observed in later 2.5 mg/kg of MPA in a young, healthy bitch can be used trials. Regarding fertility all effects are fully reversible and safely for at least 18-24 months (or for 3-4 injections at mating at the end of treatment resulted in pregnancy rates 6-month intervals, provided it is injected in anestrus), a of 75%; so treatment with a melatonin implant seems to dose of 6.0 mg/kg is at risk of causing side effects well offer a new promising alternative for short-term oestrus before 18 months, and a dose of 10 mg/kg will cause cycle control in the queen while preserving future repro- acromegaly and pyometra after an equal or shorter treat- ductive potential. However, further studies with more ment period. Similarly, a dose of 3.0 mg/kg will cause animals are necessary to finally evaluate the risk for side development of benign and malignant mammary tumours effects. in bitches if administered every 3 months for 12 consecutive treatments.

Normal dosage in healthy females Normal dosage in females with subclinical disease, high dosage, or prolonged treatment Delayed onset of parturition Benign and malignant mammary nodules Skin reaction at inoculation sites Cystic endometrial hyperplasia, pyometra Masculinization of female foetuses Acromegaly Behavioral/metabolic changes (decreased libido; increased Diabetes mellitus appetite and body weight; polyuria/ polydipsia) Adrenocortical suppression in cats (using MA) Cushing’s disease

Table 4 – Side effects due to the use of progestins following administration of a) normal dosages in healthy females, or b) normal dosages in females with subclinical disease, normal dosage for too long, or dosages higher than indicated. A reversible adrenocortical suppression is reported in normal cats receiving megoestrol acetate (MA) at dosages of 5.0 mg/cat for 7 to 14 days.

A safe dosage may cause side effects if: a) administered use the same degree of caution when using any proges- in dioestrus (because of the coincident endogenous tin (Table 4). Fertility is generally not affected by the treat- progesterone secretion adding to exogenous administra- ment with progestins, although the endometrial prolifer- tion), b) given to an animal with a pre-existing disease ative action due to these drugs may alter endometrial (such as subclinical cystic endometrial hyperplasia or di- status particularly in prolonged treatments. abetes), or c) administered to a pregnant female (as it will Similarly to progestins, androgens may cause side ef- delay perturition). An example of potential side effects fects if administered at too high dosages, for too long or occurring following a normal or a high dosage of progestins in the wrong patient. Reported side effects for andro- is reported on Table 4. gens following chronic treatment with normal dosage Although side effects have been reported more commonly include the most common clitoral hypertrophy and vagini- for MPA, CA, DA and MA than for PGS, it should be tis, and the less common virilisation, masculinisation of noted that the clinical use of gonadal steroidal compounds female foetuses, body odor, urinary incontinence, urine in dogs and cats started almost 50 years ago, at which spraying, mounting behaviour, cervical dermis thicken- time very little was known on reproductive and endocrine ing and epiphora. Furthermore, overdosing may result in effects of steroids, while PGS has been introduced into anal gland inspissation and resulting odors. Androgens the veterinary market more recently and perhaps used are known to be much less harmful to fertility due to the with more caution and attention to dosages. Reported lack of endometrial proliferation, although endometrial side effects of PGS include pain at the injection site and atrophy may become chronic following prolonged treat- discoloration of the hair; although earlier clinical trials ment. Reproductive side effects following chronic use of have not reported development of uterine disease or mam- mibolerone at efficacious dosages include ovarian fibro- mary tumours when PGS is used at the suggested dose ma, endometrial atrophy and vaginal mucosa atrophy. regimen, no large clinical studies have been performed in Beagles (but not other breeds) treated with mibolerone recent years. PGS can probably be regarded as slightly appear to have a reduced response to ACTH challenge. safer than MPA. However, small animal clinicians should In general, the use of androgens is not recommended in

36 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 the following cases: a) animals intended for future breed- in dioestrus. Heat induction can be a major inconvenience ing; b) young animals (7 months old or younger bitches, for an owner who is requesting control of oestrus for due to early epiphyseal closure); c) Bedlington terriers her/his pet. Such oestrus is normally fertile; therefore, a due to their genetical predisposition to chronic progres- bitch may conceive and become pregnant, but often spon- sive hepatitis; d) pregnant animals; e) animals with an- taneous abortion occurs at mid-pregnancy as soon as drogen dependent neoplasms or with a history of liver or pituitary down-regulation occurs. The surge in proges- kidney diseases terone production may exhacerbate a subclinical uterine GnRH agonists appear to be much less harmful for re- or ovarian condition, as well as delay parturition if treat- productive and general health of bitches and queens when ment is performed during the last trimester of pregnan- compared to gonadal steroids, because of the fact that cy. Induction of heat is not observed when bitches are their action is based on removal of endogenous steroids treated in dioestrus or retreated in anoestrus (when the from the general circulation, thereby eliminating any po- previous implant is still functioning), although break- tential risk of hormonal related conditions. However, these through heats have been observed within the last month compounds may be a source of problems both in terms prior to re-treatment. of owners convenience as well as health risks for the As with all treatments which are supposed to be repeat- female being treated. GnRH agonists provide a powerful ed over time at regular intervals, owner compliance is an stimulus for the pituitary, which is forced to release all its important limiting factor. Failure of owners to bring back reserves of gonadotrophins until down-regulation occurs. their bitches or queens for successive treatments often The interval from treatment to onset of down-regulation accounts for breakthrough heats. Treatment during a may vary from 2 to 4 weeks. During this period, ovarian breakthrough heat should be carefully avoided, as ad- activity and secretion is typically stimulated, which may ministration of any reproductive drug during the follicu- cause induction of heat if the female is treated in anoestrus, lar phase is likely to carry a risk for the female. A list of or a surge in progesterone secretion if treatment occurs effects/side effects of progestins, androgens and GnRH agonists is presented in Table 5.

Effect Progestins Androgens GnRH agonists Increased frequency of GnRH peaks XXX (a) Decreased frequency of GnRH peaks XXX XXX XXX (b) Suppression of ovarian activity XXX XXX XXX (b) Suppression of uterine motility XXX XXX XXX (b) Suppression of adrenocrotical axis XXX Ýncreased secretion of prolactin and growth hormone XXX Ýnsulin resistance XXX Endometrial proliferation and secretion XXX XXX (c) Atrophy of endometrial lining XXX Cervical closure XXX XXX XXX (d) Proliferation of mammary parenchyma XXX XXX (c) Atrophy of mammary parenchyma XXX XXX possible Lactational arrest XXX XXX XXX (possible) Foetal developmental defects XXX XXX Delayed parturition XXX XXX (e) Increased appetite and body weight XXX XXX Vaginitis XXX Increased libido/aggressiveness/mounting behaviour XXX Anabolic effects XXX Physeal closure in prepuberal animals Decreased libido/aggressiveness XXX Clitoral hypertrophy XXX Urinary incontinence/urine spraying XXX Skin decoloration XXX XXX Growth of anal hepatoid glands XXX Thickening of cervical dermis, epiphora XXX Table 5 – The most relevant clinical effects, including side effects, of progestins, androgens and GnRH agonists on the reproductive system, mammary gland, body weight and behaviour of bitches and queens. (a) present only during the first 2-4 weeks following treatment, after which it disappears; (b) present only after the end of the first 2-4 weeks following treatment; (c) present only during the first 2-4 weeks following treatment in bitches implanted with deslorelin during diestrus; (d) this effect is maintained in bitches implanted in anestrus, while it appears at the end of the induced oestrus in bitches treated in anestrus. (e) if implanted during the last trimester of pregnancy

37 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

CLINICAL CONSIDERATIONS FOR A SAFE USE OF REPRODUCTIVE DRUGS IN QUEENS The ideal candidate for a progestin or androgen treat- In general, a progestin or androgen treatment period of ment is an adult postpuberal female in anestrus, while 12-18 months is considered adequate in most patients, the ideal candidate for treatment with a GnRH agonist is although longer treatments can also be safe provided that an adult postpuberal female in diestrus. Before a female the female is given a thorough clinical check as described is treated with long acting compounds she should be above (a-d) prior to each treatment. While most bitches evaluated for normality of uterine and mammary condi- and queens may tolerate well treatment periods of more tions as well as of glucose metabolism. A minimum da- than 12-18 and up to 24 months, animals with a pre- tabase of clinical information to be gathered prior to ad- existing disease such as subclinical diabetes, small mam- ministering a long-acting compound should include a) mary nodules or cystic endometrial hyperplasia may see collecting a thorough reproductive history to rule out their condition worsen rapidly as a result of a progestin occurrence of estrus within the last 1-2 months (which treatment, or may experience a temporary worsening in would mean that the queen might have ovulated and there- case of treatment with a GnRH agonist in diestrus. A fore she might be in diestrus); b) a complete clinical exam; series of considerations on patient selection and type of c) palpation of the mammary gland to rule out presence presenting complaint for which a progestin treatment of mammary nodules; d) a vaginal smear to rule out pres- should or should not be used is presented (Table 6). ence of oestrus. Also, if heat occurred within the last 2 months it would be appropriate to wait a few more weeks or assay progesterone to rule out diestrus.

Do not use progestins … as this may cause In pre-puberal queens (depot compounds) feline mammary hyperplasia (a) In pregnant females fetal development defects or delayed parturition In pseudopregnant bitches pseudopregnancy to relapse and become chronic During diestrus side effects due to to overdosing (b) In females with vaginal haemorrhage Worsening of underlying condition (c) In diabetic patients Worsening of underlying condition (d) In bitches with prolonged heat Worsening of underlying condition (e)

Table 6 – Potential side effects due to the use of progestins at normal dosages depending on patient selection. (a) in prepuberal queens it is best to use initially a short acting compound (such as MA) per os for 1-2 weeks and then change to a long acting progestin once potential side effects have been ruled out. (b) the stage of the reproductive cycle should always be identified using vaginal cytology and/or serum progesterone assay, and the bitch or queen should best be treated during anestrus; diestrus should be ruled out in felines too, as 30-60% of queens ovulate spontaneously, maintaining thereafter a 30-45 day-long diestrus. (c) prolonged sanguineous vulvar discharge following parturition in the bitch can be a critical problem which should either be treated with a uterine contractive drug (i.e. as ergonovine) or sent to surgery. Milder bloody vulvar discharge can be caused by uterine neoplasia, cystic endometrial hyperplasia with superimposed endometrial inflammation, pyometra, metritis, none of which conditions will benefit from administration of a progestin. (d) although not always necessary, it would be wise to measure blood glucose before and/or after a prolonged treatment to confirm health status with regard to glucose metabolism. (e) a prolonged heat may be due to ovarian cyst/s, a granulosa cell tumor, or may be due to a split heat (in the bitch) or to a misinterpretation of normal estrous signs by the owner. For none of these categories is a progestin treatment indicated.

38 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Literature and Suggested Readings on Control of Reproduction Banks DR, Stabenfeldt G (1982) Luteinizing hormone release in the cat in response to coitus on consecutive days of estrus. Biology of Reproduction 26, 603-611 Chakraborty PK, Wildt DE, Seager SWJ: Serum luteinizing hormone and ovulatory response to luteinizing hormone releasing hormone in the estrous and anestrous domestic cat.. Lab An Sci 29:338-344, 1979 Concannon PW, Hodgson B, Lein D: Reflex LH release in estrous cats following single and multiple copulations. Biol Reprod 23:111- 117, 1980 Erünal-Maral N, Aslan S, Findik M, Yüksel N, Handler J, Arbeiter K. Induction of abortion in queens by administration of cabergolin

(Galastop TM) solely or in combination with the PGF2α analogue Alfaprostol (Gabbrosim TM). Theriogenology 2004;61:1471-5. Fieni F, Martal J, Marnet PG, Siliart B, Guittot F. Clinical, biological and hormonal study of mid-pregnancy termination in cats with aglepristone. Theriogenology 2006;66:1721-8. Findik M, Maral NE, Aslan S. The use of proligestone, megestrol acetate and GnRH on queens with the aim of hormonal contraception. Turk J Vet Anim Sci 1999;23 (Suppl 3):455-9. Goericke-Pesch S, Georgiev P, Wehrend A. Prevention of pregnancy in cats using aglepristone on days 5 and 6 after mating. Theriogenol- ogy 2010, accepted Georgiev P, Wehrend A. Mid-gestation pregnancy termination by the progesterone antagonist aglepristone in queens. Theriogenology 2006;65:1401-6. Georgiev P, Bostedt H, Goericke-Pesch S et al. Induction of abortion with Aglepristone in cats on day 45 and 46 after mating. Reprod Dom Anim 2009; doi: 10.1111/j.1439-0531.2009.01540.x, ISSN 0936-6768 Gimenez F, Stornelli MC, Tittarelli CM et al. Suppression of estrus in cats with melatonin implants. Theriogenology 2009;72:493-499. Gorlinger S, Kooistra HS, van den Broek A, Okkens AC - Treatment of fibroadenomatous hyperplasia in cats with aglepristone. Journal of Veterinary Internal Medicine 16, 710-713. 2002 Graham LH, Swanson WF, Wildt DE, Brown JL. Influence of oral melatonin on natural and gonadotropin-induced ovarian function in the domestic cat. Theriogenology 2004;61:1061–76. Gudermuth DF, Newton L, Daels P, Concannon P. Incidence of spontaneous ovulation in young, group-housed cats based on serum and faecal concentrations of progesterone. J Reprod Fertil 1997;51 (Suppl 1):177-84. Henik RA, Olson PN, Rosychuk RA. Progestagen therapy in cats. Compend Cont Educ 1987;7:132-41 Kutzler MA. Estrus induction and synchronization in canids and felids. Theriogenology 2007;68:354–74 Kutzler M, Wood A. Non-surgical methods of contraception and sterilization. Theriogenology 2006;66:514-25. Jöchle W, Jöchle M. Reproduction in a feral cat population and its control with a prolactin inhibitor, cabergoline. J Reprod Fertil 1993;47:419-24. Johnston SD, Kustritz MVR, Olson PNS. Prevention and termination of feline pregnancy. In: Johnston SD, Kustritz MVR, Olson PNS, eds., Canine and Feline Theriogenology. Philadelphia, London, New York, St Louis, Sydney, Toronto: W. B. Saunders Company, 2001: 414-30. Loretti AP, Ilha MR, Ordas J, Martin de las Mulas J. Clinical, pathological and immunohistochemical study of feline mammary fibroepithelial hyperplasia following a single injection of depot medroxyprogesterone acetate. J Feline Med Surg 2005;7:43–52. Lofstedt RM: The estrous cycle of the domestic cat. Compend Cont Ed Pract Vet 4:52-58, 1982 Michael RP – Observation upon the sexual behaviour of the domestic cat (Felis catus L.) under laboratory conditions. Behaviour 8: 1-23, 1961 Meisl D, Hubler M, Arnold S - Treatment of fibroepithelial hyperplasia (FEH) of the mammary gland in the cat with progesterone antagonist Aglepristone (Alizine). Schweiz Arch Tierheikd 145, 130-136. 2003 Muphung W, Rungsipipat A, Chatdarong K – Effects of the antiprogestin aglepristone on the uterine tissue of cats administered medroxyprogesterone acetate. Reprod Dom Anim 44 (Suppl 2):204-207, 2009 Middleton DJ, Watson AD, Howe CJ, Caterson ID. Suppression of cortisol responses to exogenous adrenocorticotrophic hormone, and the occurrence of side effects attributable to glucocorticoid excess, in cats during therapy with megestrol acetate and prednisolone. Can J Vet Res 1987; 51:60-5. Munson L, Bauman JE, Asa CS, Jöchle W, Trigg TE. Efficacy of the GnRH analogue deslorelin for suppression of oestrous cycles in cats. J Reprod Fertil 2001;57 (Suppl 1):269-73. Onclin K, Verstegen J. Termination of pregnancy in cats using a combination of cabergoline, a new dopamine agonist, and a synthetic PGF2α, cloprostenol. J Reprod Suppl 1997;51 (Suppl):259-63. Robinson R, Cox HW – Reproductive performance in a cat colony over a 10 year period. Lab Anim Sci 4: 99-112, 1970 Romagnoli S, Concannon P W. Clinical use of progestins in bitches and queens: a review. In: Concannon PW, England G, Verstegen J, Linde-Forsberg C, eds., Recent Advances in Small Animal Reproduction. International Veterinary Information Service, Ithaca NY (www.ivis.org) Romagnoli S – Failure to conceive in the queen. Journal of Feline Medicine and Surgery. 7 (1): 59-64, 2005 Root MV, Johnston SD, Olson PN. Estrous length, pregnancy rate, gestation and parturition lengths, litter size, and juvenile mortality in the domestic cat. J Am Anim Hosp Assoc 1995;31:429–33. Rubion S, Driancourt MA. Controlled delivery of a GnRH agonist by a silastic implant (Gonazon) results in long-term contraception in queens. Reprod Domest Anim 2009;44 (Suppl 2):79-82. Saxena BB, Clavio A, Singh M, Rathnam P, Bukharovich EY, Reimers TJ Jr, Saxena A, Perkins S (2003). Effect of immunization with bovine luteinizing hormone receptor on ovarian function in cats. Am J Vet Res 2003;64:292-8. Shille VM, Lundstrom KE, Stabendfeldt GM: Follicular function in the domestic cat as determined by estradiol 17? concentrations in plasma: relation to estrous behaviour and cornification of exfoliated vaginal epithelium. Biol Reprod 6:953-963, 1979 Shille VM. Mismating and termination of pregnancy. Vet Clin North Am Small Anim Pract 1982;12:99-106. Verstegen J P, Onclin K, Silva LDM, Donnay I. Abortion induction in the cat using prostaglandin F2 alpha and a new anti-prolactinic agent cabergoline. J Reprod Fertil 1993;47 (Suppl):411-7. Wehrend A, Hospes R, Gruber AD. Treatment of feline mammary fibroadenomatous hyperplasia with a progesterone-antagonist. Vet Rec 2001;148:346-7. Wildt DE, Guthrie SC, Seager SWJ: Ovarian and behavioural cyclicity of the laboratory maintained cat. Horm Behav 10:251-257, 1978 Wildt DE, Seager SWJ, Chakraborty PK. Effect of copulatory stimuli on incidence of ovulation and on serum luteinizing hormone in the cat. Endocrinology 1980;107:1212–7. (A)

39 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Ovarian remnant syndrome in the queen: clinical approach to a surgeon’s dilemma

Stefano Romagnoli

Introduction tery or lateral abdominal wall (queen). Cyclic signs of proestrus and estrus can be observed in bitches under- The term Ovarian Remnant Syndrome (ORS) describes going such a surgical treatment (Leroux and Venderwalt, occurrence of heat after ovariectomy or ovariohysterec- 1977). In the queen, ovarian remnants experimentally tomy in the bitch or queen which can be due to the pres- sutured or left free into the abdomen can revascularize ence of residual ovarian tissue not completely removed and become active in follicular growth in about 90% of at surgery, or to the presence of a partial or complete cases (Shemwell and Weed, 1970; DeNardo et al., 2001). separation of normal ovarian tissue during development In women, failure to perform a complete removal of the on the broad ligament (Wallace, 1991; Johnston et al., ovary may be due to presence of inflammation of the 1996; Prats, 2001). As presence of ovarian tissue on the ovary, ovarian bursa or periovarian tissues at time of sur- broad ligament has been reported only in the queen and gery. However, this is rarely the case in small animal only anecdotally (Bloom, 1954; Stein, 1975), the ORS medicine as bitches and queen are generally spayed elec- should not be considered as ovarian pathology but rather tively as young individuals with little of any chance of as a surgical complication of ovariectomy or ovariohys- presence of inflammation in the ovarian or periovarian terectomy (Pearson, 1973). When performing an elective tissues. ovariectomy or ovariohysterectomy, the surgeon should always look very carefully the broad ligament around the ovary to rule out presence of abnormal ovarian tissue in A practical approach to diagnosis of ovarian this location. A supernumerary ovary as such is thought remnants to be extremely rare and has never been reported so far. Queens and bitches with ORS may display signs of Single or double, monolateral or bilateral nodules in the proestrus or estrus at regular or irregular intervals. Signs broad ligament near the ovary are occasionally encoun- of heat generally appear within weeks to months follow- tered in the queen, but they are generally adrenocortical ing surgery, although occasionally the delay may be longer tissue which is of no clinical significance in the cat. (several months to 1-2 years). Estrous signs are often A less common cause of ORS can be a piece of ovarian characterized by the normal sequence of physical chang- tissue accidentally dropped into the abdominal cavity dur- es typical of proestrus and oestrus (male attractiveness ing surgery. Such pieces of tissue can establish vascular and acceptance, cornified vaginal smear, vulvar swelling connections with the omentum or the serosa of abdom- and discharge in the bitch). Breeding can be observed inal viscera, and become active again thus allowing ova- normally although pregnancy will not occur. Bitches with rian follicles to grow and reach the preovulatory stage. an ORS may exhibit signs of false pregnancy several weeks Revascularization of ovarian tissue following ovariecto- to a few months following estrous behaviour, or the false my has been reproduced experimentally by suturing a pregnancy may even be the only sign if estrus was silent. sliced fragment of ovary in a serosal pouch of the stom- One bitch showing signs of estrus 7 years after ovario- ach or under the splenic capsule (bitch), or to the mesen- hysterectomy was reported to have a granulosa cell tumor on the ovarian remnant (Pluhar et al., 1995). In a Stefano Romagnoli, DVM, MS, PhD, Dipl. ECAR report describing 11 cases in the cat the interval between President, European Board of Veterinary Specialisation surgery and return to estrus was 17 days to 9 years with an average of 2 years (Wallace, 1991). In one case chron- Dept. of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Agripolis, Legnaro, 35020 (PD) ic vaginitis was the presenting complaint for a toy poodle University of Padova, Italy bitch with an ORS (Perkins and Frazer, 1995). In order to [email protected] advance the diagnosis or plan a diagnostic approach es-

40 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 trus can be induced in both bitches and queens by oral both ovarian pedicles or the caudal poles of both kidney administration of cabergoline at the dose of 5 mg/kg dai- should be thoroughly checked at surgery. If nothing can ly (1.0 cc of the commercial product per 10 kg of body be identified upon visual inspection at this time a vast weight) for 3-4 weeks, starting in anestrus (Prats, 2001). excision of scar tissue around the ovarian pedicle/s should Diagnosis of ORS requires confirmation of presence of be performed and all tissues submitted for histopatholo- residual ovarian tissue through observation of a cornified gy. Remnants of ovarian tissue are almost always found vaginal smear in a spayed female. Assaying serum estra- around the ovarian pedicle/s (Miller, 1995; Johnston et diol may not be helpful as estradiol is secreted in a pulsa- al., 1996). Therefore it is not necessary to perform a tile manner, thus making confirmation of high serum lev- long and exhaustive search of the entire abdominal cavi- els often impossible on just a single serum sample. Vag- ty, although the broad ligament should always be checked inal cytology is more useful, although occasionally it may as accessory ovarian tissue might be present there to- not be fully consistent with estrus (Wallace, 1991). The gether with an ovarian remnant. Removal of an ovarian vaginal smear should be collected when the female shows remnant in diestrus in a bitch may induce pseudopreng- signs of heat as reported by the owner. A degree of nancy. cornification >50% indicates that an estrogen source The only other option would be a life-long treatment with somewhere within the organism is targeting the vaginal a progestogen, which is not advisable for its side effects epithelium. If the ovary is ruled out, the only other es- and because of practical implications (twice yearly injec- trogen source is the adrenal glands. However, adrenals tions, costs etc.). A more recent alternative, still not com- are not known to be able to secrete estrogens in quanti- mercially available, would be the use of long acting GnRH ties enough to cause recurrent and cyclic estrous signs. superagonists such as Deslorelin (Romagnoli et al., 2009). Ovulation induction is of pivotal importance in the queen This compound is reported to inhibit the hypothalamic- and can be performed in the bitch as well (although less pituitary release of LH and FSH for up to one year in crucial in this species) using GnRH at 25-50 mg/queen dogs and cats, therefore preventing estrus in bitches and or 2.2 mcg/kg in the bitch, or hCG at 250-500 IU in the queens without causing any of the progestogen or ste- queen or at 50 IU/kg in the bitch (England, 1997; Prats, roid-related side effects. Deslorelin comes in small cylin- 2001). Serum progesterone should be assayed on blood drical oil-based implants the size of a microchip, which sample collected 2 weeks after heat/induction of ovula- are to be placed in the subcutaneous space. Animals have tion. been re-implanted after the first year with prolonged ef- Differential diagnosis of ORS includes all those condi- fect and no negative consequences. Preliminary data from tions responsible for vulvar swelling and discharge in the our laboratory indicate that prolonged use of deslorelin spayed bitch, or for estrous behaviour and breeding ac- in queens may be a viable option (Romagnoli et al., un- ceptance in the spayed queen, such as: vaginal or uterine published observations). (if only ovariectomy was performed) neoplasia, vaginitis, When discussing therapeutic options for a case of ORS uterine stump pyometra, exogenous estrogen therapy, with a client, it is important to highlight the fact that trauma, coagulopathy. Abdominal ultrasound or radiog- recurrence of estrus after spaying is a common problem raphy are not considered useful techniques in cases of especially in queens (Miller, 1995) and it is not related to ORS because of the small size of the ovarian fragment ability of the surgeon or conditions of the animal: no and the fact that tissue reaction around ovarian pedicle/s correlation was found between occurrence of ORS and often prevents recognition of an ovarian remnant unless any of the following patterns in the bitch: age of the dog an exploratory laparotomy is performed. Even on explor- at spaying, breed, difficulty of surgery (elective vs non- atory lapatoromy it may be difficult to recognize a small elective) physical conditions of the bitch (normal weight piece of pinkish/red tissue among viscera, unless one or vs obese) or ability of the veterinary surgeon (newly grad- more follicles or corpora lutea are present. For this rea- uate vs experienced veterinarian) (Wallace, 1991). son it is very important that surgery is not attempted unless a fully cornified vaginal smear is present or serum progesterone has risen to concentrations >2.0 in the bitch, or >1.5 ng/ml in the queen. A serum progesterone concentration above the threshold is indicative of presence of luteal tissue which is easily identified (more easily than follicles) because of its yellowish colour.

How to eliminate an ovarian remnant Exploratory laparotomy is the treatment of choice. As ovarian remnants can be present on one or both ovaries,

41 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

References Bloom F – Pathology of the dog and cat. Evanston, IL. American Veterinary Publications, Inc, 1954 DeNardo GA, Becker K, Brown NO, Dobbins S – Ovarian remnant syndrome: revascularization of free-floating ovarian tissue in the feline abdominal cavity. J Am An Hosp Assoc 37:290-296, 2001 England GCW – Confirmation of ovarian remnant syndrome in the queen using hCG administration. Vet Rec 141:309-310, 1997 Johnston SD, Root MV, Olson PNS – Ovarian and testicular function in the domestic cat: clinical management of spontaneous reproductive disease. Anim Reprod Sci 42:261-274, 1996 Leroux PH, Venderwalt LA – Ovarian autografts as an alternative to ovariectomy in bitches. J South Afr Vet Assoc 48:117-123, 1977 Pearson H – The complications of ovariohysterectomy in the bitch. J Small An Pract 14:257-266, 1977 Perkins NR, Frazer GS – Ovarian remnant syndrome in a toy poodle: a case report. Theriogenology 44:307-312, 1995 Prats A – Ovarian remnant syndrome in the queen. EVSSAR Newsletter, 4 (1):5-8, 2001 Pluhar GE, Memon MA, Wheaton LG – Granulosa cell tumor in an ovariohysterectomized dog. JAVMA 207:1063-1065, 1995 Shemwell RE, Weed JC – Ovarian remnant syndrome. Obstet Gynaecol 36:299-303, 1970 Stein BS – The genital system. In: Feline Medicine and Surgery. Santa Barbara, American Veterinary publications Inc., 1975 Romagnoli S, Stelletta C, Milani C, Gelli D, Falomo ME, Mollo - Clinical use of deslorelin for the control of reproduction in the bitch. Reproduction in Domestic Animals, 2009 vol. 44; p. 36-39, Wallace MS – The ovarian remnant syndrome in the bitch and queen. Vet Clin North Am 21:501-507, 1991

42 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

SR^NO POPUŠ^ANJE IN ARTERIJSKA TROMBOEMBOLIJA PRI MA^KAH

Aleksandra Domanjko Petri~

Sr~no popuš~anje in arterijska tromboembolija sta še ved- Klini~na predstavitev ma~ke v sr~nem no slabo prepoznavni stanji v klini~ni praksi. Zlasti prvo popuš~anju in diferencialne diagnoze se pogosto zamenjuje z drugimi vzroki za dihalne teàve, kar ima pogosto usodne posledice za ìval. Predstavljeni Klini~na slika ma~k v sr~nem popuš~anju je lahko dokaj bodo znaki ter najpogostejše nepravilne interpretacije v razli~na in zavajajo~a, zato klinika pogosto zavede v razmiš- takih primerih, pravilna diagnostika ter terapija zlasti ur- ljanje od drugih mo`nih diferencialnih diagnozah. gentnih stanj, ki je pri ma~ki nekoliko specifi~na. Ma~ka v sr~nem popuš~anju je pogosto tahipnei~na in/ali dispnei~na. Tahipnei~na je praviloma zaradi napredovale- Pogosti vzroki sr~nega popuš~anja pri ga plju~nega edema, dispnei~na pa zaradi plevralnega izliva. Lahko je prisotna kombinacija obojega. Lahko diha z ma~kah odprtim gob~kom in na ta na~in v èlodec nabere veliko Najpogostejši vzroki sr~nega popuš~anja pri ma~ki so zraka, kar je è zavedlo nekatere, da so pomislili na zasuk razli~ne kardiomiopatije – patološka stanja sr~ne mišice. èlodca. Pogost problem pri ma~kah je, da jih interpreti- Poznamo ve~ vrst kardiomiopatij glede na morfologijo, tj. ramo kot pse, kar pa je zavajajo~e. Zavede nas lahko tudi, hipertrofno, restriktivno, dilatacijsko ter desno-prekatno ker pri vseh ma~kah ne slišimo šuma na srcu ali aritmij. aritmogeno.(1) Sam izgled kardiomiopatije se lahko s pro- Nekatere imajo povsem normalni sinusni ritem v okviru gresijo bolezni spremeni, zato obstaja tudi razred nekla- normalnih frekvenc. Kadar pri ma~ki slišimo galopni ritem sificiranih kardiomiopatij. Za hipertrofno kardiomiopatijo ali vsaj rahlo aritmijo je to znamenje, da z njenim srcem vemo, da je genetskega izvora, podobno se sumi za arit- nekaj ni ~isto v redu. (~e pa tega ne slišimo, pa ni nujno mogeno desnostransko kardiomiopatijo. Nekatere sekunda je s srcem vse v redu!) Plju~ni hropci in odsotnost darne kardiomiopatije nastanejo kot posledica nekega šuma lahko koga zavede v razmišljanje o astmati~ni krizi, drugotnega vzroka, taka je dilatacijska, ki je posledica vendar so pri astmi praviloma prisotni piski, lastnik pa pomanjkanja taurina v prehrani. pove, da ma~ka ob~asno kašlja. Kašelj ni zna~ilen za ma~ko Od sekundarnih vzrokov za sr~no popuš~anje pri ma~ki v sr~nem popuš~anju kot je to pri psih. Znaki tahipneje/ je potrebno omenit nekontroliran hipertiroidizem, rela- dispneje se praviloma pojavijo nenadno brez predhodnih tivno pogost pri ma~kah starejših od 10 let. Pri tej bolez- znakov. Pridušeni toni srca in plju~ govorijo v prid plev- ni je levi prekat lahko zmerno hipertrofiran, vendar nikoli ralnega izliva, prav tako nabrekle jugularne vene. Rent- tako kot pri hipertrofni kardiomiopatiji. Ob hipertrofiji leve- gen in ultrazvok sta klju~ni diagnosti~ni metodi za ugoto- ga prekata pomislimo tudi na sistemsko hipertenzijo, ki vitev vzroka, vendar je potrebna posebna previdnost, da se lahko pojavi so~asno s hipertiroidizmom ali pa naj- ma~ko v taki stresni situaciji ne spravimo ~ez rob. Butor- ve~krat kot posledica ledvi~ne bolezni. phanol (0,1 mg/kg IM) omogo~i varnejše ravnanje s tako stresno ìvaljo.(1) Na rentgenski sliki lahko vidimo plju~ne Za klinika je predvsem pomembno prepoznat napredo- infiltrate v primeru popuš~anja srca, ali plevralni izliv. Ma~je vanje bolezni in pravšnji ~as ko je potrebno ukrepanje. srce pogosto ni tako o~itno pove~ano kot pri psih (saj Asimptomatska ma~ka s kardiomiopatijo zahteva druga~en hipertrofiran prekat hipertrofira navznoter) in pove~an levi pristop kot tista v sr~nem popuš~anju. atrij tako o~itno ne privzdigne sapnika kot pri psih v stran- ski projekciji, ker je ma~je srce v toraksu nekoliko bolj leè~e. Kadar nismo prepri~ani o vzroku dihalne stiske lahko ma~ko v sternalnem poloàju in po potrebi z doda- janjem kisika pogledamo na hitro še z ultrazvokom. V doc.dr. Aleksandra Domanjko Petri~, dr.vet.med. ve~ini primerov levostranskega popuš~anja srca je levi Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, SI-1000 Ljubljana, atrij zna~ilno pove~an. Natan~nejšo ultrazvo~no preiska- [email protected] vo lahko odloìmo na kasnejši ~as, ko je ma~ka stabilna,

43 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 saj natan~na determinacija miokardne bolezni ni nujna za Doma~a oskrba ma~ke s sr~nim primarno urgentno zdravljenje. popuš~anjem Smiselno je ma~ki izmerit tlak, saj ~e je hipotenzivna naša Dolgoro~no èlimo vzdrèvat primeren tlak v srcu in nadaljnja diureti~na terapija ne bo delovala. Ostale rutin- prepre~it ponovitev akutnega sr~nega popuš~anja, ter ske laboratorijske preiskave odloìmo na ~as, ko je ma~ka tromboembolije, ob tem, da se ma~ka po~uti dobro. Prva stabilna. Takrat je predvsem smiselno kontrolirat elektro- dva cilja doseèmo z aplikacijami furosemida ter zaviral- lite, saj ma~ke ob neješ~nosti hitro postanejo hipokale- ca konvertaze. Furosemid drìmo na najni`jem mo`nem mi~ne, ter ureo in kreatinin. odmerku, ki še prepre~uje zadrèvanje teko~ine v telesu Diferencialno diagnosti~no pomislimo še na travmo prsne- (ma~ke so nanj ob~utljivejše), npr. 1-2 mg/kg /12-24 ur ga koša (anamneza!), preveliko koli~ino infuzijske teko~ine, ali vsakih nekaj dni). Nekatere ma~ke po akutni krizi lahko nekardiogeni plju~ni edem ali hude plju~ne infekcije. Plev- celo ne potrebujejo ve~ furosemida. ralni izliv je najpogosteje modificiran transudat ali pravi V kolikor je potrebna kontrola sr~ne frekvence zaradi izbolj- hilotoraks v povezavi z obstrukcijo venskega in limfa- šanja diastoli~ne disfunkcije lahko dodamo zaviralce beta, ti~nega priliva (1). (zlasti velja za ma~ke z obstrukcijo levega izto~nega trakta), oz. zaviralce kalcija (npr. diltiazem). Zaviralce beta Terapija ma~k v sr~nem popuš~anju nikoli ne vpeljemo v ~asu sr~nega popuš~anja, ampak šele Kratkoro~ni cilj terapije ma~ke v sr~nem popuš~anju je v kompenziranem stanju. olajšanje hipoksemije, zmanjšanje tlaka v levem preddvoru in izboljšanje hemodimani~ne funkcije. Akutno sr~no Arterijska tromboembolija popuš~anje zdravimo ne glede na tip miokardne bolezni. Pri vseh oblikah napredovalih kardiomiopatij lahko pride Kisik, diureza in venodilatacija predstavljajo pravilen pris- do arterijske embolije zaradi visokega tveganja za nas- top k ma~ki v levostranskem sr~nem popuš~anju. Plev- tanek strdka, ponavadi v levem preddvoru. Le ta se v ralni izliv moramo drenirati, najbolje z metuljasto iglo nekem trenutku odlepi in odpotuje v arterijski sistem, kjer »roza barve«. Furosemid apliciramo previdno 1-2 mg/kg/ se najve~krat zagozdi v razcepiš~u aorte z obema iliaka- 2 uri, raje pa na ve~je ~asovne razmike (npr. na 6-8 ur), ma. Prizadete ma~ke so v hudi bole~ini, se oglašajo in so ob tem pa moramo spremljati diurezo in pitje. Ma~ke v pareti~ne. V~asih je epizoda embolije prvo znamenje, da takem stanju ne pijejo, zato jim dajemo vodo po brizgi, ima ma~ka bolezen srca. Klini~ni znaki so bolj nezna~ilni ~e pa s tem povzro~imo prevelik stres pa apliciramo nekaj pri emboliji mezenterialne, cerebralne, koronarne, renal- teko~ine pod koò ali damo ma~ko na perfuzor na zelo ne ali drugih arterij. po~asno I.V. infuzijo elektrolitske raztopine. Ne apliciramo glukoze, ker s tem pove~amo kapilarni tlak in tlak v Hipotermija je slab prognosti~ni znak. Ma~ke so zaradi levem preddvoru, kar pove~uje plju~ni edem. bole~ine tahipnei~ne in takšne je te`ko lo~iti od tistih v sr~nem popuš~anju (potreben RTG). Najprej poskrbimo za bole~ino, obi~ajno z opiati, v nadaljevanju lahko damo Ma~ke v sr~nem popuš~anju in hipotenziji fentanilski obli` (1-3 µg/kg/h). Ni idealne terapije, še ved- Nekatere ma~ke razvijejo znake nizkega minutnega vo- no ni enovitega sklepa o naju~inkovitejšem zdravljenju. lumna skupaj s sr~nim popuš~anjem. Obi~ajno so Uporablja se aspirin (5 mg/ma~ko vsake tri dni – nizek hipotermi~ne, bradikardne in mo~no hipotenzivne (sisto- odmerek se je izkazal za enako u~inkovitega z manj stran- li~ni tlak >70 mmHg).(1) V takih primerih so potrebni skih u~inkov kakor visoki odmerek aspirina), nefrakcioni- pozitivni inotropi, ki jih apliciramo intravensko, (dopam- ran heparin, ali nizkomolekularni heparin kot preventiva in, dobutamin) v odmerkih za izboljšanje tlaka (1-2 µg/ novemu nastajanju strdkov (ob heparinski terapiji je po- kg/min titriramo do maks. 5 µg/kg/min za dobutamin). S trebno preverjati ~ase strjevanja). Warfarin, ki se upo- tem èlimo izboljšati sistoli~ni tlak na 100 in ve~ mmHg, rablja v ta namen pri ljudeh je povezan s previsokim tve- normalizirati sr~no frekvenco in telesno temperaturo, zato ganjem za krvavitve, ma~ke je tudi te`ko spremljati v ta ma~ko tudi ogrevamo dokler je potrebno (obi~ajno 12-24 namen. V preizkušanju je novo zdravilo clopidogrel, ki pa ur). S teko~inami i.v. smo zelo previdni, apliciramo s per- pri nas še ni na razpolago (2). fuzorjem ni`je odmerke od vzdrèvalne teko~ine.

Literatura 1. Luis Fuentes V. Management of Feline Myocardial Disease. In: Bonagura DJ & Twedt DC. Eds. Kirk’s Current Veterinary Therapy XIV. Saunders 2009;809-15. 2. Tobias AH, Fine DM. Arterial Thromboembolism in Cats. In: Bonagura DJ & Twedt DC. Eds. Kirk’s Current Veterinary Therapy XIV. Saunders 2009

44 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

ZGODNJA STERILIZACIJA IN KASTRACIJA MA^K

Vanja Knez

Uvod Mednarodno priznane študije Zadnjih 10 do 15 let sterilizacija in kastracija ma~k nista Ena izmed prvih pomembnejših študij zgodnje steriliza- ve~ tabu, ampak veljata za osnoven servis ma~k v veteri- cije in kastracije je iz leta 1993 (3-4). Študija je zajela 96 narski mali praksi. Le-ta po protokolu zajema dehelminti- ma~k (od tega 48 samcev in 48 samic), starih od 6 do 14 zacijo, cepljenje (core, non-core priporo~ila AAFM, ABCD) tednov. Dokazali so, da zgodnja sterilizacija in kastracija in sterilizacijo oz. kastracijo. Z omenjenim protokolom ne ogroàta ma~jih mladi~ev, ~e se drìmo predpisanega podaljšamo ìvljenjsko dobo ma~k in tako ve~inoma protokola. do~akajo normalno pri~akovano starost, ki je od 10 do Istega leta je AVMA podprla koncept sterilizacije in kas- 15 let. V tem ~asu so tako oskrbovane ma~ke za veteri- tracije za pse in ma~ke pri starosti 8 do 16 tednov zaradi narje vir stalnega dohodka. V strokovnih krogih pa se preštevil~nosti populacije. postavlja ve~na dilema, v katerem obdobju je najbolj pri- Susan Little v svojem ~lanku Zgodnja sterilizacija in kas- merno in najla`je opraviti poseg. Stroka mora biti v tem tracija ma~k poudarja, da koncept zgodnje kastracije in soglasna in zagovarjati je potrebno strokovne argumente, sterilizacije ni nobena novost. (1) V razvitem svetu se oba ki jih bom v tem referatu podala. posega izvajata è dobrih 35 let. Kadar govorimo o zgodnji sterilizaciji in kastraciji, govorimo o posegih v starosti Zgodovina od 8 do 16 tednov. V Severni Ameriki in Kanadi je zgodnja sterilizacija in kas- Opustiti moramo tradicionalno mišljenje, da je primeren tracija rutinski poseg è dobrih 35 let. (1) Zgodnjo sterili- ~as za sterilizacijo in kastracijo med 5-im in 7-im mese- zacijo in kastracijo opravljajo od starosti 6 do 12 tednov cem starosti. Mnogo veterinarjev àl še vedno najraje pri teì vsaj 1 kg. Potreba po zgodnji sterilizaciji in kas- opravlja posega v tem obdobju, kajti takrat se po~utijo traciji je izvirala iz dejstva, da so ìvali, posvojene iz zave- najbolj varne. V zgodnejšem obdobju jih skrbita pred- tiš~ kljub zagotovljenim brezpla~nim posegom, dogo- vsem protokol in anestezija. vorom in pogodbam imele mladi~e. Ker so zaradi prenatr- Ostali zadr`ki, povezani z zgodnjo sterilizacijo in kastracijo, panosti zavetiš~ morali prepre~iti nezaèlena rojstva, so so zaostajanje v rasti, pretirana debelost, spremembe v se odlo~ili za zgodnejšo sterilizacijo in kastracijo. Vse obnašanju in boleznim spodnjih se~il. Iz Englove študije posege so prestavili na ~as pred posvojitvijo. iz leta 1977 (1) izhaja splošno znani mit, da so zgodnje V Evropi, predvsem v razvitih dràvah, sta bila sterilizaci- kastrirani samci nagnjeni k obstrukciji se~nice in boleznim ja in kastracija rutinska posega, vendar ~asovno postav- spodnjih se~il. Ta zastarela študija je bila polna napak, ljena v obdobje od 6. meseca dalje. V današnjem ~asu pa vendar se nekateri še vedno sklicujejo nanjo. Novejše nevladne organizacije, ki se ukvarjajo z zaš~ito ìvali v raziskave so pokazale, da bolezni se~il pri kastriranih dràvah EU, pozivajo h kastraciji in sterilizaciji okoli 4. ma~kih niso povezane s kastracijo, ampak izhajajo iz dru- meseca starosti. Tudi zdruènje The cat group (RSPCA, gih faktorjev, kot so stres, dieta ter število ma~kov. (3-4) FAB, ESFM, AHT, BSAVA, CATS PROTECTION, THE Vzroki pretirane debelosti so ponavadi povezani s pre- BLUE CROSS idr.) zagovarja in promovira politiko zgod- hrano, telesno vadbo, pasmo, starostjo in statusom. nje sterilizacije in kastracije. Pomemben je njihov akt: 4 Raziskava iz leta 1996 (5) kaè, da je potreba po kalorijah months-policy statement 1.(2) manjša za sterilizirane/kastrirane ma~ke. Za samce, kas- Predsodki glede posega se porajajo predvsem v ju`nih in trirane med 7 tedni in 7 meseci, je 28% manj, za sterilizi- nerazvitih dràvah. Z razvitostjo dràve raste tudi odgo- rane samice iste starosti pa 33% manj. Ker je miši~ni vornost ljudi do ìvali. razvoj pri samcih odvisen od androgena, je manjša miši~na masa posledica le-tega, ne glede na ~as kastracije. Vanja Knez, dr. vet. med. Klinika Tristokosmatih, velika klinika za male ìvali, Kajuhova 5a, SI-1000 Ljubljana [email protected]

45 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Ena izmed pomembnejših raziskav (6) predpubertetne ste- Ciklus ma~ke in razmnoèvanje rilizacije/kastracije je dokazala, da ne prihaja do telesnih Ma~ka je sezonsko poliestri~na ìval, pri kateri se gonitev in vedenjskih razlik (mese~no so preverjali šest vedenj- lahko za~ne è s štirimi meseci, odvisno od pasme, telesne skih lastnosti) med skupino ma~k, pri katerih sta bila po- teè in vpliva fotoperiode oz. delovanja melatonina, ki ga sega opravljena zgodaj in skupino ma~k, steriliziranih/ izlo~a ~ešarika. Ovulacija nastopi ob parjenju. Brejost kastriranih pri tradicionalni starosti. Dokazali pa so, da ma~ke traja v povpre~ju od 57 do 63 dni. prihaja do vedenjskih razlik med steriliziranimi/kastrira- nimi in nesteriliziranimi/nekastriranimi ma~kami. Sterili- zirane/kastrirane ma~ke so v odnosu do ~loveka bolj Pasemske ma~ke in vzreditelji ljube~e. Tudi do ostalih pripadnikov svoje vrste kaèjo Velika ve~ina vzrediteljev prodaja svoje mladi~e, ki niso za manj znakov agresije. vzrejo, è sterilizirane/kastrirane. Poskusno smo s tem V to študijo so bile zajete 3 skupine ma~k: 1. skupina: za~eli v letu 2000. Šlo pa je predvsem za ma~ke, ki so bile ma~ji mladi~i, sterilizirani/kastrirani pri 7-ih tednih sta- prodane za ljubljen~ke in niso bile namenjene za razplod rosti; 2. skupina: ma~ji mladi~i, sterilizirani/kastrirani pri zaradi genetskih ali kakšnih drugih napak. Tako pri kon- 7-ih mesecih starosti in 3. skupina: nesterilizirane/nekas- genitalni napaki, kot je npr. popkovna kila, korigiramo trirane ma~ke. Predmet analize je bil tudi vpliv gonadnih hernijo in isto~asno ma~ko še steriliziramo/kastriramo, hormonov na razvoj skeleta. Distalna radialna zrast se ker take ma~ke ni dovoljeno uporabljati za razplod. Za ponavadi zapre po puberteti v starosti od 14 do 20 mese- sterilizacijo/kastracijo pred prodajo smo se odlo~ili, ker cev. Predvidevali so, da so gonadni hormoni potrebni za smo imeli slabe izkušnje s pogodbami in smo edino tako normalen razvoj simfizne zrasti. Pri prvi in drugi skupini lahko prepre~ili nadaljnje razmnoèvanje za razplod ne- so ugotovili zapoznelo zaprtje distalne radialne zrasti. Na primernih ma~k. dolgi rok pa ni bilo nikakršne razlike v dolìni kosti radius Ma~ke gredo lahko v nov dom pri starosti 12 tednov in in ulna pri vseh treh skupinah. ni~ prej. Druga študija zaprtja radialne zrasti pa kaè (7-8), da prihaja do razlik v dolìni opazovane kosti med sterilizirani- Pediatri~ni protokol mi (ne glede na to ali so bili sterilizirane/kastrirane pri 7 tednih ali 7 mesecih) in nesteriliziranimi ma~kami. Pri zgodnji sterilizaciji/kastraciji je anestezijski protokol varen in ni potrebno imeti posebne opreme. Kirurški po- Izsledki ameriške raziskave (9) kaèjo, da sta zgodnja ste- seg je tehni~no nezahteven. Prednosti in koristi so rilizacija in kastracija popolnoma varna posega glede vpli- obojestranske za ìvali in praktike. Pred posegom samim va na zdravje in vedenje ma~k. Raziskava je zajela 263 moramo pozornost nameniti: hipoglikemiji, hipotermiji, ma~k, posvojenih iz zavetiš~, ki so jih spremljali 37 mese- krvavitvam in infekcijskim boleznim. cev.

1. splošni pregled mladi~a pred posegom Priporo~eno je da so prej dehelmintizirani in cepljeni. Pri pregledu smo pozorni na razne anomalije (npr. kriptorhizem, hernije). 2. teà Ma~ji mladi~ naj ima vsaj 1 kg telesne teè. 3. prepre~evanje hipoglikemije Da prepre~imo hipoglikemijo, odstranimo hrano le 3 do 4 ure pred posegom in è 1 uro po posegu ma~jemu mladi~u ponudimo manjši obrok. 4. pred posegom Mladi~i iz istega legla naj bodo skupaj v mirnem in toplem prostoru, da zmanjšamo stres in razburjenje, apliciramo i/m anestetik. 5. »koktajl« anestetikov V literaturi je razli~no število kombinacij za pediatri~ni protokol. KDT (Ketamin-Domitor-Turbogesic) koktajl: - 4 IE ketamina (100 mg/1ml) - 2 IE medetomidina (Domitor 1 mg/ml) - 2 IE butorfanola (Torbugesic 10 mg/ml) Doza za 1 kg. Za kastracijo je zadostna i/m aplikacija, za sterilizacijo pa po potrebi še inhalacija izoflurana (tubus 2.0). 6. omoti~ni mladi~i Mladi~em, ki so še zelo omoti~ni, dodamo 5 % glukozo oralno. 7. prepre~iti hipotermijo Hipotermijo prepre~imo z grelnimi blazinami, minimalnim britjem in minimalnim polivanjem z alkoholom. Po operaciji preverimo temperaturo rektalno (normalna TT mladi~a 37,6-38°C). Mladi~e grejemo s toplimi brisa~ami, termoforji, grelnimi lu~mi. Pri tem pa moramo biti ves ~as pozorni, da jih ne pregrejemo. 8. zbujanje Zbujamo z Antisedanom. 9. analgetik Metacam kapljice,1 gtt oralno (0,1-0,05 mg/kg TT ma~ke)

46 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

V zadnjem obdobju je bilo izvedenih nekaj študij predvsem zaradi t.i. stranskih u~inkov in predsodkov, ki so se porajali v povezavi z zgodnjo sterilizacijo in kastracijo. Veterinarji, ki izvajajo pediatri~ni protokol, izjavljajo, da je hitrejši in manj stresen za `ival. Ma~ji mladi~i še niso predebeli, ni krvavitev, po posegu hitro okrevajo in se hitro zbujajo iz anestezije. Z zgodnjo sterilizacijo/kastracijo se izognemo posegom pri gone~ih ma~kah, brejih ma~kah in ma~kah s piometro. Daljnoro~no s posegom prepre~imo tumorje na seskih in tumorje testisov. Z uravnavanjem populacije prepre~imo nepotrebne evtanazije ma~k v zavetiš~ih in zmanjšujemo prenose bolezni v preštevil~ni populaciji (npr. levkoza in ma~ji aids). Materialni stroški so pri opravljanju posega zgodaj manjši in tudi minimal- na specialisti~na oprema nam olajša delo.

Povzetek Raziskave so pokazale, da ni ne telesnih ne vedenjskih negativnih stranskih u~inkov zgodnje sterilizacije in kastracije ma~k. Stroka priporo~a sterilizacijo/kastracijo ne pri tradicional- nih 6-ih mesecih, ampak pri 4-ih mesecih v izogib prez- godnji brejosti. Sam zgodnji poseg je s poznavanjem in z upoštevanjem pediatri~nega protokola za veterinarja enostavnejši in ce- nejši.

Viri 1. http://catvet.homestead.com/EarlyAlter.html 2. http://www.fabcats.org/cat_group/policy_statements/index.html 3. Faggella, A.M. and M.G. Aronsohn (1993). Anesthetic techniques for neutering 6- to 14-week-old kittens. Journal of the American Veterinary Medical Association 202(1): 56-62. 4. Aronsohn, M.G. and A.M. Faggella (1993). Surgical techniques for neutering 6- to 14-week-old kittens. Journal of the American Veterinary Medical Association 202(1): 53-55. 5. Root, M. (1995). Early spay-neuter in the cat: Effect on development of obesity and metabolic rate. Veterinary Clinical Nutrition 2: 132-134. ISSN: 1076-3872. 6. Stubbs, W.P., M.S. Bloomberg, S.L. Scruggs, V.M. Shille, and T.J. Lane (1996). Effects of prepubertal gonadectomy on physical and behavioral development in cats. Journal of the American Veterinary Medical Association 209(11): 1864-1871. 7. Root, M.V., S.D. Johnston, G.R. Johnston, and P.N. Olson (1996). The effect of prepuberal and postpuberal gonadectomy on penile extrusion and urethral diameter in the domestic cat. Veterinary Radiology and Ultrasound 37(5): 363-366. 8. Root, M.V., S.D. Johnston, and P.N. Olson (1996). Effect of prepuberal and postpuberal gonadectomy on heat production measured by indirect calorimetry in male and female domestic cats. American Journal of Veterinary Research 57(3): 371-4. 9. Howe, L.M., M.R. Slater, H.W. Boothe, H.P. Hobson, T.W. Fossum, A.C. Spann, and W.S. Wilkie (2000). Long-term outcome of gonadectomy performed at an early age or traditional age in cats. Journal of the American Veterinary Medical Association 217(11): 1661-1665.

47 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

KIRURŠKO ZDRAVLJENJE ZLOMOV STEGNENICE PRI MA^KAH

Jo`e Kogovšek

Izvle~ek Najpogostejši vzroki za zlom stegnenice so travme. Med temi prevladujejo prometne nesre~e, padci iz višine, udar- Pri ma~kah so med zlomi skeletnih kosti najpogostejši ci... Ve~ina lastnikov ma~k ob prihodu v ambulanto pove, zlomi stegnenice. Konzervativno zdravljenje je smiselno da vzroka ne pozna, da je prišla ìval s potepa po treh le v primerih, ~e fragmenti niso dislocirani. Frakture z nogah ali pa, da so onemoglo našli nekje ob cesti. Niso dislociranimi fragmenti je potrebno zdraviti kirurško z prav redki primeri, da zlom spremljajo še druge poš- osteosintezo. Najve~krat se pri tem uporabljajo intramedu- kodbe; zlom medenice, poškodbe v podro~ju trebuha, alarne igle ali zunanji fiksatorji. Kadar po implantaciji igel prsnega koša... pri~akujemo med fragmenti nemir, je potrebno take osteosinteze kombinirati s hemicerklaàmi, zunanjimi fiksatorji, ploš~icami ali cerklaàmi. Za odprte kominutivne NEKAJ ANATOMSKIH POSEBNOSTI frakture je najprimernejša imobilizacija z zunanjimi fiksa- STEGNENICE PRI MA^KAH: torji. Diafizni del femurja je pri ma~kah oblikovan nekoliko ovalno in je praviloma raven. Med diafiznim in vratnim delom Abstract stegnenice je pribli`no 130 stopinjski kot. Femoral fractures are the most common fractures of ske- Glavica stegnenice se prehranjuje ve~inoma iz ekstrakap- leton in cats. Conservative treatment is indicated only if sularnega krvnega pleteà, ki obkroà vrat stegnenice. there is no dislocation of the fragments. Surgical treat- Pri mladih ma~kah se znatno oskrbuje tudi preko ìl ligament with osteosynthesis is needed for fractures with mentum teresa (vrvasta vez). Oskrba preko ìl ligamenta dislocated fragments. Intramedullary needles and exter- se pri ma~kah prekine pri starosti nad sedem mesecev. nal fixators are most commonly used for osteosynthesis. Kondila stegnenice sta, ~e jih primerjamo s pasjo kostjo, If instability of fracture is expected after needle implanta- skoraj povsem v osi diafize. Rastna cona v distalnem tion, osteosynthesis should be combined with hemicer- fiznem delu je znotraj sklepne kapsule, kar je pomembno clage, external fixators, lamellas and cerclages. pri kirurškem zdravljenju distalnih epifizioliz (pri Salter Harris zlomih). UVOD Pri ma~kah so zlomi stegnenice, glede na odstotek zlomov ostalih kosti skeleta, na prvem mestu. Fossumova IMOBILIZACIJA ZLOMOV STEGNENICE ocenjuje, da je takih zlomov ve~ kot 30 %, po naši analizi pa kar 48 %. Ugotovili smo tudi, da je po pogostnosti KONZERVATIVNO ZDRAVLJENJE zlomov na drugem mestu tibija s 14 % in na tretjem man- dibula s 4 odstotki. Konzervativno zdravljenje zlomov femurja je smiselno, ~e je zlom brez dislokacij. Pri odraslih ìvalih so te poš- Glede na mesto zloma stegnenice delimo na tiste na kodbe zelo redke. Klasi~na imobilizacija z obvezami, oziro- proksimalne delu, diafizne in zlome v distalnem delu. ma opornicami za ma~ke praviloma ni primerna. K sre~i Najve~ je zlomov v diafiznem delu. Zlomi v bliìni sklepov ma~ki bole~e ekstremitete drìjo v fleksiji ob telesu (naravna so posebnost mladih ìvali, pri katerih rast še ni zaklju- imobilizacija), zato pogosto zadoš~a le drànje ìvali v ~ena. zaprtem prostoru (kletki). prof.dr. Joè Kogovšek, dr.vet.med. Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, SI-1000 Ljubljana [email protected]

48 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

OPERATIVNO ZDRAVLJENJE Zunanji fiksator Pri ma~kah zlome femurja z dislociranimi fragmenti Za osteosintezo femurja se uporablja ve~inoma eksterni naravnamo v pravilno anatomsko pozicijo le z ustrezno fiksator tipa I. Primeren je skoraj za vse vrste zlomov. kirurško tehniko. Za imobilizacijo se uporabljajo implan- Skoraj nikoli pa niso primerni za fiksacijo intraartikularnih tati, ki zagotavljajo stabilnost in zato tudi hitro zraš~anje. kominutivnih fraktur. Le redko se aplicira zunanji fiksator To pa je tudi dovolj za ~im krajšo rehabilitacijsko dobo. tipa II. Ta bi bil primeren predvsem za imobilizacijo Salter Harris fraktur. Debelina transosalnih igel ne sme presegati 20 do 25% Intramedularne igle premera kosti. Najprimernejše transosalne igle so s pozi- Za osteosinteze diafiznega dela femurja pri ma~kah se tivnim (izven nivojskim), notranje pa z negativnim navojem pogosto uporabljajo intramedularne igle ali èblji. Naj- (v nivoju). Igle vstavljamo nekoliko kavdalno (kavdolate- boljši rezultati so s Steinmannovimi iglami. Kirshnerjeve ralno) ob vastusu lateralisu. V enem fragmentu naj bosta ìce so primerne za mlade ma~ke oziroma ma~ke manj- vstavljeni vsaj dve igli. Minimalni nemir med fragmenti ših pasem. Kuntscherjevi in Rusheve èblji se precej doseèmo, ~e so vstavljene tri transosalne igle. opuš~ajo. Primeren je tudi Schantzov vijak, ki je sicer Pogosto se nameš~a zunanje fiksatorje skupaj z intramedu- namenjen za imobilizacijo z zunanjim fiksatorjem. larnimi iglami. V takih primerih je lahko dovolj le ena trans- Slaba lastnost osteosintez z iglami so pogostokrat nesta- osalna igla v vsakem od fragmentov. Fossum zagotavlja bilnosti med fragmenti (rotacija fragmentov). dobre rezultate, ~e sta sklenjeni povezovalna palica in in- Premer medularnega kanala je povpre~no od 5 do 6 mm. tramedularna igla “tie–in povezava”. Za imobilizacijo se uporabljajo igle, ki izpolnjujejo pribli`no CRIF sistem (Clamp – Rod Internal Fixator) nekoliko spo- 70 % medularne odprtine ( premer 3,5 do 4,2 mm.). Po minja na eksterni fiksator. Razlika je v tem, da je fiksator implantaciji igel, ki izpolnjujejo le 30 do 40% medularne prekrit z mehkimi tkivi in je verjetno metoda prihodnosti. votline, je zaradi pri~akovanega nemira med fragmenti, Zaradi visoke cene je pri~akovati, da se bo metoda ve~ potrebna še dodatna imobilizacija. V ta namen lahko uporabljala za osteosinteze pri psih. uporabimo enega od naslednjih antirotacijskih materia- lov: cerklaè, hemicerklaè, zunanje fiksatorje ali nevtral- izacijske ploš~ice. Imobilizacija s ploš~icami Odli~na rešitev so Steinmannove igle na zaklep. Za imo- Za imobilizacijo stegneni~nih zlomov se pri ma~kah upo- bilizacijo s takim implantatom se uporabljajo igle, ki rabljajo dinami~ne kompresijske ploš~ice, oziroma nev- zapolnijo medularno votlino do 70 %. tralizacijske ploš~ice. Boljše so ploš~ice, ki se na dolo~enih mestih stikajo s kostjo LCDCP (limited contact – DCP). Igle lahko vstavljamo z retrogradno ali z normogradno tehniko. Priporo~ajo normogradno tehniko, ker se tako VCPs ploš~ice lahko med operacijskim posegom odreèmo manj verjetno poškoduje ishiati~ni ìvec. Po izkušnjah (rezalne) do èlene dolìne. Ker so nekoliko tanjše, jih Montavona se je med retrogradnim vstavljanjem in zaradi zato lahko oja~imo tako, da poloìmo eno na drugo (send- predolgega intramedularnega implantata poškodoval ta vi~ sistem). Najboljši rezultati so z LCDC ploš~icami za ìvec kar pri vsakem ~etrtem pacientu. Z normogradno diafizne transverzalne frakture femurjev. tehniko, še posebej ~e je implantat tanjši, se pri ma~kah Zelo dobro anatomsko repozicijo doseèmo z Uni Lock lahko vstavljajo igle nekoliko lateralno od ishiati~nega ìvca. ploš~ico (mandibularne zaklepne ploš~ice), ki sodijo med Normogradna tehnika je primerna tudi za perkutano vsestransko prilagodljive implantate. Predvsem so upo- naravnavo zlomljene stegnenice. rabne za zlome v distalnem delu femurja. V proksimalno Dolìno igel odmerimo na osnovi rentgenskega posnet- in distalno luknjo vstavljamo bikortikalne, v ostale pa ka. Za srednje velike ma~ke so primerne igle dolìne od 9 monokortikalne vijake. ê je stabilnost slabša po names- do 11 cm. Igla naj bi segala po implantaciji do proksimal- titvi ene ploš~ice, lahko drugo privijemo z druge (medial- nega roba patele, oziroma do višine trohanterja. Najmanj ne) strani. nevarnosti, da bi implantat poškodoval ìvec, je takrat, ~e je igla potopljena v fosso trochantearico. Med zlome proksimalnega dela sodijo zlomi glavice fe- Za suprakondilarne ali epiziolizne frakture je mogo~a murja, epifiziolize, zlomi vratu, avulzije trohanterja in sub- imobilizacija tudi z nameš~anjem igle skozi kolenski sklep trohanterne zlome. iz med~vršne jame. Boljša je retrogradna tehnika, ker Zlome vratnega dela in glavice femurja lahko po anatom- èlimo hrustan~ni del le odpreti kot pokrov~ek, ki ga po ski repoziciji imobiliziramo z vijakom in antirotacijsko iglo. vstavitvi igle vrnemo v prvotno lego. Sicer se epifiziolize Pri mladih ìvalih je mogo~a osteosinteza le z dvema Kir- imobilizira z dvema Kirschnerjevima ìcama – lastovi~ji schnerjevima iglama. Biomehaniki so dokazali, da se do- rep. sega stabilnejšo osteosintezo, ~e sta igli postavljeni paralel- no. Igle se lahko vstavlja retrogradno ali antegradno. Ret-

49 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 rogradno je enostavnejše za nameš~anje, vendar z ante- gradnim principom povzro~imo manj poškodb na mehkih tkivih. Še manj poškodb na mehkih tkivih pa povzro- ~imo po ventralnem pristopu. Trohanterne frakture so za kirurga manj zahtevne. Dobre rezultate se dose`e s tehniko „zuggurtung“. Subtrohanterni zlomi so pri ma~kah redki. Navadno so sestavni del kominutivnih zlomov diafiznega dela. Za osteosintezo se uporabljajo zunanji fiksatorji, ploš~ice ali tudi igle. V nekaterih primerih je potrebna kombinacija dveh (n.pr. igla in eksterni fiksator). Kominutivne frakture vratu ali glavice pogosto ne omogo- ~ajo tako solidne naravnave in fiksacije, da bi lahko pri~akovali dobro pooperativno funkcijo prizadete noge. V takih primerih se je potrebno odlo~iti za osteotomijo preostalega dela glavice.

LITERATURA 1. P.M. Montavon, K. Voss, S.J. Langley–Hobbs. Feline Orthopedic Surgery and Musculoskeletal Disease.Philadelphia: Saunders, 2009. 2. Fossum TW. Chirurgie der Kleintiere. Urban & Fischer, 2007. 3. Auer J. Veterinary specialty news. The VetFix System (Clamp-Rod Internal Fixator) AO – Development News – Number 1, 2004: 2 – 4. 4. Keller M, Voss K. UniLock: Application in small animals. Locking bone plate/screw systems were developed for use in human maxillofacial surgery. The authors describe applications of the UniLock system in small animal surgery. AO Dialogue, 15, 2002. 20 - 21. 5. Brinker WO, Piermattei DL, Flo GL. Small animal orthopedics and fracture repair. Philadelphia: WB Saunders, 1997.

50 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Fungal diseases of the skin in cats

Patrick Bourdeau

Fungi form a group of very original pathogens more or less adapted to develop in the living tissues. Amongst domestic mammals the cat is probably the most frequently concerned by mycoses, and skin infection the most common. Dermatophytes are the first cause of dermatomycose but a variety of other fungi can be encountered in Europe.

I Dermatophytoses Dermatomycoses, generally superficial, due to keratinophilic fungi: Microporum and Trichophyton (+ in humans Epidermophyton). Synonym: ringworm.

The most important species of dermatophytes in cats is by far Microsporum canis. The second species, probably misdiagnosed isTrichophyton mentagrophytes. Cats can be infected by other species of dermatophytes (See table I).

Table I: Most important species of dermatophytes infecting cats Main host, source Others species Human contamination M. canis Cat, dog Rabbit, horse, rodents … +++++ M. persicolor Rodents microtinae (voles) Dog, cat .. ++ M. gypseum Soil Dog, horse… + T. mentagrophytes Rodents All species (Dog, cat…) +++

Morphology of dermatophytes in lesions - Septate hyphae (2- 6 µm. diam.) in stratum corneum, more visible in hairshafts (in bundles). - Arthrospores. ± spherical (2 à 8 µm according species). (hair follicle, surface of skin…) - Development in hairshaft Ectothrix (= endo-ectothrix). Hairshafts surrounded by small spores (2 µm) « mosaic » = microsporic : (i.e : M. canis) short chains = microïd (i .e : T. mentagrophytes) (Microsporum persicolor do not infect hairshaft.

Clinical aspects a) Classical annular ringworm - The most frequent with Microsporum canis. Prof. Patrick Bourdeau, - Frequent in young animals, incubation 1 - 4 weeks DVM, Dipl. ECVD, EVCP (2 months ?) Dermatology /Parasitology / Mycology - Non pruritic (general situation). Oniris: Ecole Nationale Vétérinaire de Nantes, France - Annular alopecia (0.5 to 5 cm in diam.) spontane [email protected]

51 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

ous regrowth of hairs in the center of lesions (individ Diagnosis ual spontaneously heal). Skin non reactive, thin scal Successsive steps are necessary to observe, isolate then ing. identify causal agent. - A variant in hunting or foraging animals due to 1) History : frequent in young cats ( less than 1 year of T.mentagrophytes (Microsporum persicolor or Mi age) ; persians and other longhaired breeds ; colonies crosporum gypseum.) : Localized, slowly extensive, (catteries) ; season (T. mentagrophytes : autumn-Winter) generally facial and scaly lesion. May become multifo ; contagion : other cats, dogs, humans cal and generalized. 2) Wood’s light : Fluorescence from living spores of der- b) Kerions matophytes in anagen hairs : only Microsporum canis - Quite unfrequent in cats as compared to dogs, mainly (most of strains) : Modified by topical therapy. Positive due T. mentagrophytes (M. canis …) wood’s light is confirmed by microscopic examination. - Surelevated, rounded, inflammatory suppurative (fol 2) Microscopic examination liculitis) plaques. Unique or multiple, mainly on face. Skin scrapings and hairshafts examined in lactophenol, c) Diffuse alopecic dermatophytosis (lactic blue, KOH). Quite frequent in cats. Moderate erythema, diffuse Typical aspect of parasitised hairshafts. (M persicolor do alopecia ± scales and crusts. Localized or extensive. not develops in hairshaft). d) Feline miliary dermatitis 3) Optionnal : orientation test : Dermatophyte test Pruritic medium.DTM Diffuse alopecia, moderate erythema and scaling ; mul - The growth of dermatophytes is suggested if rapid tiple little papules and crusts. change of color of the agar (turn to red). 7 to 14 days. Many limits (sensitivity – specificity). False positive and e) Onychia and paronychia negative. - Rare. Mainly T. mentagrophytes or M. canis. Fragil - must be confirmed by identification under microscope. ity of claws, (several digits and legs) 5) Fungal culture f) Combined dermatophytoses Sample : (Mc Kenzie toothbrush method, Mariat carpet - Much less frequent than in dogs method). Inoculation of Sabouraud medium. Condition - Extensive, scaly and erythematous many combina for development may vary with dermatophytes. Incuba- tions of species. tion 27°C. g) Mycetomas Growth can be modified when previous antifungal treat- - Underdiagnosed. Mainly in persian cats. Sometimes ment have been applied. called « pseudomycetoma ». Deep infection (dermis Identification depends on the technicity of the lab : in with dermatophytes that forms « grains » in a suppu general 3 wks (to less than 6 days). rative reaction (plaques, fistulae). Lesions quite fre Precise identification will help to understand epidemiolo- quently located on the dorsum. See below gy of each case, and conception for control. 6) Histopathology : Not an indication except : Histopathological findings a) If interesting for differential diagnosis (histopatholgy - PAS stain allows a better visualisation of fungal ele- useful for other suspected dermatoses) ments (hyphae) b) In case of mycetoma. 1) Moderate inflammation: only filaments in stratum corneum + arthrospores + invasion of infundibulum and hairshafts. Control 2) Inflammatory. : Papulovesicular. Intraepidermal vesi- - Once the diagnosis is made the infected animal(s) has cles, spongiosis, crusts, dermal infiltrate (neutrophils, to be isolated in a place easy to clean and disinfect. lymphocytes, eosinophils). (Possible Confusion with auto- - Other animalsl shoud be separated and a fungal culture immune skin disease). performed (Carpet or Toothbrush). If contaminated they 5) Mycetomas : granulomatous inflammation surroundig will be treated. filamaents and vesicles grouped in « grains ». Topical treatment Long haired cats should be clipped before and during the treatment (only 10% of cure in Persians if not clipped..) Topical antifongal agents applied once or twice a week :

52 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Enilconazole rinse – antifungal containing shampoos (mi- Evolution/follow up conazole). Total duration of antifungal therapy 6 weeks (2 weeks Systemic treatment after « clinical » cure). Even in case of apparent cure 25 - Griseofulvin : dosage frequently too low in labelled prod- to 30% remain carriers or infected and relapse may oc- ucts. At least 25 mg/kg bid (oral) is necessary. Contrain- cur. dicated in pregnant females and immunosuppressed cats. - Ketoconazole : 5-10mg/kg (oral) daily. Control liver pa- Environmental disinfection rameters. - It is important to clean the environment of infected cats - Itraconazole : 5 mg/kg/day. Treat very other week 3 (vacuuming, washing at high temperature…) times (total of 6 weeks). Well tolerated in general. - Enilconazole in spray (Clinafarm may help to treat potentially infected surfaces. Some authors propose the use of fumigation although no demonstration support the efficacy of such protocol).

II Malassezia - The importance of Malassezia yeasts has been initially demonstrated in human (Malassezia furfur) then in cdog (Pityrosporyum canis). In cats the knowledge is much more recent and limited. - A group or yeasts (13 species described) lipophilic, morphologically similar. Amongst these species only one species : M. pachydermatis, the most common species in dogs and cats, do not need lipids to grow in culture. All other species are said lipodependant. Malassezia furfur is mainly anthopophilic (75-78 % of healthy people, 46 % of normal fungal flora of hairs). Occasion- ally isolated from animals (pig, sheep, elephant…). Agent of pityriasis versicolor in humans. - Malassezia pachydermatis Zoophilic. Isolated in numerous species of mammals and birds : Ear canals, skin, mucosae (perianal, oral…). Acciden- tal transient contamination have been described: M. furfur in animals, M. pachydermatis in humans : hands, ears, eye. (+ vaginal, urines, fungemias)

Characteristics of major species of Malassezia (adapted from de Hoog) Malassezia Buds growth CremophorEL growth Esculin Catalase SGA 40°C Tween 80 Tween 40 Tween 20 pachydermatis Wide + + - + + - V v furfur Wide - + + + + + + V sloffiae Wide - + - +,V + + + - sympodialis Wide - + -,V + + + + + obtusa Wide ------+ globosa Narrow ------+ restricta Narrow ------

- Rapid growth in culture (1 mm at D1–D2) . - Elongated yeasts (cylindrical to globose) (2 - 7 µm in size ). - Budding (blastoconidia) wide or narrow with cicatricial marks. Thin capsule. - Typical shape « foot-print… » - Lipophilic ( olive oil 1% - medium or Dixon) - Optimal growth 35 -37°C ; in practice rapid growth at 27-32°C, - Not inhibited by cycloheximide .

53 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Malassezia dermatitis is a superficial infection (skin and III Crytococcosis mucocutaneous junctions) due to the proliferation of several species of Malassezia (terminology : malasseziosis is not recommanded ) A systemic mycosis due to Cryptococcus neoformans It is mostly observed in cats (other species : dog, cattle, horses...exceptionnal in birds). A breed predisposition has been shown in dogs (Basset hound, Teckel, West Highland White Terrier, Shar Pei), - An important disease in immunocompromised humans but nor really in cats. (transplant, neoplasia, AIDS). Proliferation favourized by many conditions: hypersensi- The agent is very common and has a Worldwide distribu- tivities, endocrinathies, immunodeficiencies. tion. Cryptococcosis is likely underdiagnosed. Malassezia otitis - Erythemato-ceruminous, generally bilateral. - Rapid growth in culture (opt. 32 °C). Inhibited by Actid- ione. - Pruritus (positive auditopedal reflex) abundant (± liquid), brownish cerumen. - Spherical yeast 4-6 µm. (2-25 µm in lesions); Unipolar to multiple budding ; Thick Capsule (visible in indian ink)

Malassezia dermatitis - Other species of Cryptococcus do not grow at 37°C. - Erythema, diffuse alopecia, greasiness of skin, scaling (non pathogenic) : C. albidus, C. laurenti, C. terreus, C. variable. uniguttulatus.… - Typically on ventral part of neck (±oval), chin, skin folds - A major source is dejections of birds (digestive tract), and periorificial areas. fruits, milk… - Generalized seborrhoea. Contamination is mainly by inhalation, (possible inocula- Malassezia pododermatitis : ± paronychia (brownish tion in cat). Dissemination via blood and lymph and tro- deposit at the base of claws). pism for CNS. Not contagious - Defects of cellular immunity facilitate the development. Diagnosis (FeLV), corticotherapy). FIV+ cats have an increased carriage, more severe clinical signs and respond less to treat- Observation of numerous Malassezia in skin smears or ment. acetate tape tests: Look for Malassezia on a least 5 microscopic fields (X 400 or 1000). Clinical signs Interpretation: carriage is normal ; - Many subclinical infections - Huge number in otitis or high number in dermatitis - In general a chronic disease. Several forms may coexist - MOG (= Malassezia OverGrowth = microcolonies as- on the same individual sociated to corneocytes) in stained smears, associated with suspicion for hypersensitivity. Fungal culture (both lipid-rich and non lipid-rich medium Rhinosinusal form in case of suspicion) The most common. Chronic nasal discharge, respiratory Many possible methods for sampling. distress, proliferations at nares openings, ulcers of the nose. Pseudotumoral mass on the nose occasionally fis- Histopathology : Malassezia can be eliminated from tulized. Enlarged lymph nodes. May extend to eyes (chori- biopsies at the beginning of the process for fixation. oretinitis) or CNS (meningitis). Non specific perivascular pattern associated, to occasional Respiratory : Rare in carnivores . Dyspnoea and cough. spongiosis. Lymphohistiocytic infiltrate.The presence of Malassezia within infundibulum could be a criteria for Neurologic pathogenicity. Ocular Photophobia, uveitis ( uni or bilateral) Skin lesions Very frequent ( > 50% of cases), mainly located on the face and extremities Secondary to dissemination, possibly primitive ( inoculation)

54 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Papules, nodules (2 cm), plaques, ulcers reddish and - Diagnosis : purulent. In general multiples. Direct examination of pus (filaments ± irregular ± vesi- Disseminated forms cles) difficult to observe. Possible stains of smears. Histopathology: epithelioid or purulent reaction with ir- Lesions regular fragmented hyphae. Variable aspect. Fungi are pigmented or not in lesions. Little inflammatory reaction. Viscous aspect due to the very abundant yeasts in lesions (capsule material that Definitive diagnosis only by fungal culture (specialized inhibits phagocytosis). Lab.)(multiple culture, on different medias may be necessary). Interest of immunochemistry controversial (specificity ?). Diagnosis Treatment : - Yeasts in general very abundant in lesions ; observed from direct smears (diluted indian ink, Diff quick): shape, Surgical excision can be curative ? thick capsule. Variable efficacy of antifungals (no rule). Modern azoles - Fungal culture (Growth at 37°C + inhibited by cyclo- (Ketoconazole, Itraconazole) or (and) Amphotericin B (IV heximide) slowly ex 0,2 mg/kg alternate day). - Histopathology : Suggestive but not diagnostic. Abun- Prognosis guarded to poor (unresponsiveness to anti- dant yeasts, surrounded by an empty halo (capsule). Cap- fungals or relapses not rare). sule can be stained by alcian blue. - Serology : V Mycetoma Very useful by detection of circulating capsular antigens - Fungal mycetomas = Eumycetomas (agglutination). Positive at titers > 8 (frequently 16000). - Subcutanous mycoses. Generally necrotic and ulcer- Occasionally false negative. Response to therapy is asso- ative with cavities containing pus. Pus contains grains = ciated to decrease at least by 2 or 4 of the titer. microcolonies of hyphae. - Grains may be dark (black fungi) or light (Acremonium, IV Phaeohyphomycosis Pseudallescheria…dermatophytes). - Mycoses due to Brown fungi (Dematiaceous), generally - To differenciate from actinomycotic mycetomas. subcutaneous, secondarily ulcerative. - Contamination probably by inoculation. - Unfrequent but certainly underdiagnosed. (Confusions - At least 15 fungi involved in humans. In animals main- with abcesses, neoplasms..). ly: Curvularia (C. geniculata), Drechslera, Pseudallesche- - Frequent in tropical areas. In veterinary medicine main- ria, Altenaria… ly on cats (dogs, equine, birds, amphibians…) . - Worldwide or localized distribution according to spe- Most of agents are saprophytic on plants and opportu- cies. Most of these fungi are saprophytic on plants. nistics: At least 60 species involved. These fungi contain Clinical presentation : melanin and are pigmented ; olivaceous to dark brown in - Cats the most frequently species concerned culture. Identification difficult : Nomenclature changing (many names in papers are obsolete): i.e. Drechslera - Dermatophytic mycetomas (improperly called: pseudo- (Bipolaris) spicifera, Alternaria, Exophiala jeanselmi, Phi- mycetomas). Essentially Microsporum canis in persian alemonium sp. Phialophora verrucosa, Scoleobasidium cats. humicola, Pseudomicrodochium suttonii. - Lesions mainly on extremities, face, dorsum. - Sporadic - Plaques or nodule(s) with pus that contains visible grains - In general infection by traumatic inoculation rarely in- (0,1 to 3 mm). halation (human). - Favourized by intercurrent diseases or immunosuppres- Diagnosis : Direct observation of grains in lactic blue or sive therapies. KOH 10%. Differenciate from actinomycetes. - May occur years after infection. Chronic evolution. Histopathology = may also differenciate the 2 types of mycetomas. - Unique or multiple lesions : nodules, plaques, occa- Fungal culture necessary for definitive diagnosis. sionally ulcers Treatment : Difficult ; careful surgical excision + long - Other localisations (± associated) (joints, bones, ocu- and massive antifungal therapy (azoles, amphotericin B). lar, CNS). Pure neurologic forms may exist.

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IV Hyalohyphomycosis Complication : dissemination, rarely respiratory . - Subcutaneous mycoses due to colourless ( non mela- nized) fungi. Diagnosis - Many species of opportunistic fungi involved. Yeasts abundant in pus (if present). In most animal species (except cat ?) fungi are rarely seen in biopsies. Spe- - Pyogranulomatous lesions on inoculation sites. cial stains ( silver) mandatory. - Frequent diffuse panniculitis and extension. Culture. Immunology (immunofluorescence, immunodiffusion) Diagnosis : possible in humans. Direct observation of hyphae in the pus (possible staining) Treatment Careful samping and culture in a specialized laboratory. Modern systemic antifungals. Histopathology (not very specific) Classical with NaI (solution 20% IV : 20g ou 40 mg/kg 2- 5 days) then orally. Prognosis poor. Problem of tolerance. Treatment include surgical excision and drainage, systemic antifungals, correction of intercurrent diseases. Risk of transmission to humans ; bite or even licking from cats. V Sporotrichosis Infection due to the dimorphic fungus Sporothrix VI Histoplamosis schenckii. (Previously Sporotrichum schenckii). Mycosis due to systemic infection by the dimorphic His- Worldwide mainly tropics toplasma capsulatum. « Darling disease ». Cat but also pig, rodents/rabbits, birds ( parrots), horse, Wide distribution in warm and temperate countries. North dog and mainly Human being. America, South and central America (sporadic) Africa an Asia. In Europe : Italy, Rumania, Denmark. Pathogenic form = yeast Many species are concerned : Human, dog and cat … (37°C in blood agar + thiamin) non inhibited by cyclo- - Pathogenic form (generally intracellular) heximide. Slow development in culture at 37°C. (3-4 wks on blood Globose to elongated (« cigar » like) yeasts (3-6 µm). agar +CO2). Very small yeasts (2-3 X 3 -4 µm) thick- Histopathology : typical when surrounded by star shape walled, lemon shape, terminal budding on narrow basis. Splendore-Hoeppli reaction (= asteroid bodies) - Filamentous form produced in environnement (humid Filamentous form ( environment on soil and plants) and rich in organic debris) like birds nests (caves of bats…) or culture in usual media inf 30°C. Thin filaments with Culture 25°C. on usual medias 7 - 20 days. Mycelium echinulated microconidias (2-6µm) and globose conidias very thin (1-2 µm), sympodial ovoid to trinagular conid- with tubercles (6 - 25µm) ias., Infection : Sporadic disease, mainly rural. Telluric origin - Inhalation of conidias.( ingestion ( ?) pure digestive forms Inoculation (rarely ingestion). Incubation variable 2-3 in dogs). weeks. - Conidias transform to yeast in lungs then are phagocy- tised and disseminate (lymphatic , blood). Clinical presentation : Favourized by any immunodeficiency inclusion iatrogen- Cutaneo-lymphatic form ic. Mainly on extremities, face (indurated plaques, nodules) frequent ulceration with brownish pus ? Clinical presentation : In cats also nummular crusts. Many latent forms; Respiratory forms ; Digestive forms Lesions may spontaneously heal whereas other ap- (diarrhoea bloody or liquid) occasional vomiting. pear. Cutaneous forms (occasional): Nodules, plaques, fistu- Lymphatic vessels and lymph node reaction lae; oral ulcers,

56 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Others: ocular, neurologic, joints Lymph nodes en,largement. Anemia with neutrophilia and monocytosis. Hyerbilirubinemia, increase of alkaline phosphatases and ALT.

Diagnosis Difficult Radiography (thorax, abdomen : enlargement of liver and spleen) Observation of yeasts from stained smears (special stain) of pus (broncho alveolar liquid, punctions…) very small, intracellular.

Histopathology (APS, Gomori-Grocott) very small intracytoplasmic yeasts ( possible confusion with Leishmania)

IDST histoplasmin : little interest in companion animals. Serology (immunodiffusion, IDGA, agglutination...) in humans. Some cross reactions remain with Blastomyco- sis, Coccidioidomycosis).

57 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Skin conditions in cats: parasitic or not?

Patrick Bourdeau

Dermatologic conditions in cats are particularly difficult Diagnosis: to diagnose. In this species the clinical presentation is Fleas can be easily observed in light coloured animals or frequently common to very different disease conducing collected with a flea comb. Flea faeces are also easy to to “syndromes”. see and sometimes larvae are observed by owners in the Amongst these syndromes bedding. Alopecia, Pruritus and scales, Nodules and plaques are Control the most common Flea control in cats is not easy although mainly active products are available. One of the main key points is the I Alopecia and parasites action on fleas present in the environment of animals and the prevention of contamination of this environment (in- In cats alopecia appears usually in large, sometimes con- doors and outdoors). This is of importance in cat that fluent patches. goes outside. It can be self inflicted or due to abnormally easy epilation Most commonly used insecticides are fipronil and imida- or shedding. cloprid as spot on. Nitempyram is also very efficient but The underlying cause is often difficult to precise. short acting. Once fleas have been seen the treatment has to be done for months in order to control the already present generation of fleas from the environment. Ar- Ia Self inflicted alopecia thropod growth regulators have been developed for cat: lufenuron is given once a month and control the develop- Fleas ment of flea larvae that ingest the AGR in their food (adult flea faeces) this prevent the development of cocoon and Fleas are a common cause for alopecia in sensitized cats. further generation of fleas. Pyriproxyfen can be used as a The parasitism due to fleas is extremely common and, in spot on and blocks the larval stages and even the egg France, there is little seasonal variation during the year. It laying, with a very long residual effect. means that the monthly percentage of infested cats is S methopren is combined to fipronil to extend the action more or less stable (± 30% on dermatological cases) due of the insecticide. to infestations from indoor environment. Clinical presentation: To be effective the flea control has to be maintained on a Licking occurs mainly on the lateral parts of the body long period (several and AGR combined to insecticides symmetrically to the dorsal line. In general a certain de- to break the life cycle. gree of pruritus is also present and lesion extend on the body surface. The lesions can be complicated by excori- ations crusts and papules. Other causes of self inflicted alopecia (non parasitic) Food allergy Probably the second major allergic condition in cats associated to alopecia (not detailed here).

Prof. Patrick Bourdeau, DVM, Dipl. ECVD, EVCP Comments on Psychogenic alopecia Dermatology /Parasitology / Mycology This disease is diagnosed when all allergic/parasitic causes Oniris: Ecole Nationale Vétérinaire de Nantes, France have been excluded and if the cat has some behavioural trou- [email protected] bles.

58 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Stereotypies are obsessive-compulsive disorders (OCD). They - Observed in groups or catteries or rescue facilities but derive from modified behaviours ex sudden running or jump- also many individuals without any apparent contamina- ing, circling (tail chasing), head shaking, etc. Behaviours de- tion. Contagious?- Not necessarily underlying disease but rived from grooming include self-licking and hair chewing/ often FIV positive, diabetes, renal disease, neoplasia, Ia- pulling in the cat. trogenic due to steroids, - Age variable: often aged cats- This may result of an underlying abnormality (i.e: physical Infection combined to Demodex cati not rare - Biology of trauma of the CNS, epilepsy) or an abnormal behaviour, in this form: unknown. Superficial? reaction to a conflict due to inappropriate environment or management. If the conflict persists the behaviour might be- Clinical presentation:Pruritus often present, occasional- come repetitive and develop into a stereotypy to any unfavour- ly absentAlopecia, erythema, scaly and crusty dermatitis able situation. Endorphins (opioid peptides) might be impor- on the face, neck and ears. In some cases rather on ven- tant in the onset of the behaviour and, dopamine involved trum and limbs; rarely generalized or otoacariosis like with the maintenance of the behaviour. As the dopamine turn- with Demodex cati. DiagnosisSkin scrapings: on a large over is increased, stereotypies can be induced by drugs that surface (eventually apply mineral oil on skin). Examine activate the dopamine system, such as amphetamine and apo- other cats of the household. Variable abundance: In some morphine. Also a serotonin subsystem in cats could selectively activated by chewing or grooming. cases More than half of the D. gatoi population sampled is made of ova, indicating rapid population growthTri- Clinical presentation: choscopy, Histopathology Microscopic observation Siamese, Burmese, Himalayan and Abyssinian cats could be predisposed. The lesions are the result of chewing, licking and Adults of Demodex cati are quite long 180 to 220 mi- hair pulling crom. and Demodex gatoi is only 110 – 140 microm .Mixed infection with D. cati not uncommonControl Alopecia: middle of the back, perineal, genital areas, medial thighs, ventral abdomen, front legs, shoulder and feet. Treatment of demodicosis in cats is not as well estab- Initially the skin surface is normal until traumatized by the lished as it is in dogs. The most regularly active drug on tongue (development of a plaque). D. gatoi should be Lime Sulfur dips (6 times at 5 to 7 Diagnosis: days interval)Macrocyclic lactones: Very controversial. Ivermectin orally. Start with 200 ug/kg daily for one week, Trichoscopy shows broken hair and licking restriction by the application of an Elizabethan collar is temporarily curative. All if no side-effects increase dose to 0,4 mg/kg? Or 0.3 mg/ other pruritic causes of self-licking (allergies, parasites) have kg for months Lower or stop treatment if showing neu- to be ruled out. rological signs of in coordination or lethargy. Milbemy- Control cin 1 mg/kg orally e” 2 months or higher dosages ( problems of tolerance)Amitraz (0,02% once/twice a week): ± Behavioural Identification and removal of the stress cause is tolerated by cats (concentration of active ingredients?) the ideal therapy. contraindicated in diabetic catsTreatment of environment Drugs like: amitriptyline (5 mg PO BID), diazepam (1-2 mg PO sometimes mentioned (never done). BID or SID); Opiate-receptor blockers for short-term stereotypies: naloxone (1 mg/kg SC once) (naltrexone, nalmefene, diprenorphine) or dopamine antagonist haloperidol (1 mg/kg Other causes for alopecia in cats PO SID initially, then taper), for a longer period (> 1 year). Drugs that - inhibit the serotonin re-uptake: fluoxetine (1 Immune-mediated mg/kg SID), clomipramine (1,25 – 2,5 mg PO SID), imipramine. Sebaceous adenitis, mural lymphocytic folliculitis, alope- Sedatives and tranquilizers are generally ineffective. cia areata Associated with trauma/injections/topical treatments: Injection site cicatricial alopecia, topical steroid treatment, Ib Alopecia with broken hairs post-traumatic alopecia (fracture of pelvis, sacrum) Endocrine/Metabolic Broken hair due to infection or parasites; Dermatophyto- Diabetes, Cushings, iatrogenic/spontaneous – (± skin sis (see other lecture), Demodicosis hyperfragility syndrome) Neoplastic Demodex Paraneoplastic alopecia, epitheliotropic lymphoma. Two forms of Demodex have been described in cats and received different names. Demodex cati (the “regular”Demodex) and short demodex: D. gatoi. Demodex gatoi - Almost no publication is available. Mainly described and observed in North America (sunny, hot humid) In Europe very rare

59 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

II Pruritus Eosinophilic plaque : Well defined, surelevated, rounded to oval lesions. Erythematous and highly pruritic. Sometimes ulcerated. If pruritus is observed in cats it is necessary to initially evaluate a parasitic disease (not all detailed here) Mainly located on ventral abdomen and thighs. Occasion- ally in other places. Parasites causing pruritus in cats May occur on every cat: classically associated to Flea allergy, atopy or food allergy. Mites Can be combined to Feline miliary dermatitis. Mange : Notoedres cati As licking is important secondary bacterial dermatitis is Ear mite : Otodectes cynotis common. Fur mite : Cheyletiella blakei, Lynxacarus radovskyi Histopathology : Chiggers : Trombicula autumnalis Eosinophilic dermatitis with hyperplasia, mastocytes abun- Insects dant and epidermis frequently ulcerated. Fleas Cat flea : Ctenocephalides felis Feline miliary dermatitis Rabbit flea : Spilopsyllus cuniculi Small yellowish crusts and papules with diffuse distribu- … tion. Prurit present, generally moderate. Dorsum, neck, generalized. Lice Histopathology similar to eosinophilic plaque bust less Felicola subrostrata severe. FMD could be a relatively initial step before other Diptera clinical manifestations. Observed with allergies, ectopar- Mosquitoes : asites, bacterias, dermatophytes, drug reactions, pem- phigus foliaceus….

Non-parasitic causes of primary pruritic skin disease in cats are mainly related to allergies (Food intolerance al- Indolent ulcer lergy), infections (superficial pyodermas), neurologic de- A necrotic, ulcer, generally localized to the upper lip (uni fects (i.e: cervical pruritus) or even neoplasia. –bilateral). Not painful. Has been associated to allergies or infections Most often the clinical presentation and skin lesions ac- Histopathology variable: frequent neutrophilic infiltrate, companying these diseases are not specific and include fibrosis, occasional “eosinophilic mush”. syndrome like: Feline miliary dermatitis, eosinophilic gran- Occasionally could evoluate in epidermoïd carcinoma? (Or uloma complex, and indolent ulcer. rather carcinoma from the beginning). Mosquito bite hypersensitivity. Eosinophilc granuloma, linear granuloma Repeated mosquito bites on cats may result in papular to Eosinophilic granuloma is composed of surelevated well ulcerative lesions (nose, pinnae …). delimited lesion (papules, nodules), firm, yellow to pink It is a seasonal condition, more frequent in cats living in colour, linear, frequently on the posterior aspect of outside during night. Thighs (also chin, digits, oral cavity). Histopathology reveals an inflammation rich in eosino- It is asymptomatic and rarely the lesion may become ul- phils. cerate with white points (collagen). Differential includes allergies, viral (herpes, pox) derma- Initial pruritus is minimal but may increase toses and dermatophytes. There is no breed predisposition but young animals and females seem predisposed. Comments on Exotic fur mite This condition may spontaneously resolve or associated Lynxacarus radovskyi (= Felistrophorus radovskyi) is a para- to eosinophilic plaques or indolent ulcer. site in cat, another species is found on Lynx in America: Lynx- It has been associated to flea hypersensitivity, food aller- acarus morhani slightly different. - It is a permanent parasite, gies, atopy, mosquito bites, genetic predisposition, bac- eggs; larvae nymphs and adults are found onto the host. - terial or viral (calicivirus) infection. Known distribution is warm and humid areas: Pacific, west tropical Atlantic, south and central America USA (Texas). Histopathology: a granulomatous nodular infiltrate mul- This parasite could easily extend (cf worldwide extension of tifocal (eosinophilic mush).

60 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Cheyletiella in cats and dogs).The condition is contagious and Leishmania infantum is involved in Mediterranean coun- sometimes epizootic. Transmission probably by direct contact. tries however other species may develop in cats. Nothing is known about the resistance in environment. More prevalent in adults (6 – 12 years)- Pruritus is occasional. Fe- Clinical signs line Miliary dermatitis has been observed. Occasional gastro- - General symptoms (50%), Loss weight, anorexia, oc- intestinal signs and gingivitis (licking?) Clinical signs are not casion anal fever.- Haematology: specific. Haircoat matted, scaling, a « pepper and salt » aspect (scales + mites). Epilation is easy and tegument itself not Anaemia frequent (pale mucosae) (non regenerative), (± concerned. - Lesions are more pronounced on dorsal and lum- leucopoenia, leucocytosis, monocytosis) Hyperproteine- bar area, head and neck.- Differential includes causes of scal- mia, less marked/dog: gamma-beta Glob.± incr. Creati- ing in cats: ectoparasites (Cheyletiella, fleas an lice), causes of nin, urea. seborrhoea. - Final diagnosis is based on trichoscopy with parasites and eggs. - Skin The control is not difficult and similar to lice. Carbamates, lime sulfur, pyrethrins have shown to be effective. Macrocy- Ulcers = the most frequent (> 50%) on face, ears, lips, clic lactones are also effective (i.e. ivermectin 0.3 mg/kg once). tongue, ± disseminated.Nodules = Suggestive (± 50%) Probably all other acaricidal (phenylpyrazoles) are also effec- « Oriental sore » like? Inoculation sore? tive.- There is no risk of human contamination. Unique or multiple Simultaneous or progressiveGeneral- ly small (± 0.5 cm) occasionally large > 3 cm. Ears, nose, lips, eyelids, extremitiesAlopecia: Head, ventral Nodules and plaques …Scales, crustsEosinophilic granuloma complex: one case ( Hubert) Causes for nodules and plaques in cats include: Lymphadenopathy (30%) Infection: - Also mentioned: Bronchopneumonia, digestive, stoma- Abscesses (very common), bacterial granulomas (includ- titis, renal failure, - Ocular signs- Asymptomatic carriage ing actinomycetes and mycobacterias), fungal granulo- (isolation of Leishmania or serology) mas (phaehyphomycosis, cryptococcosis, mycetoma). - Diagnosis: Neoplasia Blood: Anaemia frequent (± leucopoenia, monocytosis), A variety of skin tumours develop in cats like in other Hyperproteinemia, ± incr. Creatinin, urea. Less marked/ species. dogDetection of FIV ± FeLV ± IFPSerology Antibodies: Parasites IFA: positive generally low titers: 80 to 160 (-> 2560); Various ectoparasites may induce the eosinophili granu- ELISA, pos. > 0.5?Others: Circulating antigens? PCR loma complex (see above) Passos et al (1996): Positive on isolated confirmed cases (Laruelle, Pennisi) Positive on 61% of a group of suspect- Parasite granulomas: myiasis, aberrant migration of nem- ed cases (Pennisi) atodes, and rare cases of Dirofilaria repens. IFA + PCR to recommend? Smears (cf dog): Ulcers, lymph Feline leishmaniosis. nodes, bone marrow ++ (necropsy: liver, spleen) Histopathology (cf dog) Leishmaniosis in cats a new reality ? Direct observation routine stains or Immunochemistry - General leishmaniosis (leishmania infantum) is described (when not visible). in cats in some foci (particularly in Italy). - During a long -Treatment: Medical: very few data on series and nor real time this disease was considered as non existing (failure reference treatment of inoculations. and negative surveys). However argu- ments “pro” also existed, and infections were observed Treatment similar to those used in dogs. in a number of countries in new and old world, half of them asymptomatic. Epidemiology : The age is often not indicatedThere is no role of sex or breed although facial lesions are common in longhaired breed.It may occur on domestic or feral cats. The role of an underlying disease, like in humans, remains unclear and a variety of associated conditions have been described (ectoparasites, fungal infections, allergic or auto-immune diseases).

61 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

PRISTOP K DIAGNOSTIKI BOLEZNI SPODNJIH SE^IL PRI MA^KI

Maja Brlo`nik1, Pavo Zaninovi}1, Irena Zdovc2

Prevalenca bolezni spodnjih se~il pri ma~ki (BSSM) je ok- rog 7%. Pri ma~kah do 10 let, so najpogostejši idiopats- ko vnetje, urolitiaza in uretralni plaki. Bakterijske oku`be najdemo ve~inoma le pri ma~kah nad 10 let. V prispevku je podan problemski pristop k diagnostiki obolenj s prikazom zna~ilnih klini~nih skupin (obstrukcija se~nice, bakterijska oku`ba in idiopatski cistitis). Podane so zna~ilnosti anamnesti~nih podatkov, opa`anja ob klini~nem pregledu in razlike v urinskih sedimentih pri skupini sedemdesetih ma~k - klini~nih pacientov z znaki BSSM. Na osnovi anamnesti~nih podatkov, temeljitega klini~nega pregleda in analize urina lahko v ve~ini primerov postavimo zanesljivo diagnozo

Maja Brlo`nik, dr.vet.med., dr. Pavo Zaninovi}, dr.vet.med., doc.dr. Irena Zdovc, dr.vet.med. 1 PRVA-K, Klinika za male `ivali, Gorki~eva 6, SI-1000 Ljubljana 2 Univerza v Ljubljani, Veterinarska fakulteta, Inštitut za mikrobiologijo in parazitologijo, Gerbi~eva 60, SI-1000 Ljubljana [email protected]; [email protected]; [email protected]

62 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

POSPEŠENI PROTOKOL OBSEVANJA PRI ZDRAVLJENJU PLOŠ^ATOCELI^NEGA KARCINOMA SMR^KA IN USTNE VOTLINE PRI MA^KAH

Ana Rejec1, Matja` Jeraj2, Janoš Butinar1, Janean L Fidel3

Ploš~ato celi~ni karcinom (PCK) smr~ka pri ma~kah je brez napredovanja) je trenutno 4,5 mesece. PCK ustne tumor belih ali svetlejših ma~k, nastanek pripisujemo votline, zdravljen s 14 frakcijami v 9 dneh pa je ravnokar ultravijoli~nim `arkom. PCK ustne votline je najpogostej- kon~an. Vidni del tumorja je v regresiji. ši tumor ustne votline pri ma~kah, povezujemo ga z okolj- skimi dejavniki in mutacijami. PCK smr~ka je lokalno agresiven tumor, ki redko metastazira. PCK ustne votline je lokalno agresiven tumor z napredujo~o destrukcijo kosti in visokim metastatskim potencialom. Incidenca metastaziranja je razmeroma neraziskana zaradi te`ke lokalne kontrole in umiranja preden se razvije metastat- ska bolezen. Prognoza PCK smr~ka je dobra, posebej pri zdravljenju v zgodnjih fazah, pri ustnem PCK je prognoza slaba, problem je uspešna in trajna lokalna kontrola, boljša je v zgodnjih fazah bolezni. Zdravljenje PCK smr~ka je kirurško, resekcija ulcerativne lezije z ustreznimi zdravimi robovi, vendar povzro~i iznaka- `enost obraza; v poštev pride še krioterapija, fototerapi- ja, intralezijska kemoterapija z derivati platine, sama in v kombinaciji z radioterapijo in radioterapija sama. PCK ustne votline pri ma~kah lahko zdravimo kirurško, uspeš- nost je mo~no odvisna od lokacije. Znano je, da ma~ke prenašajo velike ustne resekcije slabše od psov. Empiri~no vemo, da so ustni PCK locirani bolj rostralno manj maligni, novejši podatki pa govorijo o korelaciji volumna tumorja in malignosti, kar govori v prid manjše malignosti bolj rostralnih tumorjev, saj jih odkrijemo la`je, ko so še manjši in najverjetneje manj maligni. Radioterapija PCK smr~ka je znana kot uspešna, manj pa je uspešna pri PCK ustne votline. Znano je, da ima PCK kratek podvojitveni ~as, kar govori v prid radioterapiji s kratkimi ~asovnimi intervali (hiperfrakcioniranje) z majhnimi dozami. Avtori- ca (JF) je razvila pospešene protokole, ki smo jih uporabili pri dveh ma~kah z obema vrstama PCK. PCK smr~ka smo uspešno zdravili (10 frakcij v 5 dneh), PFI (interval

Ana Rejec, dr.vet.med., Matja` Jeraj, dipl.ing.radiol., prof.dr. Janoš Butinar, dr.vet.med., Janean Fidel DVM MS DACVR (radiation oncology) DACVIM (oncology), Dept.of Veterinary Clinical Sciences, Washington State University, USA 1 Bolnica za `ivali Postojna, Cesta v Staro vas 20, SI-6230 Postojna 2 Onkološki Inštitut Ljubljana, Zaloška c. 2, SI-1000 Ljubljana 3 Dept.of Veterinary Clinical Sciences, Washington State University, College of Veterinary Medicine, ZDA [email protected]; [email protected]; [email protected]; [email protected]

63 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

SINDROM »OKNA NA KIP« IN AKUTNE LEDVI^NE ODPOVEDI PRI DOMA^I MA^KI

Igor Firm1, Ana Rejec2, Janoš Butinar2

Sindrom “okna na kip” je zaradi pogostosti takšnega tipa oken v Evropi pogost vzrok travmatske ishemi~ne nevro- miopatije. Predstavljamo primer doma~e ma~ke, ki je bila pripeljana v Bolnico za ìvali Postojna dva dni po tem, ko je obvisela na doma~em oknu. Tipi~ni simptomi, zna~ilni za ta tip poškodbe, so: hipotermija; bole~ine v zadnjih okon~inah, ledvenem podro~ju in trebuhu; otekline mišic zadnjih nog; hladne zadnje okon~ine; slaboten do odso- ten femoralni pulz; parapareza ali paraplegija, pogosto v povezavi z zmanjšanimi spinalnimi refleksi zadnjih okon~in; odsotnost globinske bole~ine. V opisanem primeru je prišlo še do dodatnih zapletov v zdravljenju (ventrikularna tahikardija, hiperkalemija), ki smo jih pripisali reperfuzijski poškodbi, in do akutne ledvi~ne odpovedi (v nadaljevanju ALO), ki je bila najverjetneje posledica ledvi~ne ishemije in hipoperfuzije v ~asu vkleš~enja v okno. Zaradi ALO smo se znašli pred resno dilemo, kakšno prognozo dati v tem primeru in kaj svetovati skrbnici ìvali glede na omejene fina~ne zmo`nosti in negotovo prognozo, ki je brez ALO kar dobra, saj si kar 80% ìvali po enem mesecu opomore (~as trajanja hospitalnega zdravljenja je od 1 do 12 dni). Kljub negotovi prognozi smo se skupaj s skrbni- co odlo~ili za nadaljevanje zdravljenja, ki je bilo v prvih dneh usmerjeno predvsem v protibole~insko terapijo, zdravljenje šoka, zdravljenje motenj v sr~nem ritmu in antibioti~no profilakso zaradi nevarnosti bakterijske trans- lokacije iz ~revesja. V nadaljevanju pa se je terapija osredoto~ila predvsem na lajšanje simptomov ALO in zadostno energijsko oskrbo anoreksi~ne ìvali. Zato smo ma~ki vstavili ezofagealno sondo, ki se je pokazala kot klju~ni del terapije. Slednje izpostavljamo, ker je bilo glede na etiologijo in akutnost procesa ledvi~ne odpovedi predvsem pomembno dati ma~ki dovolj ~asa za vzpostavi- tev normalne ledvi~ne funkcije, k ~emer bi seveda pripo- mogla tudi hemodializa, ki pa àl v Sloveniji in bli`nji okolici ni dostopna. Po desetih dneh smo ma~ko odpustili v doma~o oskrbo.

Igor Firm, dr.vet.med., Ana Rejec, dr.vet.med., prof.dr. Janoš Butinar, dr.vet.med. 1 FIRM, Veterinarska interna medicina, Igor Firm s.p., Nove Loke 35, SI-3330 Mozirje 2 Bolnica za `ivali Postojna, Cesta v Staro vas 20, SI-6230 Postojna [email protected]; [email protected]; [email protected];

64 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

DIAGNOSTIKA PANKREATITISA PRI MA^KAH

Estera Pogorevc, Barbara Celinšek

UVOD KLINI^NI ZNAKI Bolezni eksokrinega pankreasa so relativno pogoste, ven- Klini~ni znaki pri ma~kah s pankreatitisom so nespecifi~ni. dar pri ma~kah àl mnogokrat napa~no diagnosticirane Ma~ke so letargi~ne in neješ~e; izguba teè, bruhanje in zaradi nespecifi~nih klini~nih znakov ter pomanjkanja driska se pojavijo redkeje (1-4). ob~utljivih in specifi~nih laboratorijskih testov. Napredek Pri pregledu lahko ugotovimo dehidracijo (54%), hipoter- na podro~ju razumevanja patofiziologije, prevalence in mijo (46%), ikterus (37%), povišano temperaturo (25 %), potencialnih vzrokov pankreatitisa je lahko klju~nega pome- bole~ trebuh (19%) ali maso v trebuhu (11%) (2). na na poti do pravilne in uspešne terapije. Pri ma~kah s hujšo obliko pankreatitisa se lahko pojavijo resni sistemski zapleti kot so diseminirana intravaskular- ETIOPATOGENEZA PANKREATITISA na koagulacija (DIC), plju~na tromboembolija, kardio- Ne glede na vzrok je pri vseh pacientih problem nepravil- vaskularni šok in multiorganska odpoved (4). na zgodnja aktivacija tripsinogena znotraj pankreasa kot posledica avtoaktivacije in/ali zmanjšane avtolize. Tripsin LABORATORIJSKE UGOTOVITVE je glavna proteaza, ki jo izlo~a pankreas. Njegova prez- Hematološke preiskave lahko pokaèjo normocitno, nor- godnja aktivacija znotraj acinarnih celic vodi do avtodi- mohromno, regenerativno ali neregenerativno anemijo, gestije in hudega vnetja, zato je zaš~itni mehanizem ta, hemokoncentracijo, levkocitozo ali levkopenijo. da je tripsin shranjen v zimogenih granulah v acinusih v obliki inaktivnega prekurzorja tripsinogena. Kadar se av- Biokemijske preiskave: hiperbilirubinemija, povišana vred- toaktivira prevelika koli~ina tripsina, zaš~itni mehanizem nost alanin aminotransferaze in alkalne fosfataze, hiper- popusti in pride do veri`ne reakcije, kar vodi v avtodi- holesterolemija, hiperglikemija, hipokalcemija in hipoal- gestijo pankreasa, vnetje in nekrozo peripankreati~ne buminemija (2). Zniàne vrednosti kobalamina se lahko maš~obe ter lokalnega ali bolj generaliziranega sterilnega pojavijo pri nekaterih ma~kah, najverjetneje v povezavi s peritonitisa (1). spremljajo~im ~revesnim obolenjem (motena absorbcija v ileumu) (1, 4). Dejavniki tveganja za pojav pankreatitisa so holangitis, vnetno obolenje ~revesja (IBD), infekcije (FIP, herpesvi- rus, calicivirus, panleukopenija, toksoplazmoza), travma, SPECIFI^NI TESTI ishemija, hiperkalcemija, hipertrigliceridemija, zastrupi- Aktivnost amilaze in lipaze tev z organofosfati, mastna hrana. Nimata klini~nega pomena pri diagnostiki pankreatitisa Pri ma~ki se izvodilo trebušne slinavke in òl~no izvodilo ma~k (4). stekata v duodenum preko skupnega voda. Ob mehanski ali funkcionalni obstrukciji tega voda pride do vdora òl~nih Tripsin-like immunoreactivity (TLI) kislin v izvodilo trebušne slinavke. IBD lahko povzro~i Ma~ji TLI (fTLI) meri tripsinogen in tripsin v serumu. pankreatitis zaradi bruhanja (zviša se intraduodenalni Kljub temu, da imata tripsinogen in tripsin izklju~no pritisk, kar lahko povzro~i pankreati~nobiliarni refluks), pankreati~ni izvor, je ob~utljivost tega testa pri diagnosti- refluksa duodenalne vsebine in vdora bakterij skozi skup- ki pankreatitisa ma~k nizka. no papilo (2). Pancreatic lipaze immunoreactivity (PLI) Specifi~no dolo~a koncentracijo ma~je pankreasne lipaze v serumu in je trenutno najbolj ob~utljiv in uporaben test asist. Estera Pogorevc, dr.vet.med., Barbara Celinšek, dr.vet.med. za diagnostiko pankreatitisa pri ma~ki (2, 3, 4). Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, SI-1000 Ljubljana Diagnosti~na ob~utljivost fPLI pri kroni~nem pankreatitisu ni znana (1). Trenutno se test izvaja le v Idexx-ovih [email protected], barbara.celinš[email protected] referen~nih laboratorijih.

65 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

RENTGENSKA DIAGNOSTIKA Na rentgenski sliki trebuha so lahko le blage spremembe ali pa jih ni, vendar je slikanje zelo pomembno za izklju~itev morebitne akutne popolne obstrukcije ~revesja.

ULTRAZVO^NA DIAGNOSTIKA Najbolj ob~utljiva in neinvazivna slikovna metoda je ultrazvok, ki je zelo specifi~en, ob~utljivost same preiskave pa je v veliki meri odvisna od izkušenosti operaterja in resnosti bolezni. Še ve~jo ob~utljivost se ugotavlja pri akutnem pankreatitisu, saj je takrat dobro vidna meja med edemom pankreasa in nekrotizirajo~o peripankreati~no maš~obo.

CITOLOGIJA Pri citološkem pregledu vzorca tankoigelne biopsije, lo~imo lahko med vnetjem in novotvorbo. Negativni izvid ne izklju~i pankreatitisa, saj gre lahko za fokalne spremembe (4).

PATOHISTOLOGIJA Na podlagi ugotovitev klini~nega pregleda, laboratorijske in slikovne diagnostike za ~asa ìvljenja ma~ke ne moremo lo~iti med kroni~nim in akutnim pankreatitisom – potrebna je patohistološka preiskava post mortem. Akutni nekrotizirajo~i pankreatitis (ANP-Acute Necrotiz- ing Pancreatitis) se kaè kot nekroza acinarnih celic pankreasa in peripankreati~ne maš~obe z razli~nim obse- gom vnetja, krvavitev, mineralizacije in fibroze. Vnetje je lahko prisotno, vendar prevladuje nekroza. Akutni gnojni pankreatitis (ASP-Acute Suppurative Pan- creatitis) se razlikuje od ANP po tem, da je prisotno vnetje (lahko tudi nekroza), vendar prevladujejo nevtrofilci. Po- javlja se redkeje kot ANP in ve~krat prizadene mlajše ìvali. Kroni~ni negnojni pankreatitis (CP-Chronic Nonsuppura- tive Pancreatitis) se kaè kot vnetje, kjer prevladujejo lim- fociti, fibroza in atrofija acinusov, prisotna je lahko tudi nekroza. Ostala obolenja pankreasa, ki jih lahko natan~no razlikujemo le na podlagi patohistološke preiskave, so še nodularna hiperplazija pankreasa, novotvorbe, pseudociste in absces pankreasa. Atrofija pankreasa je pogosto rezultat degeneracije, involucije, nekroze in apoptoze eksokrinega dela `leze. Pri ma~kah to najve~krat kaè na zadnjo fazo kroni~nega pankreatitisa.

LITERATURA 1. Watson PJ, Bunch SE. The Exocrine Pancreas. In: Nelson RW, Guillermo Couto C. Small Animal Internal Medicine. 4th Ed., Missouri, Mosby Elsevier, 2009: 579-606. 2. Washabau RJ. Acute necrotizing pancreatitis. In: August JR. Consultations in feline internal medicine. Vol. 5, Missouri: Elsevier Saunders, 2006: 109 – 119. 3. Stinehewer J. The liver and pancreas. In: Chandler EA, Gaskell CJ, Gaskell RM. Feline Medicine and Therapeutics. 3rd Ed., Gloucester: BSAVA, 2007: 435 – 453. 4. Xenoulis P, Steiner J. Feline pancreatitis. Veterinary Focus. Vol. 19, No. 2, 2009: 11 – 19.

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DIHALNA STISKA PRI MA^KI – STABILIZACIJA, DIAGNOSTIKA IN POGOSTI VZROKI

Radovan Zajc

Uvod drebrni prostori vbo~ijo, prav tako trebušna stena. Ob izdihu pa se trebuh izbo~i. Zdravljenje dihalne stiske (DS) pri ma~ki je lahko zelo stresno za veterinarja. Njihova ob~utljiva narava nam oteùje delo. Slabo se odzivajo na diagnosti~ne in terapevtske Klini~ni pregled ukrepe, saj jih prestrašijo, s tem pa se njihova DS še Pri klini~nem pregledu opazujemo barvo vidnih sluznic. poglobi. Zato nam primanjkuje ~asa za poglobljeno diag- Blede sluznice kaèjo na hipoksemijo, anemijo ali peri- nostiko in vzro~no terapijo. Odzivati se moramo hitro, ferno vazokonstrikcijo, cianoti~ne ali modre sluznice pa vzporedno morata potekati diagnostika in terapija. Ko- na hudo hipoksemijo. ristne informacije dobimo s hitro, a iz~rpno anamnezo. Pri avskultaciji plju~ lahko slišimo piske, poke in pove~ano Zelo pomembno je, da si vzamemo ~as in natan~no opa- ali pridušeno plju~no dihanje. Piski so nepretrgani zvoki zujemo dispnoi~no ma~ko. Na koncu opravimo še hiter razli~nih višin in glasnosti, ki jih slišimo obi~ajno le med klini~ni pregled. izdihom. Ko sta steni bronhija dovolj blizu, nastane pisk zaradi vibriranja sten. Slišimo jih pri obstruktivnih boleznih Anamneza dihal (astma). Poki nastanejo zaradi nenadnega odprtja Anamnesti~ne ugotovitve nam lahko mo~no pomagajo prej stisnjene dihalne poti. Slišimo jih lahko med vdihom pri diagnostiki in terapiji. Nekaj uporabnih vprašanj, ki jih (bronhitis) in izdihom (bronhitis, plju~ni edem). Kadar zastavimo lastniku: Koliko ~asa te`ko diha? Kje ìvi ma~ek? so dihalni zvoki tihi, govorimo o pridušenem plju~nem Ali kašlja? Ali hujša in nima apetita? zvoku. Nastane takrat, ko se plevralni prostor napolni z zrakom, teko~ino ali tkivom (pnevmotoraks, plevralni izliv). Klini~ni znaki Sr~no avskultacijo in palpacijo pulza delamo so~asno, da zaznamo sr~ne šume ali aritmije. Izvid sr~ne avskultacije Pomembno je prepoznati klini~ne znake DS pri ma~ki. pri ma~ki pogosto ni v sorazmerju s sr~no disfunkcijo. Lahko se pove~a frekvenca dihanja, pove~a se napor pri Zato odsotnost sr~nih šumov in galopnega ritma ne vdihu in izdihu, diha z odprtimi usti, lahko je zaspana in izklju~uje bolezni srca. depresivna. Ma~ka sedi ali leì v sternalni poziciji (ortop- nea). Za DS ma~ke sta zna~ilna dva dihalna vzorca: restriktivni in obstruktivni. Pri restriktivnih motnjah se plju~a Stabilizacija te`ko razširijo ob vdihu. Zato je dihanje hitro, kratko in Vzporedno z iskanjem vzrokov DS za~nemo tudi z zdrav- plitvo. Sem prištevamo bolezni plju~nega parenhima, kot ljenjem. Na prvem mestu je to dovajanje kisika. so plju~nica, edem in novotvorbe ter bolezni plevralnega Na naši kliniki v ta namen uporabljamo kisikovo kletko in prostora, kot so pnevmotoraks in plevralni izliv. kisikov ovratnik. Kisikova kletka je optimalna metoda za Pri obstruktivnih motnjah prihaja do mehani~nega oènja zagotavljanje dobre oksigenacije. Prednosti te metode so: dihalnih poti, kar povzro~i, da je dihanje po~asnejše in minimalni stres za ma~ke, dobra kontrola koncentracije globoko. Oènje zgornjih dihalnih poti sproì napor pri kisika, ogljikovega dioksida, temperature in vla`nosti zra- vdihu, medtem ko pri boleznih spodnjih dihalnih poti (ast- ka. Edina slabost je izolacija pacienta. ma) opazimo napor ob izdihu. Zelo priro~en in u~inkovit za kratkotrajno dajanje kisika je Pri hudi in dolgi DS se dihalne mišice utrudijo. Nastopi kisikov ovratnik. Za dolgotrajno terapijo ni primeren, ker paradoksalni vzorec dihanja. Zanj je zna~ilno, da se ob lahko nekontrolirano naraste koncentracija ogljikovega vdihu medrebrne in trebušne mišice skr~ijo. Zato se me- dioksida, hkrati pa se zrak v ovratniku preve~ segreje. Zelo dispnoi~ne ma~ke pogosto niso dovolj stabilne za Radovan Zajc, dr.vet.med. diagnostiko. Hkrati nam klini~ni znaki in hitri klini~ni pre- Veterinarstvo Trstenjak – Zajc, d.o.o., Klinika za male ìvali, Ul. padlih borcev 23, gled ne povesta dovolj. V takšnih primerih uporabljamo SI-1000 Ljubljana, www.klinika-vtz.si empiri~no zdravljenje, dokler ma~ka ni dovolj stabilna za [email protected] nadaljevanje diagnostike.

67 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Ker je plevralni izliv zelo pogost vzrok DS pri ma~ki, nare- anamneze te`kega dihanja in drugih klini~nih znakov. V dimo plevralno punkcijo, posebno pri ma~ki, ki ima tihe nasprotju z psi ma~ke ne kašljajo, obi~ajno nimajo šuma, dihalne zvoke. Plevralno punkcijo naredimo pred RTG sli- niti galopnega ritma. Vzorec dihanja je restriktiven, pri kanjem . V primeru pozitivnega rezultata diagnosti~na avskultaciji plju~ slišimo glasnejše dihalne zvoke ali poke. plevralna punkcija preide v terapevtsko. Rentgenska slika plju~ nam ka`e klasi~ni perihilarni al- ^e je plevralna punkcija negativna, posumimo na dva naj- veolarni vzorec ali so alveolarni vzorci kjerkoli po plju~ih. pogostejša vzroka DS: kardiogeni plju~ni edem in astmo. Zato je empiri~na terapija sestavljena iz enega odmerka Bolezni plevralnega prostora furosemida V našem okolju so bolezni plevralnega prostora med (1 – 2 mg/kg, IM, IV) in enega odmerka kortikosteroida najpogostejšimi vzroki DS pri ma~ki. Sem spadata plev- (deksametazon 0,25 – 0,5 mg/ kg, IM, IV ). Nizka doza ralni izliv in pnevmotoraks. furosemida ni škodljiva za astmo, prav tako tudi nizka Restriktivni dihalni vzorec in pridušen dihalni zvok ob doza steroida ne bo škodila ma~ki z boleznijo srca. avskultaciji sta klasi~na znaka bolezni plevralnega prostora. Z rentgenskim slikanjem prsnega koša potrdimo pris- Pogosti vzroki DS pri ma~ki otnost teko~ine. Ob hudi DS in sumu na plevralni izliv se Najpogostejši vzroki DS pri ma~ki so: bolezni srca, bolezni zgodaj odlo~imo za plevralno punkcijo. plevralnega prostora in astma. Manj pogosti vzroki pa Diagnosti~na punkcija preide v terapevtsko. Analiza plev- so: bolezni zgornjih dihal, bakterijska plju~nica in plju~na ralne teko~ine (celokupni proteini, število celic, citologija) tromboembolija. nam pomaga zdraviti osnovno bolezen.

Bolezni srca Astma K boleznim srca pri ma~ki spadajo: hipertrofna, restrik- Pomemben vzrok DS pri ma~ki je astma. Pri njej gre za tivna in dilatativna kardiomiopatija. Hipertrofna in restrik- so~asno stiskanje bronhijev, pove~ano produkcijo sluzi tivna kardiomiopatija vodita v diastoli~no disfunkcijo in in hipertrofijo gladkih mišic bronhijev. Pomemben je posledi~no pomanjkljivo polnjenje levega prekata. Dilata- anamnesti~ni podatek o dolgotrajnem kašlju. Dihalni tivna kardiomiopatija pa vodi v sistoli~no disfunkcijo in vzorec je obstruktivni z pove~anim naporom pri izdihu. zmanjšano kr~ljivost levega prekata. Vsem pa je skupno Pri avskultaciji slišimo ekspiratorne polifone piske. Rent- levostransko sr~no popuš~anje, ki se klini~no ka`e z genska slika poka`e bronhialen vzorec z »krofi« in plju~nim edemom. Obi~ajno ma~ke preidejo v DS brez »tra~nicami«, hiperinflacijo in ravno trebušno prepono.

Astma Bolezni srca Bolezni plevralnega prostora

Piski Poki Pridušen dihalni zvok Poki Sr~ni šumi Pove~an ekspiratorni napor Galopni ritem Kašelj

Obstruktivni vzorec Restriktivni vzorec Restriktivni vzorec

Kisik Kisik Kisik Bronhodilatatorji Diuretki Plevralna punkcija Glukokortikoidi Zdravljenje osnovne bolezni

Slika1: Algoritem diagnostike in zdravljenja DS pri ma~ki

Literatura 1. King LG. Respiratory Disease in Dogs and Cats: Elsevier, Saunders, 2004 2. Smith FWK, Jr., Keene BW, Tilley LP. Rapid Interpretation of Heart and Lung Sounds: Elsevier, Saunders, 2006 3. Schwarz T, Johnson V. BSAVA Manual of Canine and Feline Thoracic Imaging: BSAVA, 2008

68 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

REHABILITACIJA IN FIZIOTERAPIJA PSA PO OPERACIJI KOLKA - klini~na primera

Kristina Porenta

1. UVOD zadnejga dela telesa, predvsem zadnje desne noge, miši~ast prednji del telesa, izrazit prenos teè na prednje Med pogostejše operativne posege na kol~nem sklepu noge, razbremenjevanje zadnjih nog. Omejena in bole~a štejemo trojno osteotomijo medenice, totalno endoprot- ekstenzija (110°/B) in abdukcija operiranega kolka, ezo kolka, stabilizacijo po luksaciji in zlomih kolka ter propriocepcija zadnje desne noge odsotna. Gibljivost odstranitev glavice stegnenice. Najpogostejši problem po ostalih sklepov ohranjena. Trias znotraj referen~nih operaciji kolka so bole~ina, atrofija mišic operirane noge vrednosti. in zmanjšana gibljivost prizadetih sklepov, še posebno, ~e so bile te teàve prisotne è pred operacijo. Zaradi bole~ine in oslabelih mišic ìval noge ne uporablja prim- b) Klini~ni primer 2 - po osteotomiji medenice erno, kar pogosto vodi v dodatne komplikacije, ki okre- V fizioterapevtski ambulanti je bil sprejet 1 leto star, vanje podaljšujejo. Program rehabilitacije in fizioterapije nekastriran, 40 kg teàk nemški ov~ar Thor, 3 tedne se sestavi na podlagi vrste operativnega posega, klini~nega po operaciji desnega kolka (trojna osteotomija meden- stanja pacienta in mo`nosti lastnika za sodelovanje. V ice) zaradi kol~ne displazije. Pri klini~nem pregledu je prispevku sta predstavljena program rehabilitacije po ugotovljeno šepanje na zadnjo desno nogo med stojo odstranitvi glavice stegnenice in program rehabilitacije po 1/5, hojo 2/5 in tekom 3-4/5. Pri sedanju spodvije zadnji trojni osteotomiji medenice. Bistvena razlika med njima nogi v desno stran, pri vstajanju izrazito razbremeni je, da se obremenjevanje operiranega uda po osteotomiji operirano nogo, pri hoji jo postavlja preve~ vstran in glavice stegenice spodbuja ~imprej, po osteotomiji meden- obra~a navzven. Pri uriniranju ne dvigne nobene noge. ice pa bolj postopno in previdno (1). Prisotna atrofija in zmanjšan tonus mišic operirane noge, napete in bole~e mišice hrbta, predvsem lum- 2. MATERIALI IN METODE bosakralno in interskapularno, bole~e tudi mišice ra- Anamneza: menskega obro~a. Ob brazgotini tipne trdoelasti~ne bulice. Gibljivost operiranega kolka rahlo zmanjšana - a) Klini~ni primer 1 - po osteotomiji glavice stegnenice fleksija (60°/B), extenzija (155°/B), bole~ina (B) prisot- V fizioterapevtski ambulanti je bila sprejeta 15 mesecev na tudi pri kon~nih obsegih gibov abdukcije ter notranje stara, sterilizirana, 48 kg te`ka psica Lia, pasme veliki in zunanje rotacije. Gibljivost ostalih sklepov ohranje- švicarski planšarski pes. Pri 6-ih mesecih starosti je priš- na in nebole~a, propriocepcija ohranjena. Trias znotraj lo do epifiziolize glavice femorja in opravljena je bila fiksaci- referen~nih vrednosti. ja s 3 iglami. êz ~as psica noge ni ve~ obremenjevala, ugotovljena je bila asepti~na nekroza glavice stegnenice in migracija ene igle, zaradi hudih bole~in na nogo ni ve~ Lestvica šepanja: stopila, zato je bila opravljena osteotomija glavice. Pri OBREMENJEVANJE UDA MED STOJO: 0 - normal- klini~nem pregledu 10 dni po odstranitvi desne glavice no; 1 - delno obremenjuje;, 2 - rahlo se dotika tal; 3 - stegnenice je ugotovljeno šepanje na zadnjo desno nogo drì ud v zrak; 4 - ne more stati MED HOJO in MED med stojo 2/5, hojo 3/5, teka ne zmore. Strma stoja zad- TEKOM: 0 - ne šepa (vse ude obremenjuje enakomer- njih nog. Pri sedanju se vrè na levi bok, vstane s teàvo. no); 1 - komaj opazno šepa (z razbremenjevanjem uda;, Med hojo zelo zvija telo. Opazna je huda atrofija mišic 2 - o~itno šepa (z razbremenjevanjem;, 3 - o~itno šepa (z intermitentnim obremenjevanjem); 4 - sploh ne stopi (drì ud v zrak ves ~as) Kristina Porenta, dr.vet.med., dipl.fiziot., CCRP Univerzitetni rehabilitacijski inštitut Republike Slovenije – So~a, Linhartova 51, SI-1000 Ljubljana [email protected]

69 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Program fizioterapije: 4. DISKUSIJA - Hlajenje operiranega kolka v akutni fazi. Vrnitev ìvali v normalno funkcijo se po osteotomiji glav- - Segrevanje operiranega kolka pred razgibavanjem. ice stegnenice pri~akuje po treh mesecih, pri osteotomiji - Masaà zadnjih nog, hrbta, mišic ramenskega medenice pa po štirih mesecih po operaciji (2), ~e je bila obro~a. ìval pred posegom v dobri fizi~ni kondiciji. Lia noge pred operacijo è ve~ tednov ni uporabljala. Prišlo je do - Pasivno razgibavanje in raztezanje sklepov operirane hude atrofije in skrajšave mišic zadnje desne noge ter noge. posledi~ne omejene gibljivosti sklepov, predvsem kol~nega, - Stimulacija refleksov. kar je zahtevalo daljšo in zahtevnejšo rehabilitacijo. Zara- - Vaje za propriocepcijo, koordinacijo in ravnote`je. di velikosti in teè pasme bo šepanje verjetno stalno prisotno, saj bi bila optimalna rešitev le kol~na endoproteza, - Vaje za krepitev atrofiranih mišic. za kar pa se lastniki niso odlo~ili. Nasprotno je Thor okre- - Hoja v vodi. val hitreje od pri~akovanj, kar morda lahko pripišemo - Krajši po~asni sprehodi na vrvici ve~krat na dan, zgodnjemu pri~etku intenzivne in strogo nadzorovane kasneje postopna uvedba teka. rehabilitacije in fizioterapevtskih postopkov. K uspehu ter- - 2 dni v tednu po~itek, od aktivnosti samo sprehodi. apije so v obeh primerih veliko pripomogli tudi lastniki, ki so upoštevali navodila in redno izvajali del terapije tudi - Uporaba pripomo~ka za la`jo hojo za zadnje noge. doma. - NSAID in hondroprotektivna terapija. - Ambulantna terapija 2 – krat na teden, druge dneve 5. ZAKLJUÊK lastniki v omejenem obsegu izvajajo sami. Program rehabilitacije po osteotomiji medenice se upor- - Prepre~evaje skokov, zdrsov, padcev in nenadnih ablja tudi pri okrevanju po vstavitvi kol~ne endoproteze in ekstremnih gibov. stabilizaciji kolka po poškodbi. Zgodnje vklju~evanje po- operativne rehabilitacije omogo~a hitrejše in boljše okre- 3. REZULTATI vanje, in tako lahko pripomore k optimalnemu rezultatu operacije, ne glede na vrsto operativnega posega na kolku. a) Po 16-ih tednih rehabilitacije Lia hodi lepo, vsede se, uleè in vstane pravilno. Zmore enouren sprehod in hojo v klanec. Nogo med stojo obremeni normalno, šepa med hojo (1/5) in tekom (1-2/5), sicer je ìvahna in razigrana. Razlika v miši~ni masi zadnjih nog ni ve~ opazna, okrepl- jen cel zadnji del telesa. Boljša gibljivost operiranega kolka - ekstenzija 145°. Propriocepcija prisotna. b) Po devetih tednih rehabilitacije (12 tednov po operaciji) je Thor zelo ìvahen in razigran, vsede se, uleè in vstane pravilno, poskuša skakati, kar se mu še ne dovoli, pri uriniranju pa dviguje obe nogi. Pri stoji in hoji operirano nogo normalno obremenjuje, pri teku in po intenzivnejši aktivnosti pa ob~asno še šepa (1/5), Ohranjena polna gibljivost operiranega kolka, rahlo bole~a le v kon~nih stopinjah obsegov gibov. Obseg miši~ne mase na zadnjih nogah simetri~en.

6. LITERATURA 1. Schulz K. Diseases of the Joints. In: Fossum TW. Small animal surgery. 3rd ed. St. Louis: Saunders, 2007: 1143-315. 2. Bockstahler B. Postoperative Joint Rehabilitation. In: Bockstahler B, Levine D, Millis D. Essential facts of physiotherapy in dogs and cats. Im Schloss: BE Vet Verlag 2004, 128-72.

70 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Osnove elektrokardiografije za veterinarske tehnike

Igor Firm

Uvod Elektri~na aktivnost srca Elektrokardiograf (EKG) ni v svoji najbolj osnovni obliki Da bi lahko srce u~inkovito opravljalo svojo funkcijo ni~ drugega kot voltmeter (galvanometer), ki meri spre- ~rpalke, mora delovati usklajeno. Kr~enju obeh preddvorov, membe v elektri~ni aktivnosti srca med dvema ele- ki kri iztisneta v prekata, sledi kr~enje le-teh in iztisk krvi ktrodama. Elektrokardiografija je postopek zapisovanja teh v aorto in plju~no arterijo. Govorimo o usklajeni atrio- sprememb na papir oziroma monitor. Prvi, ki se je resne- ventrikularni kontrakciji. Miši~ne celice srca se skr~ijo le v je ukvarjal z beleènjem elektri~ne aktivnosti srca, je bil primeru sprejema elektri~nega stimulusa, kar strokovno Nizozemec Willem Einthoven, ki je tudi uvedel poimeno- imenujemo depolarizacija. V fizioloških okoliš~inah se vanje valov, uporabljano še danes (P-QRS-T), ter leta 1924 najprej depolarizirata oba atrija in nato z ustreznim prejel za svoje izsledke tudi Nobelovo nagrado za medici- zamikom še oba prekata. Temu sledi obdobje repolariza- no. cije, ki omogo~i ponovitev celotnega procesa. Pozitivno in negativno elektrodo lahko postavimo kamor Vse sr~ne celice imajo sposobnost lastne elektri~ne ak- koli na ali v telo. Najpogosteje uporabljana in najeno- tivnosti, vendar je v desnem atriju podro~je, ki ga ime- stavnejša postavitev je namestitev elektrod na koò nujemo sinoatrijski vozel (SA vozel), v katerem prihaja do okon~in. Tako pridobljen posnetek elektri~ne aktivnosti pospešenga nastanka elektri~nih dra`ljajev. Zaradi te last- imenujemo površinski EKG s postavitvijo elektrod na nosti imenujemo ta del srca tudi sr~ni ritmovnik (’pace- okon~ine (za razliko od prekordialnega, ezofagealnega maker’), ki lahko pod vplivom simpati~nega ìv~nega siste- oziroma intrakardialnega na~ina, pri katerih postavimo ma sr~no frekvenco zviša, pod vplivom parasimpatikusa elektrode na prsni koš, v poìralnik oziroma neposredno pa znià. v sr~ne votline). Za~etek vsakega sr~nega cikla je torej v SA vozlu, od ko- Uporabnost EKG v veterinarski medicini se kaè danes der se elektri~ni dra`ljaj najprej širi skozi mišice preddvo- predvsem pri diagnosticiranju in monitoriranju aritmij in ra in naprej skozi atrioventrikularni vozel, v katerem pride motenj v prevajanju dra`ljajev, spremljanju u~inkov zdravil do kratkega zamika oziroma upo~asnitve prenosa. Pre- z vplivom na srce, monitoriranju sr~ne funkcije pred, med hod elektri~nega dra`ljaja iz preddvorov v prekata poteka in po anesteziji ter oceni sr~ne frekvence v primerih, ko skozi Hisov snop, ki se nato razcepi na levo in desno vejo zaradi slabo tipljivega femoralnega pulza ali zelo neena- ter kon~uje v sr~ni mišici kot Purkinjejeva vlakna. komernega in hitrega ritma to ni mogo~e.

Snemanje elektrokardiograma Za pogled na elektri~no aktivnost srca iz šestih smeri (standardni površinski EKG s šestimi odvodi – I, II, III, aVL, aVF, aVR) moramo na pacienta pritrditi vsaj tri `ice, ki glede na nastavitev na aparatu predstavljajo pozitivno ali negativno elektrodo. Lahko pa pritrdimo še ~etrto, ki jo pritrdimo samo zaradi zmanjšanja motenj (ozemljitev).

Okon~ina Standardni Ameriški Oznake na medicinskih EKG napravah Prednja desna Rde~a Bela RA (right arm – desna roka) Prednja leva Rumena ^rna LA (left arm – leva roka) Zadnja leva Zelena Rde~a LL (left leg – leva noga) Zadnja desna ^rna Zelena RL (right leg – desna noga)

Igor Firm dr. vet. med. - FIRM, Veterinarska interna medicina, Igor Firm s.p., Nove Loke 35, 3330 Mozirje, [email protected]

71 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Standardni površinski EKG idealno snemamo v desnem Po izpisu zadovoljivega EKGja ne pozabimo na ustrezno stranskem poloàju, na podlagi, ki izolira pacienta od ozna~itev, ki naj vsebuje datum, podatke o kalibraciji, ozna- okolice (plastificirana pena, debela brisa~a). Pri zelo neko odvodov, podatke o pacientu in uporabljenih zdravilih. mirnih pacientih, ki no~ejo leàti na boku, pa ga lahko posnamemo tudi v stoje~em poloàju. Pri snemanju v Interpretacija EKG zapisa stoje~em poloàju moramo biti še toliko bolj pozorni na mo`nost motenj, ki nastanejo kot posledica premikanja Pri interpretaciji EKGja je najbolje slediti naslednjim kora- okon~in, nekoliko pa se lahko tudi spremeni velikost kom: posameznih kompleksov. Elektrode v veterinarski medi- 1. ocenimo kakovost in kalibracijo zapisa cini pritrdimo na okon~ine ìvali s pomo~jo ’krokodil~kov’ 2. dolo~imo frekvenco in ritem (na prednjih tacah na ko`no gubo nad komol~nim skle- pom, na zadnjih tacah na ko`no gubo nad kolenskim skle- 3. ocenimo morfologijo P-QRS-T valov pom), ki jim nekoliko pobrusimo zobe ali pa uporabimo 4. dolo~imo srednjo elektri~no os srca samolepilne elektrode za enkratno uporabo, ki jih prilepi- 5. posvetimo se interpretaciji motenj v ritmu. mo na blazinice stopal. Stik elektrod s koò izboljšamo z Najenostavneje dolo~imo frekvenco iz EKG posnetka tako, uporabo ultrazvo~nega gela (nekaj ve~ dela s ~iš~enjem) da ozna~imo na posnetku šest sekundni odsek (pri hitrosti ali pa kar z raztopino za razkuèvanje koè, ki vsebuje snemanja 25 mm/s je to 15 cm in pri hitrosti 50 mm/s 30 alkohol. cm), v katerem preštejemo komplekse in njihovo število Najprej obi~ajno posnamemo kratke odseke vseh šestih pomnoìmo z deset. V primeru, da število P valov ni ena- odvodov pri standardni kalibraciji (hitrost papirja 25 mm/ ko številu QRS-T kompleksov, si njihovo število zabeleìmo s in ob~utljivosti 10 mm/mV). Temu sledi še snemanje lo~eno. Preverimo tudi, ~e so kompleksi kompletni, t.j. daljšega odseka v II odvodu za interpretacijo ritma. Novej- ali ima vsak QRS-T kompleks pripadajo~ P val in vsak P še ve~kanalne EKG naprave naredijo to avtomatsko. Pri val svoj QRS-T kompleks. snemanju bodimo pozorni na mo`nost nastanka artefak- Izmerimo amplitude in trajanje intervalov reprezentativnega tov. Najpogostejši artefakti so motnje zaradi elektri~ne P-QRS-T kompleksa v II odvodu, obi~ajno pri hitrosti interference, miši~nih kr~ev (tremorji) in gibanja ìvali. snemanja 50 mm/s (1 mm = 0,02 s) in ob~utljivosti 1 Ve~ini se lahko izognemo z ustreznimi filtri, premike ìvali mm = 0,1 mV. pa lahko na EKG izpisu ustrezno ozna~imo.

Parameter Enota PES MA^KA Frekvenca Udarci na minut 60-180 (mladi~i <220) 120-240 Trajanje P vala Sekunda 0,04 0,04 Amplituda P vala mV 0,4 0,2 P-Q interval Sekunda 0,06 – 0,13 0,05 – 0,09 Trajanje QRS Sekunda 0,06 0,04 Amplituda R vala mV <2,5-3,0 <0,9 Trajanje Q-T intervala Sekunda 0,15-0,25 0,12-0,18 Srednja elektri~na os Kotne stopinje 40-100 0-160

72 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

POOPERACIJSKA OSKRBA MA^KE

Barbara Lukanc

Nadzor in pomo~ pri zbujanju ma~k iz anestezije mora- 90 %, je obstrukcija najverjetneje le delna in ne popolna. mo zagotavljati tako dolgo, dokler ni ma~ka popolnoma V tem primeru ma~ke oksigeniramo, ~e jim s tem ne pri zavesti. Bolne ìvali lahko po~asneje okrevajo po aneste- povzro~amo preve~ stresa in jim iztegnemo vrat. ê je ziji in pri teh je potreben daljši nadzor. Najve~ nenadnih ma~ka cianoti~na, izgublja zavest ali je saturacija pod 90 in nepri~akovanih anestezijskih smrti se zgodi ravno med %, jo moramo intubirat, ~e je mogo~e, sicer napravimo prebujanjem in to najpogosteje zaradi neèlenih u~inkov tra-heotomijo (4). Po ekstubaciji ìvali namestimo ster- anestetikov (zavor kardiovaskularnega in respiratornega nalno z iztegnjenim vratom in jezikom, da omogo~imo sistema) in pomanjkljivega spremljanja ter pomo~i med prosto dihalno pot (2, 5). prebujanjem (1). Podporna terapija pri prebujanju pri skoraj vseh ìvalih zajema teko~insko in protibole~insko terapijo (1) ter ogre- Ekstubacija vanje (3). Preden ìval ekstubiramo, pogledamo ustno votlino, jo o~istimo in s prijemalkami ali s sukcijo, odstranimo krvne Ogrevanje strdke, slino, zloènce, zlasti po posegih v ustni votlini Po operaciji so ìvali pogosto hipotermi~ne, ker anestetiki (2) in po potrebi s sukcijo skozi traheotubus o~istimo kri, zavirajo proces termoregulacije. Hipotermija je najve~krat sluz in slino iz dihalne poti (3, 4). Odpihnemo meši~ek in razlog za podaljšano zbujanje (1), ker je zmanjšana pres- odveèmo tubus (5). Pri prebujanju moramo biti pozorni nova in podaljšano izlo~anje anestetikov. Za hipotermijo tudi na bruhanje, da ma~ka ne bi aspirirala vsebine zlasti, so dovzetnejše manjše ìvali, zato je najbolje, ~e hipoter- ko je è ekstubirana. ê ma~ka bruha po ekstubaciji, ji mijo lahko prepre~imo. Dodatno se ìvali ohlajajo pri ope- nagnemo glavo navzdol, da je ni`je od prsnega koša in s racijah, kjer je odprt prsni koš ali trebušna votlina. Blago tem prepre~imo aspiracijo. Nato pregledamo ustno votli- hipotermijo ìvali dobro prenašajo, hujša hipotermija pa no in odstranimo izbruhano vsebino. Ma~ke ekstubiramo lahko povzro~i ve~ komplikacij (3). Zaradi hipotermije lahko zelo zgodaj, ko se jim povrne palpebralni refleks in refle- pride do motenj v koagualciji (slabša funkcija tromboci- ks poìranja. Pri ma~kah ne odlašamo z ekstubacijo, saj s tov, po~asnejša aktivacija kaskadnega sistema koagulacije), tem lahko sproìmo laringospazem (2, 5). Pri larin- pove~a se mo`nost infekcije, upo~asnjena je presnova gospazmu so grlni hrustanci tesno skupaj, da zrak ne zdravil, nastane tkivna hipoksija (sekundarno zaradi va- more prehajati v sapnik. Pri nekaterih ma~kah lahko pride zokonstrikcije (1), ker se pove~a periferni ìlni upor in do refleksnega zaprtja dihalnih poti ob ekstubaciji in ~e zmanjša poraba kisika), acidoza in motena je elektri~na so nezavestne lahko pride do popolne zapore dihalnih prevodnost srca. Z drgetanjem ìvali pove~ajo telesno poti (4). Klini~no izgleda zelo podobno laringealni edem, temperaturo, zaradi pove~anega miši~nega dela se pove~a ki lahko nastane po ponavljajo~i intubaciji v plitvi aneste- poraba kisika, lahko za ve~ kot za 200 %. Hipotermi~ne ziji, po poškodb pri intubaciji, zaradi prevelikega tubusa ma~ke lahko ogrevamo z ogretimi odejami, vodno grelno ali zaradi alergije (2, 4). Pri laringospazmu in laringeal- blazino, masaò (3), grelnimi telesi, ki so lahko polnjeni s nem edemu ma~ke dihajo glasno, hropejo ali te`ko di- suhim rièm in jih pogrejemo v mikrovalovni pe~ici. Pre- hajo, poudarjeno je gibanje prsnega koša, lovijo sapo in den jih poloìmo ob ìvali, preverimo temperaturo grelnih pri vdihu vzdigujejo glavo. Preverimo barvo sluznic, teles in jih zavijemo v brisa~o. Kadar ogrevamo pomerimo saturacijo s pulznim oksimetrom in ~e je nad hipovolemi~ne ìvali, damo grelna telesa na prsni koš in abdomen, ekstremitete pa pustimo hladne, da prepre~imo periferno vazodilatacijo in da z ogrevanjem periferije ne asist.dr. Barbara Lukanc, dr.vet.med. zmanjšamo povratne informacije nevronov do termoreg- Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, ulacijskega centra. Manjše ma~ke lahko ogrevamo v inku- SI-1000 Ljubljana batorju. Pomembno je, da ma~ke med ogrevanjem osk- [email protected] rbimo tudi s teko~insko terapijo in smo pozorni na hipo-

73 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 tenzijo, aritmije, odstopanja v elektrolitih, prizadetost cen- Intravenski katetri tralnega ìv~nega sistema in plju~ne zaplete (6). S preve~ Ve~krat na dan preverimo poloàj intravenskega katetra intenzivnim ogrevanjem ìvali z elektri~nimi grelnimi blazi- in morebitno ote~enost ta~ke distalno od venskega katet- nami in s toplimi plastenkami lahko ìvalim povzro~imo ra. Za zaš~ito pred grizenjem venskega katetra lahko upo- opekline, ki so zelo bole~e in jih lahko opazimo šele ~ez rabimo ovratnik (6). nekaj dni (3). Ko telesna temperatura ma~ka doseè 37°C, ponovno preverimo krvni tlak, ki ga po potrebi lahko zviša- mo z infuzijo hetaškroba (6). Sistoli~ni krvni tlak pri Transfuzija ma~kah lahko merimo neinvazivno s pomo~jo doplerskega Pri podaljšani koagulaciji ìvali potrebujejo koagulacijske merilca tlaka (3). faktorje, ki jih lahko nadomestimo s transfuzijo sveè krvi, ki je prav tako potrebna pri hipoproteinemiji in hema- Teko~inska terapija tokritu ni`jem od 18 % (1). Nezadostno nadomeš~anje in vzdrèvanje intravaskularne- ga in intersticialnega volumna je najpogostejši razlog za Oksigenacija dekompenzacijo in smrt ma~k. Za oìvljanje ma~ka s @ivali lahko oteèno dihajo pri: poškodbah glave (oslab- hipovolemi~nim šokom uporabimo kombinacijo krista- ljena odzivnost na hiperkarbijo), po operacijah v prsnem loidov in koloidov ter ma~ka ogrevamo. Z oìvljanjem s košu, ìvali s plju~nim edemom, ascitesom (zaradi pritis- samimi kristaloidi pogosto povzro~imo nabiranje teko~ine ka na diafragmo), anemijo, hipermetabolnimi stanji (hip- v plju~ih in plevralno (6). Koloide uporabljamo pri ma~kah ertiroidizem), bronhospazmom (astma, bronhitis) (2), v odmerku 10 do 15 ml/kg/dan intravensko (i.v.), kadar kriti~no bolne in resno poškodovane ìvali, ìvali v stresu pa je potrebno hitro pove~anje volumna, jih lahko damo (zaradi hospitalizacije, bole~ine) (1). Tem ìvalim poleg nekoliko hitreje in sicer 1 do 3 ml/kg i.v. v 15 do 30 ostalega potrebnega zdravljenja (analgetiki, diuretiki) zago- minutah (1), oziroma 5 ml/kg v 10 do 15 minutah, dokler tovimo še oskrbo s kisikom (1, 2). Nasi~enost hemoglo- ni sistoli~ni tlak nad 90 mmHg. Hitra intravenska infuzija bina s kisikom (preskrbljenost tkiv s kisikom) lahko ugo- hetaškroba lahko povzro~i bruhanje in hipotenzijo. ê se tavljamo s pulznim oksimetrom (3). Kisik jim lahko dova- krvni tlak ni zvišal odmerek hetaškroba ponovimo in nada- jamo prek maske, nosnega katetra, kisikovega ovratnika ljujemo s kontinuirano infuzijo hetaškroba in sicer 0,2 do ali s pihanjem kisika s pomo~jo anestezijskih cevi. Na ta 1 ml/kg/uro. Pri tem skrbno spremljamo ma~ka, da mu na~in pove~amo vdihano koncentracijo kisika na pribli`no ne damo prevelike koli~ine teko~in, s ~imer bi povzro~ili 40 % (1). edem plju~. ê se nam to zgodi, zmanjšamo koli~ino kristaloidov, koloide prenehamo dajati in damo furosemid

(6). Tabela 1: Dele` vdihanega kisika (FiO2) glede na na~in dovajanja (7). Šokovna triada pri ma~kah Na~in dovajanja kisika FiO Pretok kisika (l/min) Šokovno triado pri ma~ku predstavljajo hipotenzija - 2 bradikardija - hipotermija. Ko baroreceptorji zaznajo neza- »flow-by« - z anestezijsko cevjo 0,24 – 0,45 6 – 8 dostno napetost arterij, se simultano s simpati~nimi vlakni Obrazna maska 0,35 – 0,55 6 – 10 stimulirajo tudi vagusova vlakna. Zaradi tega ma~ki v šoku Nosni kateter 0,3 – 0,5 1 – 6 ne odgovorijo s tahikardijo. Tkivna prekrvitev na periferiji Kisikova kletka 0,4 – 0,5 je poslabšana, kar prispeva k hipotermiji. Ko pade telesna Kisikov ovratnik 0,3 – 0,4 0,2 – 0,5 temperatura, se zni`a tudi sr~ni utrip. Kratko obdobje hipotermije je koristno pri krvavitvi, da se mo`gani in Predihavanje 0,21 – 1,0 10 – 15 srce zaš~itijo pred ishemijo, dokler ne nadomestimo vo- Intratrahealni kateter 0,4 – 0,6 50 ml/kg/min lumna krvi. Kadar pa telesna temperatura pade pod 34°C je termoregulacija oslabljena. @ivali se pri tej temperaturi Pretok kisika pri nosnem katetru uporabljamo 100 do 200 niso sposobne same ogreti, ker jim preneha sposobnost ml/kg/min, kar nam zagotavlja 30 do 50 % kisika (2, 5). drgetanja. Ko telesna temperatura pade pod 31°C ter- Kadar pa uporabljamo kisikov ovratnik pa za dosego 30 moregulacija popolnoma odpove. Pove~ana viskoznost do 40 % kisika uporabljamo pretok kisika 1 l/min. (5). Za krvi in metabolna acidoza, ki spremljata hipotermijo lah- zelo hipoksi~ne `ivali uporabljamo kisikovo kletko ali inku- ko še zmanjšata funkcijo miokarda. Pri ni`ji temperaturi bator (2). Zaplete pri zbujanju lahko pri~akujemo tudi po se tudi izgubi termoregulacijski mehanizem vazokon- operaciji diafragmalne kile in sicer reekspanzijski plju~ni strikcije in pojavi se vazodilatacija z bradikardijo, ki ima edem, ki nastane zaradi hitre ponovne razširitve za posledico hipotenzijo (6). atelektati~nih plju~. Ve~krat se ti zapleti pojavijo po operaciji kroni~ne diafragmalne kile. To lahko prepre~imo med anestezijo, da se izognemo agresivnemu predihavanju

74 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 plju~ s pozitivnim pritiskom in agresivnemu odstranje- vanju zraka iz prsne votline prek torakalnega drena (8).

Analgezija Ustrezna in zadostna protibole~inska terapija omogo~i hitrejše zbujanje in manj neèlenih u~inkov, kot so: tahikardija, vazokonstrikcija, aritmije, tahipnoa in nezadostno dihanje, slabše celjenje ran zaradi sproš~anja kortizola in imunosupresivnega delovanja. Prav tako nam bole~ina lahko npr. pri poškodovanih ìvalih zakrije druge znake (tahikardija, blede sluznice, podaljšan ~as polnjenja kapilar), ki so prav tako lahko znak hipovolemi~nega (hemo- ragi~nega) šoka (1). Za analgezijo in kemi~no imobilizacijo ma~k poskrbimo še pred bole~im posegom. Ma~ke bole~ino pokaèjo z nemirom, depimiranostjo in razdra- `ljivostjo, agresivnostjo, redko pa s tahikardijo (6). Opio- idni analgetiki in lokalni anestetiki so primerni skoraj pri vseh prizadetih ìvalih, medtem, ko nesteroidne analgetike smemo uporabljati le pri zdravih ìvalih, prizadetim ìvalim pa jih smemo dati le po rehidraciji in po ustreznih laboratorijskih izvidih seruma (ledvica, jetra) (1). Hudo bolnim ma~kam sedative in analgetike titriramo do u~inka, ker je lahko odgovor organizma razli~en (disfunkcija ledvic in jeter). Za blago sedacijo in protibole~insko terapijo lahko uporabimo butorfanol (0,4 do 0,8 mg/kg intravenozno), na 2 do 6 ur na za~etku. Pri hudi bole~ini pa uporabimo morfij (0,1 mg/kg intramuskularno) skupaj z diazepamom (0,2 mg/kg intravenozno). Uporabimo lahko fentanilske obliè z odmerkom 12 ali 25 µg/h na ma~ka (6). Terapevtski odmerek v krvi doseè po pribli`no 12 urah in traja do 6 dni. Pri ma~kah moramo paziti, da jim ne damo prevelikih odmerkov opioidov, saj lahko povzro~ijo vznemirjenost in zmedenost, zlasti pri tistih ma~kah, ki niso dobile sedativa. Pri mo~ni bole~ini bomo to razburjenje zaradi opioidov redko opazili (5).

Kletka Poskrbimo, da so `ivali na mehkem in ~istem, da jim sproti odstranimo blato, urin, bruhanje in jih o~istimo oziroma umijemo. V kletkah za prebujanje pa naj ne bo hrane in vode (3).

Literatura 1. Grubb TL. Anesthesia for patients with special concerns. In: GL Carroll ed. Small animal anesthesia and analgesia. Ames: Blackwell, 2008:193 – 238. 2. Holden D. Postoperative care: general principles. In: Seymour C, Duke-Novakovski T eds. BSAVA Manual of canine and feline anaesthesia and analgesia. 2nd ed. Gloucester: BSAVA, 2007: 265-73. 3. Taylor R, McGehee R. Postoperative management. In: Manual of small animal postoperative care. Williams & Wilkins, USA, 1995:5 -23. 4. McKelvey D, Hollingshead KW. Anesthetic problems and emergencies. In: Veterinary anesthesia and analgesia. 3rd ed. St. Louis: Mosby, 2003: 238-85. 5. McKelvey D, Hollingshead KW. General anesthesia. In: Veterinary anesthesia and analgesia. 3rd ed.St. Louis: Mosby, 2003: 51-118. 6. Kirby R. The cat is not a small dog in ICU: Parts I and II. In: Proceedings of WSAVA, Rhodes, 2004. 7. Cave C. High Dependency Nursing. In: Aspinall V. The complete textbook of veterinary nursing. Elsevier, 2006:533 – 554. 8. MacPhail CM. Diaphragmatic hernias. Proceedings of the European Veterinary Conference - Voorjaarsdagen, Amsterdam, Netherlands 2009.

75 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

MA^KA IN ANALGETIKI

Alenka Seliškar

Prepoznavanje bole~ine Ankete, ki so jih izvedli med veterinarji in veterinarskimi bolezenskem procesu. Uporabimo multimodalni na~in tehniki v razli~nih dràvah (1, 2, 3, 4), so pokazale, da pri zdravljenja, kar pomeni, da hkrati zdravimo z razli~nimi ma~kah uporabljajo bistveno manj analgetikov kot pri psih. analgetiki, kar nam omogo~i boljši izid zdravljenja. Razlog naj bi bila bojazen pred neèlenimi u~inki analgetikov in nepoznavanje vzorcev obnašanja, s katerimi ma~ke Opioidi izraàjo bole~ino. Opioidi se uporabljajo za zdravljenje bole~ine è ve~ kot Znaki akutne bole~ine so bolj izraziti kot pri kroni~ni 2000 let in še vedno ostajajo zdravilo izbora za zdravljen- bole~ini in jih je zato la`je prepoznati. Ma~ke se le redko je zmerne do mo~ne bole~ine. Spadajo med mamila, ka- oglašajo v primerjavi s psi, ki pogosto cvilijo ali stokajo. terih proizvodnjo in promet ureja Zakon o proizvodnji in ê se poskusimo dotakniti bole~ega dela telesa, nekatere prometu s prepovedanimi drogami. Veterinarski tehnik ma~ke pihajo ali ren~ijo, druge pa se poskušajo skriti ali jih lahko aplicira ìvali le pod nadzorom dr.vet.med. z pobegniti. Pri bole~ini v trebušni votlini se drìjo zgrb- licenco za opravljanje veterinarske dejavnosti, ki odredi ljeno. Manj se gibljejo in ne kaèjo zanimanja za okolico, koli~ino in na~in aplikacije mamila. O nabavi in izdajanju se ne ~istijo in imajo zanemarjen koùh, odklanjajo hrano opioidov mora dr.vet.med. voditi ustrezno evidenco, in stike s ~lovekom (prostoìve~e ma~ke se zavle~ejo na mamila pa shranjevati na predpisan na~in. nedostopno mesto ali se sploh ne vrnejo domov). Pri mo~ni bole~ini pospešeno dihajo, pri prebujanju iz aneste- Opioidi lahko pri ljudeh in nekaterih ìvalskih vrstah zije po bole~ih posegih brez ustrezne analgezije pa lahko povzro~ijo spanje, zato jih imenujemo tudi narkoti~ni anal- pride celo do mani~ne reakcije. Ma~ke se me~ejo po klet- getiki. Ve~ji odmerki (npr. morfij ali metadon nad 0,3 mg/ ki, grizejo obvezo, nas poskušajo napasti, ren~ijo in zavi- kg) lahko povzro~ijo ekscitacije ali mani~no reakcijo pri jajo (5, 6). ma~ki. V Tabeli 1 so našteti le opioidi, ki so dostopni v Republiki Sloveniji. Za uporabo pri ìvalih je registriran Znaki kroni~ne bole~ine so bolj subtilni in nemalokrat jih butorfanol (Torbugesic, Fort Dodge Animal Health), zanj spregledamo. Ma~ke so manj aktivne, ne zanimajo se za velja tudi manj oster reìm uporabe (ni potrebno voditi okolico, telesna teà se zmanjša na ra~un neješ~nosti. Pri evidence izdajanja zdravila, ni potrebno shranjevanje na lokalizirani bole~ini so znaki bolj specifi~ni; npr. pri bole~ini na~in, ki je predpisan za npr. morfij). Vsi ostali našteti v ustni votlini grizejo z manj prizadeto stranjo gobca, opioidi so registrirani za uporabo pri ljudeh. Te lahko ob šepajo na prizadeto okon~ino, mišice okon~ine, ki je ne upoštevanju kaskadnega sistema uporabljamo tudi pri lju- obremenjujejo, so atrofi~ne. Kadar je prizadetih ve~ skle- biteljskih vrstah ìvali, ki niso namenjene za prehrano lju- pov, hodijo zvezano (5). di. Za uspešno zdravljenje bole~ine je klju~nega pomena Opioidi zavirajo dihanje, minutni dihalni volumen se zmanj- poznavanje obnašanja ma~k in zdravil, s katerimi odprav- ša predvsem na ra~un frekvence dihanja. Zavor dihanja ljamo bole~ino. Pomembno je tudi, da pristopimo k od- obi~ajno ni izrazit, razen kadar uporabimo visoke odmerke krivanju in zdravljenju bole~ine antropomorfno, kar pome- opioidov v kombinaciji s sedativi ali anestetiki. Ve~ina ni, da predvidevamo, da ma~ka ~uti bole~ino vselej, ka- opioidov minimalno vpliva na sr~no-ìlni sistem. îsti dar bi jo ~util ~lovek v podobni situaciji oziroma pri enakem agonisti povzro~ijo bradikardijo in hipotenzijo pri hitrem intravenskem injiciranju. Bradikardijo lahko zdravimo z dajanjem antiholinergikov, hipotenziji (posledica sproš~anja histamina in zavora vazomotornega centra) pa se posku- doc.dr. Alenka Seliškar, dr.vet.med. šamo izogniti s po~asnim intravenskim ali intramusku- Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, larnim dajanjem. Petidin lahko injiciramo samo intra- SI-1000 Ljubljana muskularno. [email protected]

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Opioidi u~inkujejo tudi kot antitusiki, pri psih in ma~kah dola z opioidnim antagonistom naloksonom. Zaradi me- je v te namen registriran butorfanol. Zmanjšanje venskega šanega mehanizma delovanja tramadol spada med zdravila tonusa in s tem zmanjšanje venskega priliva po dajanju z manj ostrim reìmom uporabe, podobno kot butor- opioidov (morfij) s pridom izkoriš~amo tudi pri zdrav- fanol. Injekcijska oblika tramadola se lahko uporablja le v ljenju kongestivnega sr~nega popuš~anja. veterinarskih klinikah, medtem, ko lahko peroralno obli- Opioidi zmanjšajo propulzivno aktivnost prebavil. Tonus ko (tablete s podaljšanim delovanjem, kapsule, kapljice) gladke miši~nine in sfinkterjev se zve~a, peristaltika pa in rektalne sve~ke predpišemo tudi za doma~o uporabo. upo~asni. Bruhanje je posledica draènja centra za bru- Tramadol lahko povzro~i zavor dihanja v kombinaciji z hanje (morfij) (7, 8). anestetiki. Kratkotrajno dajanje lahko izzove slabost in Tramadol je sinteti~ni centralno delujo~i analgetik, ki se bruhanje (zelo redko pri ma~kah), dolgotrajno pa zaprtje veè na m opioidne receptorje, obenem pa inhibira ali drisko. sproš~anje noradrenalina in serotonina, zato ga razvrš~ajo Tramadol se uporablja za zdravljenje zmerne do mo~ne med druge opioide. Mešani mehanizem delovanja lahko akutne in kroni~ne bole~ine. Po oralnem dajanju se dobro pojasnimo z le delnim antagoniziranjem u~inkov trama- absorbira (75% biorazpolo`ljivost).

Tabela 1: Priporo~eni odmerki opioidov pri ma~ki generi~no ime lastniško ime, proizvajalec odmerek, ~as delovanja morfij Morphini chl., Alkaloid Skopje 0,1 – 0,2 mg/kg i.m., s.c 6 – 8 h metadon Heptanon, Pliva 0,1 – 0,2 mg/kg i.m., s.c 6 – 8 h petidin Dolantin, Hoechst 5 – 10 mg/kg s.c., i.m.2 h, u~inkuje v 30 min po s.c. aplikaciji fentanil – injekcijska oblika Fentanyl Torrex 50 mcg/ml, Torrex Pharma 1 – 4 mcg/kg i.v.medoperacijsko, 15 – 20 min, u~inkuje v 2 – 5 min fentanil – transdermalni obli` Durogesic, Janssen Pharmaceutica NV 2 – 5 mcg/kg/h, 6 dni, u~inkovina dose`e terapevtsko plazemsko koncentracijo v 12 h po namestitvi obli`a, 12 in 25 mcg/h butorfanol Torbugesic, Fort Dodge Animal Health 0,2 – 0,4 mg/kg, iv., i.m., s.c., 1 – 2,5 h tramadol Tramal, Grunenthal GmbH; Tadol, Krka maks. do 3 mg/kg s.c. ali im. ali p.o., 8 – 12 h (do maks. 15 mg/ma~ko)

Nesteroidni analgetiki ledvic se v ledvi~no ìlje sproš~ata PGE2 (ledvi~na sredi- ca) in PGI (glomeruli), ki povzro~ita vazodilatacijo, s ~imer Nesteroidni analgetiki (NSAID iz angl. non-steroidal anti- 2 vzdrùjeta prekrvitev ledvic. Kadar je produkcija prostag- inflammatory drugs) u~inkujejo protivnetno, analgeti~no landinov znatno zmanjšana zaradi uporabe NSAID, led- in antipireti~no. NSAID inhibirajo ciklooksigenaze (COX), vice ne morejo vzdrèvati normalnega pretoka krvi, kar s ~imer zmanjšajo sproš~anje prostaglandinov in trom- vodi v odpoved ledvic. Ni povsem jasno ali je ta u~inek boksana A (7). 2 odvisen samo od COX-1 ali tudi od COX-2 inhibitorjev. Z Znani sta dve obliki COX, t.j. COX-1 ali osnovni encim ter vzdrèvanjem zadostne prekrvitve ledvic z uporabo mini- COX-2 ali induktivni encim. COX-2 sodeluje pri nastanku malnih odmerkov zdravil, ki zavirajo sr~no-ìlni sistem prostaglandinov odgovornih za vnetje, povišano telesno med anestezijo ter uporabo primerne teko~inske terapije, temepraturo in bole~ino, COX-1 pa pri nastanku prostag- lahko zmanjšamo tveganje za nefrotoksi~nost. Prav tako landinov, ki imajo pomembno vlogo pri vzdrèvanju nor- naj ne bi uporabljali NSAID hkrati z drugimi potencialno malne funkcije ledvic in prebavil. Terapevtski u~inki NSAID nefrotoksi~nimi zdravili ter izredno previdno pri ìvalih z naj bi bili vezani na inhibicijo COX-2, medtem ko naj bi boleznimi ledvic. bila inhibicija COX-1 odgovorna za nekatere toksi~ne u~inke Uporabo NSAID med brejostjo odsvetujejo, prav tako pa NSAID (razjeda èlodca, odpoved ledvic). naj jih ìvali ne bi jemale vsaj pet dni pred uporabo pros- Ve~ina NSAID v terapevtskih odmerkih ne vpliva na strje- taglandinov za reprodukcijske namene. vanje krvi. Izjema je acetilsalicilna kislina (Aspirin, Bayer Hkratna uporaba NSAID in kortikosteroidov je kontrain- Pharma), ki se ireverzibilno veè na COX trombocitov in dicirana, saj kortikosteroidi inhibirajo fosfolipazo A , ki inhibira tvorbo tromboksana A , vse dokler se trombociti 2 2 sodeluje pri sproš~anju arahidonske kisline iz fosfolipi- ne obnovijo (5 do 8 dni do nastanka novih trombocitov) dne celi~ne membrane. Ker NSAID inhibirajo COX, ki (1). katalizirajo konverzijo arahidonske kisline v prostaglandi- Do nefrotoksi~nosti NSAID lahko pride, kadar je zmanj- ne in tromboksan, se zve~a tveganje za neèlene u~inke šana prekrvitev ledvic, npr. pri hipovolemi~nih ìvalih ali (7, 8). pri hipotenziji med anestezijo. Pri zmanjšani prekrvitvi

77 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Tabela 2: Priporo~eni odmerki nesteroidnih analgetikov pri ma~ki generi~no ime lastniško ime, proizvajalec odmerek, ~as delovanja karprofen Rimadyl, Pfizer do 4 mg/kg s.c., i.v. enkratni odmerek (lahko ponovimo najve~ enkrat ~ez 3 dni s.c.), p.o. dajanje ni priporo~eno meloksikam Metacam, Boehringer Ingelheim 0,2 mg/kg p.o., s.c. ali i.v. prvi dan, naslednji dan nadaljujemo z 0,1 mg/kg p.o./24 h do najve~ 4 dni, nato 0,05 do 0,1 mg/kg p.o. vsak drugi ali tretji dan robenakoksib Onsior, Novartis 1 mg/kg p.o. (s.c. perioperacijsko), do najve~ 6 dni

Gabapentin Gabapentin (Neurontin, Pfizer) je strukturno analog gama- hemoglobinurijo, intravaskularno hemolizo, zlatenico in aminomaslene kisline, registriran za zdravljenje nevro- znake okvare jeter (zve~anje aktivnosti jetrnega encima patske bole~ine pri ljudeh. Dnevni odmerek pri ma~ki je alanin transaminaza ali ALT). Koma, kr~i, plju~ni edem, 5 – 10 mg/kg p.o., razdeljeno v dva odmerka. Neèleni jetrna nekroza in akutna odpoved ledvic so slabi u~inki se pojavijo pri do 25% ìvali in sicer zaspanost, prognosti~ni znaki. Smrt nastopi obi~ajno 2 do 6 dni po utrujenost in pridobivanje telesne teè pri dolgotrajnem zauìtju paracetamola. dajanju (1). Zdravljenje do 2 uri po zauìtju paracetamola vklju~uje gastri~no lavaò (ali pa izzovemo bruhanje). Ma~ki aplicira- Katerih analgetikov ne smemo uporabiti pri mo protistrup (N-acetilcistein, Fluimikan, Lek) v kombi- ma~ki? naciji s C vitaminom, jo oksigeniramo in nudimo podpor- no teko~insko terapijo (2). Pri nesteroidnih analgetikih se drìmo pravila, da upo- Nesteroidni analgetik fenilbutazon (ena od u~inkovin v rabljamo le zdravila, ki so registrirana za uporabo pri preparatih Tomanol, Dexa-Tomanol, Byk Gulden Kon- ma~kah, saj ma~ke zaradi druga~ne jetrne presnove kot stanz), ki se ponekod še uporablja pri zdravljenju vnetij jo imajo psi in ljudje (imajo omejeno koli~ino encima gluku- lomotornega aparata pri psih in konjih, je izredno toksi~en ronil transferaza, ki omogo~a presnovo NSAID prek gluku- za ma~ke in sicer povzro~a hepatopatije, nefropatije, krva- ronske konjugacije), niso sposobne presnoviti NSAID. vitve iz prebavil in ob~asno tudi ireverzibilno supresijo Posledica je mo~no podaljšan razpolovni ~as zdravila in kostnega mozga (7, 8). kopi~enje zdravila do toksi~nega odmerka, ~e zdravilo odmerjamo na enak na~in kot pri psu ali ~loveku. Torej, ne uporabljamo NSAID registriranih za ljudi, saj jih ima ve~ina zelo ozek varnostni profil ali pa so celo toksi~na za ma~ko! Paracetamol ali acetaminofen je analgetik-antipiretik. Ne u~inkuje protivnetno. Pri ljudeh ima dober varnostni profil, ~e ga uporabljamo v predpisanih odmerkih. U~inkovino najdemo v številnih preparatih (npr. Lekadol, Lek; Dale- ron, Krka; Panadol, Glaxo Smith Kline; Calpol, Mc Neil Products), ki so naprodaj v lekarnah brez recepta. @e naj- manjši odmerek za npr. otroka je toksi~en za ma~ko. Zara- di omejene glukuronske konjugacije pri ma~ki se paracetamol presnavlja na druge na~ine (sulfacija, oksidacija), pri ~emer nastajajo toksi~ni presnovki, ki povzro~ijo methe- moglobinemijo, nastanek Heinzovih telesc in denaturaci- jo eritrocitne membrane. Klini~ni znaki zastrupitve v prvih 4 urah po zauìtju paracetamola so: progresivna cianoza (blede sivomodre sluznice), tahikardija, tahipnoa, dispnoa, apati~nost, bruhanje, neješ~nost, obrazni edem in edem šap, srbe` in hipotermija. Ma~ke so redkeje hipertermi~ne. S preiskavo krvi in urina ugotovimo hematurijo, anemijo in hemolizo. Redkeje prisotni klini~ni znaki so: ataksija, letargija, raz- širjene in neodzivne zenice, nistagmus, fotofobija, slinj- enje, solzenje, napet trebuh, hiperestezija in trzanje. Kas- neje (2. do 7. dan po zauìtju paracetamola) ugotovimo

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Literatura 1 Dohoo SE, Dohoo IR. Attitudes and concerns of Canadian animal health technologists toward postoperative pain management in dogs and cats. Can Vet J 1998; 39: 491-6. 2 Dohoo SE, Dohoo IR. Factors influencing the postoperative use of analgesics in dogs and cats by Canadian veterinarians. Can Vet J 1996; 37: 552-6. 3 Lascelles VBX, Waterman A. Analgesia in cats. In Practice 1997; 19(4): 203-13. 4 Watson ADJ, Nicholson A, Church DB, Pearson MRB. Use of antiinflammatory and analgesic drugs in dogs and cats. Aust Vet J 1996; 74: 203-10. 5 Mathews KA. Management of pain in cats. In: Hellebrekers LJ, editor: Animal pain. Utrecht: Van der Wees, 2000: 131-44. 6 Dobromylskyj P, Flecknell PA, Lascelles BD, Livingston A, Taylor P, Waterman-Pearson A. Pain assesment. In: Flecknell P, Waterman- Pearson A, editors: Pain management in animals. London: W.B. Saunders Company, 2000: 53-79. 7 Nolan AM. Pharmacology of analgesic drugs. In: Flecknell PA, Waterman-Pearson A, editors. Pain management in animals. London: WB Saunders, 2000: 21-52. 8 Lascalles BDX. Clinical pharmacology of analgesic agents. In: Hellebrekers LJ, editor. Animal pain. Utrecht: Van der Wees Uitgeverij, 2000: 85-116. 9 Pascoe PJ. Problems of pain management. In: Flecknell PA, Waterman-Pearson A, editors. Pain management in animals. London: WB Saunders, 2000: 161-77. 10 Gaynor JS. Other drugs used to treat pain. In: Gaynor JS, Muir WW III., editors. Handbook of veterinary pain management. St. Louis: Mosby, 2002: 251-60. 11 Campbell A. Paracetamol. In: Campbell A, Chapman M, editors. Handbook of poisoning in dogs and cats. Oxford: Blackwell Science, 2000: 31-8.

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ODVZEM BIOLOŠKEGA MATERIALA PRI MA^KI

Barbara Celinšek

UVOD ODVZEM VENSKE KRVI Jemanje vzorcev pri ma~ki lahko predstavlja pravi izziv. Epruvete Praskala bo in se upirala, poleg tega je tudi izredno gib~na, Pred jemanjem krvi si pripravimo ustrezne epruvete: zato moramo izbrati najmanj stresen na~in zanjo in hkra- - epruvete z antikoagulanti : ti ne pozabiti tudi na svojo varnost. * epruveta z EDTA za hematološke preiskave Pri naro~ilu preiskave, odvzemu in ravnanju z vzorcem (vijoli~en zamašek) se moramo izogniti napakam, ki lahko klju~no vplivajo na kon~ni rezultat laboratorijske analize in s tem na inter- * epruveta z litijevo soljo heparina za npr. pretacijo laboratorijskega rezultata. amoniak (zeleni zamašek) * epruveta s soljo heparina in litijevega PREDPRIPRAVA NA ODVZEM jodacetata za dolo~anje glukoze in laktata (sivi zamašek) Pred vsakim jemanjem vzorcev izpolnimo spremni dopis s podatki o vrsti analize, katero èlimo, da naj laboratorij - epruveta za odvzem krvi z natrijevim citratom za opravi, vrsti ìvali, priimku lastnika, imenu napotnega teste hemostaze (modri zamašek) veterinarja, datumom in ~asom odvzema ter ostalimi po- - epruveta za odvzem krvi brez dodatkov – serum (rde~i datki, ki bi lahko vplivali na rezultat analize (1). Vzorce po zamašek) (1). odvzemu tudi ustrezno ozna~imo. Pripravimo si tudi material za odvzem (igle, brizge, Mesta odvzema katetri,...) in material za hranjenje vzorca (epruvete, Vzorec venske krvi lahko pri ma~ki odvzamemo iz jugu- sto`~aste epruvete za urin,…). larne vene, v. cephalice in redkeje, iz v. saphene med. Roke si umijemo in razkuìmo, pri jemanju urina obvezno Odlo~itev, iz katere vene bomo jemali kri, je odvisna od uporabimo rokavice. koli~ine krvi, ki jo potrebujemo, klini~nega stanja in ko- operativnosti ma~jega pacienta. Jugularni veni potekata po obeh straneh vratu od baze uhlja do vhoda v prsno votlino. Asistent prime ma~ko v sternalnem poloàju z eno roko za glavo in jo rahlo povle~e navzgor, z drugo pa jo prime za sprednje ta~ke in jo raz- tegne preko roba mize. Na ta na~in si zagotovimo dovolj maneverskega prostora in varen odvzem. Prednost jemanja iz jugularne vene je hitrost odvzema in zadostna koli~ina krvi, kar zagotavlja kakovostno odvzet vzorec. Previdnost pri takem odvzemu velja pri ma~kah v dihalni stiski, ma~kah z izcedkom iz nosnic in ma~kah s hujšimi stomatološkimi teàvami. Vena cephalica antebrachii poteka od medialne strani kar- pusa preko dorzomedialnega dela sprednje tace do Barbara Celinšek, dr.vet.med. komol~nega pregiba. Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, Ma~ko fiksiramo s prijemom za vratno gubo in ji glavo SI-1000 Ljubljana usmerimo v nasprotno stran od mesta odvzema. S pal- [email protected]

80 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 cem druge roke komprimiramo veno v komol~nem pre- Cistocenteza je najprimernejša metoda, kadar èlimo pri- gibu in jo malce potegnemo lateralno, da jo zravnamo. Z dobiti vzorec za bakterijske kulture, saj se izognemo kon- ostalimi prsti ~vrsto drìmo za komolcem, s ~imer taminaciji preko spodnjega genitourinarnega trakta. Po- prepre~imo, da bi ma~ka potegnila taco k sebi (2). treben pa je zadostno poln mehur, kar pa je pri pacientih s cistitisom v~asih nemogo~e. V vzorcu se lahko pojavi tudi iatrogena hematurija, ki se je ne da lo~iti od pato- Vpliv odvzema loške, bolezensko povzro~ene, zato je ta metoda manj Pri po~asnejšem odvzemu lahko pride do strdkov v vzor- primerna za monitoriranje pacientov s patološko hema- cu. Tak vzorec ni primeren za hematološke preiskave. turijo (3, 4). Sprostitev hemoglobina iz eritrocitov (hemoliza) je najve~krat posledica nepravilnega odvzema in lahko vpli- ODVZEM DLAKE ZA MIKOLOŠKE va na laboratorijske analize. Vzroki za hemolizo so lahko: PREISKAVE - mesto vboda nismo posušili po uporabi dezin Kadar dlake pri preiskavi z Woodovo svetilko fluorescira- fekcijskega sredstva jo, s pomo~jo forcepsa populimo predvsem te dlake ter - predolga uporaba ìlne preveze jih shranimo v primerno embalaò (npr. petrijevka). - dolgotrajni odvzemi s tanko iglo V primeru, da dlake ne fluorescirajo, populimo ~im ve~ - premajhen volumen krvi odvzet v epruveto s dlak z roba sprememb, po mo`nosti take, ki so polom- prevelikim volumnom, v kateri je vakuum ljene in nezdravega videza. - pregrobo stresanje epruvete (1). ê klini~nih sprememb ni in sumimo, da gre za asimp- tomatskega nosilca oku`be, dlako odvzamemo tako, da s ODVZEM URINA primerno sterilno krta~ko pre~ešemo ìval. Faktorji, ki vplivajo na odlo~itev, s katero metodo bomo pridobili urinski vzorec, vklju~ujejo klini~no stanje pacienta, KLAMIDIOZA logistiko jemanja in vrsto preiskave, ki jo èlimo opraviti. S sterilno vatenko naredimo konjunktivalni, `relni ali nos- Ker na~in odvzema vzorca lahko vpliva na interpretacijo ni bris. Poleg vzorca epitelija je primeren tudi bris izlo~ka. urinske analize, je pomembno, da na spremni dopis zabeleìmo, s katero metodo je bil urin odvzet. VZOREC BLATA Za parazitološke preiskave je potrebno nekajdnevno zbi- Prosto ujet urin, ki ga prinesejo lastniki ali ki ga dobimo ranje blata, ki ga v tem ~asu hranimo v hladilniku. s stiskanjem mehurja, je preprosto, neinvazivno pridobljen vzorec, primeren za splošne urinske preiskave. Sla- bost takega odvzema je mo`na kontaminacija preko se~nice ali posode za lovljenje urina.

Kateterizacije se poslu`ujemo pri samcih in je relativno sterilen postopek, ki pa najve~krat zahteva sedacijo pacienta. S ~im bolj sterilnim odvzemom moramo prepre~iti iatrogene infekcije. Urinski vzorec, odvzet s kateterizacijo, lahko vsebuje ve~ eritrocitov kot prosto ujet urin, primeren je za dolo~anje bakterijskih kultur in diferencialno diagnostiko vnetja mehurja in ledvic.

LITERATURA 1. Nemec A. Vzor~enje in faktorji vpliva na interpretacijo laboratorijskih rezultatov. In: Zbornik referatov XVI. simpozija o aktualnih boleznih malih ìvali. Polj~e: Slovensko zdruènje veterinarjev za male ìvali, 2003: 26 – 31. 2. Robben JH, Dongen AM. Collection of material for laboratory examinatin. In: Rijnberk A, van Sluijs FJ. History and Physical Examination in Companion Animals. 2nd ed., Elsevier Limited, 2009: 232 – 242. 3. Foster D, Matthewman L. Laboratory techniques. In. Simpson G. Practical Veterinary Nursing. 3rd ed. Glouchester: British Small Animal Veterinary Association, 1994: 115 – 169. 4. Wamsley H, Alleman R. Complete urinalysis. In: Elliot J, Grauer Gf. BSAVA Manual of Canine and Feline Nefrology and Urology. 2nd ed. Gloucester: British Small Animal Veterinary Association, 2007: 87 - 116.

81 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

RAVNANJE Z VZORCI ZA IZVAJANJE TESTOV ZA UGOTAVLJANJE KU@NIH BOLEZNI MA^K

Alenka Nemec Svete, Nataša Tozon

Izvle~ek 1. Uvod Hitri testi, s katerimi ugotavljamo oku`bo ma~k s par- Laboratorijsko medicino lahko opredelimo kot dejavnost vovirusom (ma~ji panleukopenia virus), z ma~jim viru- v okviru katere izvajamo razli~ne preiskave biološkega ma- som imunske pomanjkljivosti (FIV), virusom ma~je levkoze teriala, ki izhajajo iz ~loveškega ali ìvalskega telesa. To (FeLV) in corona virusom (FECV), temeljijo na uporabi so na primer kri, urin, blato, znoj, likvor, kostni mozeg, imunokemijskih metod s katerimi dolo~imo prisotnost punktati telesnih votlin, solze, plodovnica in tkiva. V sod- protiteles ali antigena v vzorcih blata ali krvi (polna kri, obni medicini je vloga medicinskega (=klini~- serum ali plazma). Za zagotavljanje pravilnosti rezultatov nega=diagnosti~nega) laboratorija zelo pomembna pri z odvzetimi vzorci krvi oziroma fecesa ravnamo v skladu postavljanju ali potrditvi diagnoze, pri spremljanju zdrav- s priporo~ili za ravnanje z biološkimi vzorci. Pri izvajanju ljenja bolezni in tudi pri oceni splošnega zdravstvenega hitrega testa upoštevamo navodila proizvajalca tako za stanja. Za kakovost rezultatov, ki jih posreduje medicinski samo izvajanje testa kot tudi glede ~asovne stabilnosti laboratorij, pa so pomembne vse tri faze dela: predana- vzorcev. litska, analitska in poanalitska faza. Laboratorijsko osebje zagotavlja natan~nost in pravilnost laboratorijskih rezul- Abstract tatov preko procesa zagotavljanja kakovosti v skladu s trenutno veljavnimi predpisi in standardi (ISO 15189) v Rapid tests for the determination of infection of cats with vseh treh fazah dela (1). V veterinarski medicini, pa tudi v parvovirus (feline panleukopenia virus), feline immuno- humani (bolnišnice), se predanalitska faza, ki zajema deficiency virus (FIV), feline leukemia virus (FeLV) and naro~ilo preiskave, odvzem vzorca in ravnanje z vzorcem feline enteritic coronavirus (FECV) are based on the im- do analize, ne odvija v celoti v laboratoriju. V tej fazi ve- munochemical methods that detect antibodies or antigen likokrat sodeluje ve~ oseb razli~nih profilov, kar je nem- in blood (whole blood, serum, plasma) or faeces. In or- alokrat vzrok številnih napak. V nedavno objavljenem der to assure the accuracy and correctness of laboratory ~lanku P. Boninija in sodelavcev je prikazano, da 44-75 % results collected samples of blood or faeces must be han- napak izvira iz predanalitske faze (2). dled with the recommendations for handling with bio- Hitri testi, s katerimi ugotavljamo morebitno oku`bo ma~k logical samples. s parvovirusom, s FIV-om, FeLV in corona virusom, temeljijo na uporabi imunokemijskih metod s katerimi dolo~imo prisotnost protiteles ali antigena v vzorcih blata ali krvi. Najpogosteje uporabljene imunokemijske metode so ELISA in imunokromatografske metode. Protitelesa ali imunoglobulini so proteini, ki jih organizem proizvede kot odziv na telesu tujo molekulo, imenovano antigen. Antigeni pa so po svoji naravi lahko proteini, polisahari- di, nukleinske kisline, pa tudi manjše molekule. Imunoke- mijske so torej metode, pri katerih izkoriš~amo za identi- fikacijo dolo~enih protiteles ali antigenov v bioloških vzorcih, interakcijo protiteles z antigeni, ki so povzro~ili njihov nastanek. Lastnost imunokemijskih metod je visoka specifi~nost in ob~utljivost (3). doc.dr. Alenka Nemec Svete, univ.dipl.in`.kem.in`., prof.dr. Nataša Tozon, dr.vet.med. Hitri testi za ugotavljanje omenjenih oku`b pri ma~kah so Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, enostavni za uporabo in, kot è samo ime pove, ne SI-1000 Ljubljana zahtevajo veliko ~asa za izvedbo. Kot vzorec uporabljamo [email protected]; [email protected]

82 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 razli~ne vrste biološkega materiala, to je lahko polna kri, vzorec centrifugiramo po pribli`no 2 do 5 minutah. ê serum ali plazma ter feces. Z odvzetimi vzorci ravnamo v pa vzamemo epruvete, ki vsebujejo delce stekla, lahko skladu s priporo~ili za ravnanje s krvnimi in drugimi vzorci, vzorec centrifugiramo po 15 do 30 minutah po odvze- saj omenjene vzorce velikokrat uporabimo za nadaljnje mu. Za pridobitev seruma zadostuje centrifugiranje analize (4). Pri izvajanju hitrega testa upoštevamo navodila vzorcev na 1300g, 10 minut. Tako pridobljeni serum proizvajalca tako za izvajanje testa kot tudi glede ~asovne odlo~imo iz istih razlogov kot plazmo. Serum ni potreb- stabilnosti vzorcev. no odlo~iti v primeru uporabe epruvet z dodano inertno gelsko snovjo, ki zaradi centrifugiranja ustvari neprepustno pregrdo med serumom in strdkom. 2. Ravnanje z vzorcem venske krvi Potem, ko smo odvzeli kri po priporo~enih navodilih za odvzem venske krvi, moramo s takimi vzorci ravnati skrb- 2.2 Dejavniki, ki vplivajo na rezultate no in v skladu s spodaj navedenimi navodili (4). Najpomembnejši in najpogostejši dejavniki, ki lahko med ravnanjem s krvnim vzorcem in njegovim transportom vplivajo na rezultat analize, so izbira antikoagulanta, ~as, 2.1 Polna kri, plazma, serum lega epruvete, temperatura in pretresanje vzorcev (4). Polna kri imenujemo vzorec krvi, katerega smo odvzeli v epruveto z antikoagulantom. Antikoagulanti (EDTA, litijev heparin, natrijev citrat, natrijev flurid z litijevim heparin- Antikoagulant om) na razli~ne na~ine prepre~ijo nastanek strdka. Vse Za nekatere analize je zelo pomembno, da je kri odvzeta v epruvete z antikoagulanti, razen epruvete z natrijevim ci- epruveto z antikoagulantom, za druge analize pa brez nje- tratom, moramo po odvzemu rahlo premešati. Epruvete ga. Za izvajanje hitrih testov je najpogosteje uporabljeni z antikoagulantom vedno napolnimo s predpisanim vol- antikoagulant EDTA, to je vzorec, ki se uporablja za izva- umnom, saj premajhen volumen vzorca, glede na koli~ino janje hematoloških preiskav. antikoagulanta, lahko povzro~i nastanek mikro strdkov in vpliva na rezultate hematoloških analiz (5). Pred izvajan- âs jem hitrih testov preverimo morebitno prisotnost strdkov v odvzetem vzorcu polne krvi. Znano je, da so ma~ji Priporo~a se, da serum ali plazmo takoj lo~imo od krvnih trombociti podvrèni in vitro agregaciji (6,7). Agregacija celic oziroma najkasneje v dveh urah po odvzemu krvi trombocitov v ve~je skupke, lahko tudi manjše strdke, (8). Po kon~anem izvajanju hitrega testa preostanek vzor- vpliva ne le na rezultate hematološke analize, temve~ tudi ca seruma oziroma plazme shranimo v hladilniku ali zamr- na rezultate hitrih testov, kjer lahko ugotovimo razli~ne zovalniku za morebitne nadaljnje preiskave. nespecifi~ne reakcije. Lega epruvete Plazma je supernatant, ki ga dobimo po centrifugiranju Po odvzemu krvi postavimo epruvete v stojalo pokonci, z vzorca polne krvi, odvzete v epruveto z antikoagulantom. zamaškom navzgor. Tak poloàj omogo~a popolno koag- Tak vzorec lahko centrifugiramo takoj. Za pridobitev ulacijo, manj se pretresa vsebina epruvete in manjše je plazme, vzorce, z izjemo vzorcev odvzetih v natrijev cit- tveganje za nastanek hemolize, ki klju~no vpliva na števil- rat (koagulacijske preiskave), obi~ajno centrifugiramo na ne biokemijske parametre, ki bi jih morebiti dolo~ali po 1500g 15 minut. Po kon~anem centrifugiranju vzorec kon~anem izvajanju hitrega testa. plazme takoj odlo~imo od celic. Podaljšani stik plazme s celicami vpliva na koncentracijo analitov v plazmi zaradi metabolizma, ki poteka v celicah ter aktivnega in pasivne- Temperatura ga prehoda analitov med celicami in plazmo (8). Plazme V primeru, da bomo vzorec plazme ali seruma uporabili, ni potrebno takoj odlo~iti v primeru uporabe epruvet z ne le za izvajanje hitrega testa, temve~ tudi za dolo~anje dodano inertno gelsko snovjo, ki zaradi centrifugiranja analitov, ki zahtevajo hlajenje vzorcev (koagulacijske ustvari neprepustno pregrado med serumom in celicami. prekave, laktat, amonijev ion, kateholamini), vzorce odvzete krvi postavimo v ledeno kopel in centrifugiramo v hladilni centrifugi. Pri ravnanju s krvnimi vzorci se mora- Serum je supernatant, ki ga dobimo po centrifugiranju mo izogibati temperaturam nad 35°C, saj se pri tako vi- vzorca polne krvi, odvzete v epruveto brez antikoagulan- soki temperaturi pospeši spreminjanje sestavin, tudi pro- tov. Vzorec centrifugiramo po kon~ani popolni koagu- titeles in antigenov, ki jih dolo~amo s hitrimi testi. Za laciji, ki obi~ajno pote~e v 45 do 60 minutah pri sobni nekatere parametre è temperatura nad 22°C ni primer- temperaturi. ê ~as koagulacije ni zadosti dolg, lahko lana. V strokovni literaturi se priporo~a, da odlo~eni serum tentni fibrin povzro~a teàve tako pri izvajanju hitrih test- ali plazma ne ostane pri temperaturi 22°C dlje od 8 ur (9). ov, kot tudi pri uporabi v analizatorjih. Koagulacijo lahko Zato v primeru, da bomo z odvzetim vzorcem seruma ali pospešimo z aktivatorjem. ê uporabimo trombin lahko

83 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 plazme izvajali dodatne biokemijske preiskave, serum ali (13). V primeru odloène analize lahko vzorce seruma ali plazmo shranimo v hladilniku. Serum ali plazmo na gelu plazme, shranjene v hladilniku na temperaturi 2 - 7°C, praviloma shranjujemo pri 4°C do 24 ur. Po tem ~asu uporabimo do 7 dni po odvzemu. Uporabimo lahko tudi vzorec seruma ali plazme odlo~imo v plasti~no epruvetko predhodno zamrznjene vzorce, katere pred analizo cen- in, odvisno od namena, vzorec shranimo v hladilniku ali trifugiramo. Hemoliti~ni ali lipemi~ni vzorci ne vplivajo zamrzovalniku (4). na rezultate analiz. V primeru uporabe vzorcev polne krvi, V nasprotju s serumom ali plazmo, polno kri hranimo na kri odvzamemo v EDTA ali litijev heparin. Vzorce polne sobni temperaturi do 24 ur po odvzemu za morebitne krvi uporabimo sveè ali shranjene v hladilniku na tem- hematološke preiskave (10). peraturi 2 - 7°C v sedmih dneh po odvzemu. Pred izva- janjem testa preverimo morebitno prisotnost strdkov, saj le-ti vplivajo na rezultat. Pretresanje vzorcev Z odvzetim vzorcem ravnamo skrbno, še posebej, ~e èli- 4.3 ’FIP’ test mo odvzeti vzorec uporabiti za nadaljnje biokemijske preiskave. Pretirano pretresanje vzorcev lahko poškoduje S FIP hitrim testom, ELISA ali imunokromatografskim, eritrocite, kar povzro~i nastanek hemolize. Hemoglobin ugotavljamo prisotnost protiteles proti FECV virusu v polni v hemoliziranem vzorcu ne vliva na rezultate hitrih test- krvi, plazmi ali serumu. Kot vzorec lahko uporabimo pol- ov, zato pa vpliva na vrednosti številnih biokemijskih no kri odvzeto v epruvete z EDTA, litijevim heparinom ali parametrov (pove~a aktivnost alanin aminotransferaze, natrijevim citratom, pri ~emer preverimo morebitno pri- aspartat aminotransferaze, laktat dehidogenaze, koncen- sotnost strdkov, saj le-ti vplivajo na rezultat. V primeru odloène analize lahko vzorce seruma ali plazme, shran- tracijo T4 in èleza, rahlo pove~a koncentracijo hemoglobina, fosfata, magnezija, kalcija, serumskih beljakovin in jene na sobni temperaturi, uporabimo do 4 ure po odvze- albumnov ter zelo znià aktivnost alkalne fosfataze). mu, oziroma do 4 dni, v primeru shranjevanja vzorcev v hladilniku, na temperaturi 2 - 7°C.

3. Ravnanje z vzorcem fecesa 5. Zaklju~ek Vzorec fecesa, v primeru odlo`ene analize, lahko shranimo v hladilniku (do 2 dni) ali za dlje ~asa v zamrzovalni- Rezultate testov je potrebno ustrezno interpretirat, saj ku. prisotnost specifi~nih protiteles ne pomeni nujno bolezni, in nasprotno, njihova odsotnost ne nujno izklju~uje oku`be. 4. Hitri testi za ugotavljanje oku`b s panleukopenia Kljub visoki ob~utljivosti in specifi~nosti testov in pred- virusom, FeLV, FIV in FECV hodnemu ravnanju z vzorci ter strokovni izvedbi testov, so mogo~i tako la`no negativni, kot tudi pozitivni rezul- 4.1 ’Parvo’ test tati. Poleg tega je mo`na navzkri`na reaktivnost pri oku`bi z medsebojno sorodnimi vrstami virusov. Presoja mora S hitrim ‘parvo’ testom, ELISA ali imunokromatograf- vedno sloneti na celostni obravnavi pacienta. skim, ugotavljamo prisotnost antigena, panleukopenia (parvo) virusa, v vzorcih fecesa ma~k. Test lahko uporabimo tudi ugotavljanje parvovirusa v fecesu psov in virusa enteritisa v fecesu kun, lisic in rakunov, saj imajo vsi trije virusi zelo podobno strukturo (11). Hitri test izvajamo s sve`im vzorcem fecesa. V primeru, da testa ne bomo izvajali na dan odvzema vzorca, lahko vzorec shranimo do 48 ur na temperaturi 2 - 7°C ali zamrznemo za daljše ~asovno obdobje.

4.2 FeLV/FIV testi S hitrimi FeLV/FIV ELISA testi ugotavljamo prisotnost antigena virusa FeLV (p27 protein) in protiteles proti virusu FIV v krvi. Na tr`iš~u so na voljo številni hitri testi, kombinirani in posamezni, katerih rezultati so primerljivi s klasi~nim ELISA testom (12). Kot vzorec lahko, v skladu z navodili proizvajalcev uporabimo serum, plazmo ali polno kri. V primeru dolo~anja FeLV antigena je prioritetni vzorec serum ali plazma, nekoliko manj zanesljiva je polna kri

84 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Reference 1. Tietz NW. Quality assurance. In: Tietz NW, ed. Textbook of clinical chemistry. Philadelphia: W.B. Saunders Company, 1986; 548-592. 2. Bonini P, Plebani M, Ceriotti F, Rubboli F. Errors in laboratory medicine. Clin Chem 2002; 48(5):691-698. 3. Crowther JR. Basic immunology. In: Walker Jm, ed. ELISA. Theory and practice. Totowa: Humana Press, 1995: 1-34. 4. Prezelj M. Priporo~ila za ravnanje s krvnimi vzorci. Ljubljana: Slovensko zdru`enje za klini~no kemijo 2006: 1-18. 5. Piskar M. Priporo~eni postopek za odvzem venske krvi. Ljubljana: Slovensko zdru`enje za klini~no kemijo 1999: 1-18. 6. Zelmanovic D, Hetherington EJ. Automated analysis of feline platelets in whole blood, including platelet count, mean platelet volume, and activation state. Vet Clin Pathol 1998; 27: 2-9. 7. Thrall MA, Weiser MG. Hematology. In: Kantrowitz B, ed. Laboratory Procedures for veterinary tehnicians. 2nd ed. Goleta, Calif: American Veterinary Publications; 1992: 35-98. 8. Boyanton BL, Blick KE. Stability studies of twenty-four analytes in human plasma and serum. Clin Chem 2002; 48: 2242-2247. 9. Rehak NN, Chiang BT, Storage of whole blood: effect of temperature on the measured concentration of analytes in serum. Clin Chem 1988; 34: 2111-2114. 10. Gulati GL, Hyland LJ, Kocher W, Schwarting R. Changes in automated complete blood cell count and differential leukocyte count results induced by storage of blood at room temperature. Arch Pathol Lab Med 2002; 126: 336-342. 11. Esfandiari J, Klingeborn B. A comparative study of a new rapid and one-step test for the detection of parvovirus in faeces from dogs, cats and mink. J Vet Med B 2000; 47: 145-153. 12. Hartmann K, Griessmayr P, Schulz B, et al. Quality of different in-clinic test systems for feline immunodeficiency virus and feline leukemia virus infection. J Feline Med Surg 2007; 9: 439-445. 13. Panel report on the colloquium on feline leukemia virus/feline immunodeficiency virus: tests and vaccination. JAVMA 1991; 199: 1273-1277.

85 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

KRVNE SKUPINE MA^K

Vanja Knez

Poznavanje krvnih skupin je v praksi pomembno zaradi Neonatalna izoeritroliza transfuzije, pri pasemskih ma~kah pa zaradi neonatalne V ma~ji pediatriji se pogosto sre~ujemo s pojavom izoeritrolize. nenadne smrti na videz popolnoma zdravih mladi~ev in Krvne skupine so genetsko zapisane na eritrocitih in so eden od vzrokov je lahko tudi neonatalna izoeritroliza. To za vsako vrsto specifi~ne. Set alelov za krvno skupino je poškodba neonatalnih eritrocitov zaradi maternalnih (dva ali ve~ alelov) tvori skupaj sistem krvne skupine. @ivali protiteles, ki jih mladi~ zauìje s kolostrumom v prvih lahko proti drugi krvni skupini razvijejo protitelesa, ime- urah ìvljenja, ko je gastrointestinalna bariera prehodna. novana izoprotitelesa ali aloprotitelesa. Zaradi teh pro- Pojavlja se samo pri mladi~ih krvne skupine A, rojenih titeles nastanejo hemoliti~ne transfuzijske reakcije in pri materi krvne skupine B po porodu. mladi~ih po porodu neonatalna izoeritroliza. Prebavni trakt je prvih 16 ur ìvljenja prehoden za mater- Ma~ji sistem krvnih skupin ima tri alele: A, B in izredno nalna protitelesa. Pri materi s krvno skupino B se razvije- redko AB. Krvna skupina A je dominantna nad B. Ma~ke jo mo~na protitelesa proti antigenom krvne skupine A v krvne skupine A imajo genotip AA, Ab, AAB in samo obdobju od 1. do 3. meseca po rojstvu. Ta protitelesa homozigotna bb. lahko pri mladi~ih povzro~ijo akutno hemoliti~no reakci- Zelo redka ma~ka s krvno skupino AB ima tretji alel rece- jo. Mladi~i krvne skupine A in AB se rodijo zdravi, vendar siven na A in dominanten nad B, kar privede do izraza po zauìtju kolostruma razvijejo klini~ne znake neonatal- obeh substanc. Parjenje ma~ke s krvno skupino A z ma~ko ne izoeritrolize. Prenehajo jesti, postanejo letargi~ni, po- s krvno skupino B ne privede do krvne skupine AB, razen javi se hematurija in poginejo v nekaj minutah ali urah. ~e ni A nosilec recesivne AB. Vsi mladi~i iz rizi~ne skupine ne odreagirajo vedno tako, Poznavanje krvnih skupin je pomembno zaradi transfuzij, ampak lahko razvijejo milejšo obliko: sprva postanejo saj imajo ma~ke naravna protitelesa, razen redke krvne anemi~ni, v prvem tednu ikteri~ni, v drugem tednu pa se skupine AB. Krvna skupina B ima mo~na protitelesa anti- pokaè še nekroza konice repka, ki kasneje odpade. A. Ma~ke s krvno skupino A imajo malo protiteles anti-B. Zaradi visoke rizi~nosti pri reprodukciji pasemskih ma~k Pri transfuziji dajalca B in prejemnika A zasledimo hiter odgovoren vzreditelj pred paritvijo testira svoje vzrejne razpad eritrocitov, ni pa takšne hude reakcije kot pri neo- ma~ke. V primeru, da ima samica s krvno skupino B samca natalni eritrolizi, kjer pride posledi~no do pogina mladi~ev s krvno skupino A, bo vzreditelj mladi~e po porodu odstra- krvne skupine A od matere krvne skupine B. (1-2) nil od samice za 16-24 ur in jih hranil z nadomestnim mlekom. Lahko pa jih po porodu tudi testira s komercialnimi testi, pri ~emer uporabi popkovno kri po porodu. Mladi~i s krvno skupino B lahko ostanejo pri mami, mladi~e s krvno skupino A pa se odstrani za 16-24 ur. Posamezni vzreditelji si pomagajo tudi tako, da isto~asno parijo še samico s krvno skupino A in mladi~e s krvno skupino A prestavijo k njej, da dobijo kolostrum. Mladi~em, ki ga niso dobili, pa je za zaš~ito priporo~ljivo aplicirati pod koò serum ma~ke s krvno skupino A. Mladi~e je mogo~e prvih 24 ur tudi pustiti pri materi, da jih neguje, seske pa se prekrije, da ne morejo sesati. To pa je v~asih lahko neu~inkovito, saj so mladi~i izredno iznajdljivi in se Vanja Knez, dr. vet. med. nekako prerinejo do seskov, posledica pa je seveda po- Klinika Tristokosmatih, velika klinika za male ìvali, Kajuhova 5a, SI-1000 Ljubljana gin. [email protected]

86 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Zastopanost krvnih skupin Zastopanost krvnih skupin v posameznih pasmah v Slove- niji je slede~a (testiranje krvnih skupin pri pasemskih ma~kah v Sloveniji 2005):

pasma št. ma~k krvna skupina A krvna skupina B PERZIJSKA 9 8 1 EKSOT 8 6 2 ORIENTALKA 12 12 0 SIAMKA 9 9 0 NORVEŠKA GOZDNA 3 3 0 ABESINKA 5 5 0 BRITANKA 14 13 2 BIRMANKA 3 3 0 DEVON REKS 17 15 2 AMERIŠKA GOZDNA 17 15 2 TURŠKA ANGORA 2 2 0 DOMA^A MA^KA 70 70 0 OCICAT 7 7 0 skupaj 176 94,9% 5,1%

Dolo~ene pasme, kot so siamska, ruska modra, ocicat in orientalska, so zastopane le pri krvni skupini A. Krvna skupina B pa je pogosto prisotna pri devonih, korniš rexih, britancih, perzijcih, eksotih ipd. V tujini je stanje podobno, pozorni pa moramo biti na imena pasem, saj razli~ne organizacije pasme razli~no poimenujejo (npr. himalajka – colorpoint perzijka).(1-2,4)

Samo skupina A Nizka zastopanost skupine B(1-10 %) Srednja zastopanost skupine B(10-25 %) Visoka zastopanost skupine B (>25 %) Siamka1 Ameriška kratkodlaka ma~ka1 Abesinka1 Britanka1 2 Tonkineska1 Ameriška gozdna ma~ka1 Birmanka1 2 3 Korniš reks1 Orientalka1 Manx1 Burmanka2 Devon reks1 3 Norveška gozdna ma~ka1 Himalajka1 Eksot1 Perzijka1 2 Ragdolka1 Škotska klapouška1 Turška van ma~ka1 Somalijka1 Turška angora ma~ka1 Sfinga1 3

1 vir: Dr. Giger, University of Pennsylvania 2 rezultati raziskave opravljene na ma~kah v Veliki Britaniji, vir: C. Knottenbelt, University of Glasgow“ 3 vir: Dr Addie, University of Glasgow

87 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Testi Povzetek Testi, ki se uporabljajo za dolo~anje krvnih skupin, so Poznavanje krvnih skupin pri ma~kah torej ni pomembno komercialni in enostavni za uporabo. Testira se lahko v samo pri transfuziji, ampak tudi pri vzreji, da bi prepre~ili ambulanti, rezultat pa je na voljo `e v pol ure. Najpo- neonatalno izoeritrolizo. gosteje je v uporabi test Rapidvet-H Dms laboratories, Pred paritvijo dolo~enih pasem je potrebno narediti test Agrolabo S. p. A, v zadnjem ~asu pa tudi Alvedia, Quick krvne skupine ma~ke. Test A+B. Slednjega je la`je shranjevati, saj ga ni potreb- Kljub znani krvni skupini ma~ke je potrebno pred vsako no hraniti v hladilniku. transfuzijo narediti navzkri`no reakcijo zaradi kompati- V primeru genetskih testov za ma~ke se lahko hkrati ugo- bilnosti, ker ni univerzalnega dajalca. tavlja še krvna skupina. Laboratoriji ponujajo razli~ne pa- kete testov. Odvzem krvi je po navodilu laboratorija. Naj- pogosteje jemljemo kri z EDTA ali pa tudi vzorec sline.

Rezultati testa Krvna skupina N/N tip A ali AB N/b nosilec B; lahko tip A ali AB b/b tip B

Genetski test ne lo~i med krvno skupino A in redko skupino AB, zato ga ozna~ijo z N. To pomeni: ~e ima ma~ka genotip N/b, je nosilec krvne skupine B, ~e pa je rezultat b/b, ima ma~ka krvno skupino B. S pomo~jo genetskega testa lahko izlo~imo nosilce krvne skupine, da bi prepre~ili neonatalno izoeritrolizo. Dogaja se tudi, da vzreditelji, ki imajo samico krvne skupine B, iš~ejo le samce krvne skupine B. To pa ni priporo~ljivo, saj se tako o`a `e tako ozek genetski krog pasemskih ma~k. Kljub temu, da ima ma~ka znano krvno skupino, je pred transfuzijo vedno potrebno narediti navzkri`no reakcijo pred posegom zaradi nevarnosti hemolize. V zadnjem ~asu so odkrili krvno skupino anti Mik. Nekompatibilnost le-te lahko povzro~i transfuzijsko reakcijo kljub temu, da se ma~ke ujemajo po krvni skupini.

Navzkri`na reakcija Major; 1gtt krvi dajalca + 2 gtt plazme prejemnika Minor; 2 gtt plazme dajalca + 1 gtt krvi prejemnika Kontrola; 1 gtt krvi dajalca + 2 gtt plazme prejmnika S pipeto nanesemo na predmetnico in zmešamo. Reakci- ja se poka`e v 15-ih sekundah.V primeru aglutinacije da- jalec ni primeren za transfuzijo.(3)

Viri: 1. Urs Giger et al., Feline Blood Typing and Crossmatching to Ensure Blood Compatibility: How to Avoid Hemolytic Transfusion Reactions and Neonatal Isoerythrolysis, ACVIM 2007, DACVIM, ECVIM, ECVCP; Karen V. Jackson; Nicole M. Weinstein; Elanor Withnall. Philadelphia, PA, USA. 2. Susan Little. The Winn Feline Foundation, Feline blood types and Neonatal Isoerythrolysis. DVM, DABVP (Feline). 3. ESAVS, Feline Medicine & Surgery III, Zurich 1998. 4. Vanja Knez. Zbornik 6. podiplomskega izobra`evanja veterinarske zbornice, Neonatalna izoeritroliza, Ljubljana 2010.

88 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

ROKOVANJE S KATETRI IN SONDAMI

Darja Pavlin

Venske kanile preverimo, da smo kanilo dejansko vstavili intra- in ne paravenozno in prepre~imo nastanek krvnih strdkov v Indikacije: intravenozna aplikacija zdravil, aplikacija anes- kanili. Kanilo pritrdimo z lepljivimi trakovi ter povijemo z tetikov, infuzje kristaloidov in koloidov, transfuzija, mer- obvezo (vata in elasti~ni povoj), pri ~emer pazimo, da jenje centralnega venskega tlaka nobena od obvez ni pri~rvrš~ena pretesno, saj bi to Kontraindikacije: kanile ne vstavljamo preko koè, ki kaè oteèvalo pretok teko~ine skozi kanilo. Pri jugularni kanili kakršnekoli znake vnetja oz. infekcije (pordela, gnojna koà, bi pretesna obveza povzro~ila dodatno neugodje ìvali in izpuš~aji), centralne kanile (v v. jugularis) ne vstavljamo v skrajnih primerih celo teàve z zauìvanjem hrane in ìvalim z motnjami v strjevanju krvi. dihanjem, pri perferni kanili pa otekanje šape. Pri ma~kah Za intravenski dostop pri ma~kah najpogosteje uporab- se je izkazalo najbolje, da nogo z vstavljeno kanilo povi- ljamo periferne venske kanile, saj je njihovo vstavljanje jemo celo (vklju~no s šapo), zaš~itnega ovratnika pa pona- preprosto in vzdrèvanje nezahtevno. Kanilo najpogoste- vadi ne potrebujejo. Obvezo nad kanilo vsaj enkrat dnevno je vstavljamo v v. cephalico antebrachii na prednji nogi, odvijemo, kanilo preperemo s heparinizirano fiziološko lahko pa tudi v lateralno ali medialno v. sapheno na zadnji raztopino, da preverimo lokacijo kanile in preverimo, da nogi. Pri ma~kah za periferni venski dostop ponavadi se niso pojavili znaki tromboflebitisa, da ni prišlo do iz- uporabljamo 20 - 22 GA kanile. Skozi periferno kanilo tekanja teko~ine paravenozno in zatekanja okon~ine. Pri nikoli ne apliciramo hipertoni~nih infuzijskih raztopin (npr. ma~kah, ki potrebujejo dolgotrajni venski dostop, eno ve~ kot 0,9-odstotni NaCl, 40-odstotna glukoza, ...). kanilo uporabljamo najve~ 4 dni, nato vstavimo novo v Vensko kanilo pri ma~kah zlahka vstavimo tudi v v. jugu- drugo ìlo/okon~ino. ê se pojavijo znaki vnetja na mestu laris, saj je lahko dostopna in bistveno ve~jega premera vstavitve kanile, jo takoj odstranimo. kot periferne vene, kar je še posebej pripravno pri manj- ših ìvalih in mladi~ih. V jugularno veno pri ma~ki pona- Urinski katetri vadi vstavimo 18 - 20 GA kanilo, pri mladi~ih 22 GA. Indikacije: reševanje zapore se~nice, sterilni odvzem vzorca Posebej je primerna za hitro aplikacijo ve~jih volumnov urina, merjenje proizvodnje urina. infuzije, kontinuirano aplikacijo zdravil (s perfuzorjem), parenteralno hranjenje in aplikacijo hipertoni~nih raztopin. Kontraindikacije: ne vstavljamo ga ìvalim brez zapore Skozi centalno vensko kanilo ne apliciramo anestetikov in se~nice, pri katerih ne potrebujemo vzorca urina in so infuzijskih raztopin z dodanim kalijem. sposobne samostojnega odvajanja in higiene (se lahko premikajo in postavijo v poloàj za uriniranje). Kanilo vedno vstavljamo preko koè, nad katero smo prej natan~no pobrili dlako in jo asepti~no pripravili. Pri starej- Ma~ji samci poosto potrebujejo vstavitev urinskega katet- ših ma~kah, ki imajo debelejšo oz. bolj trdo koò ter pri ra. Pri ve~ini, še zlasti pa pri tistih z zaporo se~nice, je za mo~no dehidriranih ìvalih si pri vstavljanju lahko poma- vstavitev katetra potrebna sedacija. Kateter lahko samcu gamo tako, da najprej z debelejšo iglo naredimo majhno vstavljamo tako, da ìval leì bodisi na boku ali na hrbtu. zarezo v koì, s ~imer si olajšamo dostop do ìle. Vstav- Pomo~nik z eno roko zagrabi bazo repa ìvali in ga neko- ljeno kanilo preperemo s heparinizirano fiziološko razto- liko potegne navzor in proti glavi, s ~imer olajša prolabi- pino (2 IE heparina/ml fiziološke raztopine). Na ta na~in ranje penisa iz prepucija. Prepucij pred kateterizacijo dobro o~istimo in asepti~no pripravimo in pri vstavljanju uporabljamo sterilne rokavice. Urinski kateter namaèmo z lubrikantom in ga vstavimo v se~nico. Pri ma~kih z zaporo asist. Darja Pavlin, dr.vet.med. se~nice si pri odpravljanju zapore pogosto pomagamo s Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, prepiranjem se~nice s toplo sterilno fiziološko raztopino. SI-1000 Ljubljana @ivalim, ki bodo kateter imele vstavljen ve~ dni, tega [email protected] prišijemo na prepucij z dvema šivoma. Kateter poveèmo

89 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 z zaprtim sterilnim sistemom zbiranja urina (vre~ka za komplikacija uporabe ezofaostome. Pri previjaju kirurško zbiranje urina ali ve~ja brizga) preko podaljška za infuzi- rano okoli sonde vsaki~ namaèmo z antibioti~nim ma- jo, ki ga je priporo~ljivo na enem mestu z lepilnim tra- zilom. kom pritrditi na rep ìvali, s ~imer še dodatno onemo- Pri vseh hranilnih sondah je izrednega pomena, da se ne go~imo, da bi si ìval kateter odstranila. @ivali obvezno zamašijo z ostanki hrane. Nazogastri~na sonda zelo maj- namestimo zaš~itni ovratnik. hen premer, zato moramo biti pri pripravi hrane izredno Kateterizacija ma~je samice je mogo~a, vendar se je previdni, da jo pripravimo dovolj teko~o in brez kakršnih- posluùjemo redkeje. Pri ma~kah urinski kateter vstavlja- koli grudic ali koš~kov, ki bi lahko zamašile sondo (npr. a/ mo v enakem poloàju, kot pri samcih, s tem da pri sami- d dodatno razred~imo z vodo ali uporabljamo hrano v cah kateter v se~nico vstavimo na slepo preko vhoda v prahu, ki se zmeša z vodo, odsvetuje se uporaba kate- se~nico, ki se nahaja na dnu vagine. To izvedemo tako, rekoli zrnate hrane, tudi ~e jo dodatno spasiramo). Ezo- da konico katetra vstavimo v vulvo vzdol` ventralne stene faostoma ima ponavadi nekoliko ve~ji premer, vseeno pa in jo potisnemo kranialno, medtem ko z drugo roko robove hrano pripravimo ustrezno teko~e konsistence, da si olaj- vulve povle~emo narahlo kavdalno. Na ta na~in kateter šamo aplikacijoz brizgo. Sondo pred za~etkom hranjenja zdrsne skozi uretralno papilo v se~nico. najprej preperemo s toplo vodo, da se prepri~amo, da je normalno prehodna. Hrano pred aplikacijo pogrejemo Hranilne sonde malo nad sobno temperaturo in apliciramo po~asi ter ves ~as opazujemo, ali ìval kaè znake nelagodja (slabost, Indikacije: prehranska podpora za ìvali, ki ne morejo oz. bruhanje). Sondo po vsakem hranjenju obvezno prepe- no~ejo jesti. remo z vodo, da iz nje odstranimo vse ostanke hrane in Kontraindikacije: razli~ne, odvisno od vrste sonde: bru- zapremo s pokrov~kom. Kljub hranilni sondi naj imajo hanje, regurgitacija, nezmo`nost poìranja, funkcionalne ìvali vedno na voljo tudi hrano in vodo v posodici, da ali anatomske bolezni poìralnika, nezavest, poškodbe lahko za~nejo jesti samostojno, ~e to èlijo, saj obe omen- obraza, nosnih votlin in `rela, ... jeni sondi ne onemogo~ata prostovoljnea jemanja in Hranilne sonde se uporablja za asistirano hranjenje ìva- poìranja hrane. li, ki same niso zmo`ne zauìvanja hrane ali hrano dolgotrajno zavra~ajo. Pri ma~kah najpoosteje uporabljamo dve vrsti sond: nazogastri~no (oz. nazoezofagialno), ki jo skozi nos vstavimo v poìralnik ali èlodec in ezofagostomo, ki jo vstavimo v poìralnik skozi kirurško rano na vratu. Nazogastri~na je preprosta za vstavljanje (ne potrebujemo posebne opreme in pri kooperativnih ìvalih lahko vstavimo brez anestezije), vendar lahko preko nje hranimo le manjše koli~ine zelo teko~e hrane, saj je sonda zelo tanka. Za hranjenje jo lahko uporabljamo do najve~ dva ted- na. Sondo po vstavitvi ponavadi prišijemo z nekaj šivi na koò na ~elu in ìvalim namestimo zaš~itni ovratnik. Posebne nege ne potrebuje. Hrano lahko po njej apliciramo kontinuirano (s pomo~jo perfuzorja), ali pa dnevno koli~ino hrane razdelimo v ve~ manjših obrokov. Ezofagostomo vstavimo kirurško pri anestezirani ìvali. Po vstavitvi ìvali obvezno namestimo zaš~itni ovratnik in vrat na rahlo povijemo, da zaš~itimo kirurško rano. Obve- zo vsaj enkrat dnevno odstranimo in preverimo izgled kirurške rane, saj je infekcija ne tem mestu glavna resna

Literatura Vascular access techniques. In: Hackett TB, Mazzaferro EM. Veterinary emergency & critical care procedures. Ames: Blackwell Publishing Professional, 2006: 29-34. Urethral catheterization in male cats. In: Hackett TB, Mazzaferro EM. Veterinary emergency & critical care procedures. Ames: Blackwell Publishing Professional, 2006: 126-137. White RN. Emerency techniques. In: King L, Hammond R, eds. Manual of Canine and Feline Emergency and Critical Care. Cheltenham: BSAVA, 1999:307-341. Eirmann L, Michel KE. Enteral nutrition. In: Silverstein DC, Hopper K, eds. Small animal critical care medicine. St. Louis: Saunders- Elsevier, 2009: 53-8. Jackson MW. Nutritional support of the critically ill cat: theoretical and practical concerns. Congress Proceedings of the 18th ECVIM-CA Congress, 2008: 134-6.

90 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

RAZLIKA MED MA^JO IN PASJO USTNO VOTLINO

Vladimira Erjavec

Ma~ke so kot ljubiteljske ìvali v ZDA in VB številnejše od Ustna sluznica psov. Od psov se razlikujejo po številnih zna~ilnostih. Zelo Celotno ustno votlino z izjemo zob pokriva ustna sluzni- pogosto se ma~ke obravnava kot majhne pse, zato pri- ca, ki ima številne naloge; s svojo strukturo š~iti spodaj haja tako pri postavljanju diagnoze kot pri samem zdrav- leè~a tkiva in vsebuje receptorje za temperaturo, dotik in ljenju do številnih nepravilnosti. Zaradi tega bodimo po- bole~ino ter okušalne brbon~ice. Slina, ki je produkt slin- zorni in imejmo za relevantne informacije samo tiste, ki skih `lez, sodeluje pri zaš~itni vlogi ustne sluznice. Pri so rezultat prou~evanja ma~k. psu ima ustna sluznica klju~no vlogo pri uravnavanju telesne temperature. Razlika med usti in ustno votlino Glede na poloàj, funkcijo in sestavo delimo ustno sluznico Usta so odprtina v obrazu, s katero se pri~enjajo prebavi- na `ve~no, oblo`no in specializirano ustno sluznico. la. To je prostor med zgornjo in spodnjo ustnico. Ustna @ve~na sluznica pokriva mesta, ki so izpostavljena `ve~nim votlina (cavum oris) pa je del prebavil, ki jo omejujejo silam, primer sta dlesen in trdo nebo. @ve~na sluznica je spredaj ustnici, lica od strani, svod oblikuje trdo nebo, ~vrsta in poroèneva, trdno je pripeta na periost (vezivno spodaj pa podjezi~no dno in jezik. Zobni lok jo razdeli na ovojnico na površju kosti). Ker ima veliko manj ìv~nih ustni preddvor (vestibulum oris) in pravo ustno votlino kon~i~ev kot oblo`na sluznica, je veliko manj ob~utljiva. (cavum oris proprium). Oblo`no sluznico najdemo na spodnji strani jezika, ust- K strukturam ustne votline sodijo poleg zob, jezika, sten nem dnu, licih, zobiš~nem nastavku in mehkem nebu. Ta (lica, trdo nebo, podjezi~no dno) še ustnice in slinske sluznica je zelo ob~utljiva, mehka in premi~na, na spodaj `leze. leè~a tkiva je rahlo pritrjena. K specializirani ustni sluznici štejemo sluznico zgornje površine jezika z jezi~nimi papila- Pri ma~ki je ustna votlina kratka in široka, zato je pregled mi, ki vsebujejo okušalne brbon~ice. Jezi~ne papile imajo pri ìvalih, ki so kooperativne, razmeroma enostaven. zaš~itno in ~utilno vlogo, saj vsebujejo receptorje za do- Divji psi, ki sami lovijo, plen najprej zgrabijo z zobmi in tik, vro~ino, bole~ino in okus. ga usmrtijo z grabilci (kaninusi). Medtem ko ~vrsto drìjo plen, s sekalci in grabilci trgajo kose mesa. Pri tem si pomagajo s prednjima nogama. Hrana se tare med griz- Ustnice nimi ploskvami zob v zgornji in spodnji ~eljusti. Psi hra- Pri nekaterih vrstah ìvali (konj) sodelujejo ustnice pri raz- no bolj malo `ve~ijo. Pogoltnejo lahko namre~ razmero- biranju in preskušanju hrane, ki jo posredujejo v ustno ma velike kose mesa, ne da bi jih pre`ve~ili, temeljiteje pa votlino, zato so zelo ob~utljive in premi~ne. Pri ma~kah drobijo kosti ali druge trde dele hrane. ustnice nimajo tako pomembne vloge pri hranjenju, zato Ma~ke z zobmi odreèjo manjše kose mesa, ki jih ob- so manj premi~ne in tanjše. Pes ima obse`ne in ohlapne likujejo v gri`ljaj in ga pogoltnejo. ustnice, ki so zelo gibljive, a jih hotno lahko zelo omejeno premika. Zgornja in spodnja ustnica sta poraš~eni in nosita številne dolge tipalne (sinusne) dlake, zlasti na zgornji ustnici pri ma~ki. Imenujejo se brki. Na notranji strani zgornje ustnice se pri ma~ki nahajajo labialne papile Kak- šno funkcijo imajo labialne papile (zaradi njih so ustnice nazob~ane), ni znano. asist.dr. Vladimira Erjavec, dr.vet.med. Zgornja ustnica ima v sredinski ~rti zarezo, ki se imenuje Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, SI-1000 Ljubljana filtrum ali `lebi~, pri nekaterih pasmah psov je zelo globoka. To je ozko podro~je modificirane koè. Maksilarni labialni Klinika za kirurgijo in male ìvali, Veterinarska fakulteta – UL, Cesta v Mestni log 47, 1115 Ljubljana frenulum je pri ma~ki zelo kratek in tesno pripenja zgorn- [email protected] jo ustnico na dlesni~no sluznico.

91 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Spodnja ustnica je krajša in jo zgornja presega predvsem Slinske `leze spredaj, delno pa tudi na straneh. Pri ma~ki so v njej Pri psu in ma~ki je tkivo slinskih `lez v ustni votlini boga- lojnice, t.i. cirkumoralne `leze (snaìlne `leze), ki so števil- to in razporejeno po prete`nem delu ustne sluznice. nejše kot v zgornji ustnici. Ustni~ne ko`ne `leze izlo~ajo snov, ki se med umivanjem nanaša na dlako in jo na ta • male slinske `leze: na~in neguje, igra pa tudi pomembno socialno vlogo. V številne male slinske `leze, ki imajo številna kratka izvodi- negovanju koùha ma~ke izjemno uìvajo. Pri hujših obo- la, so razporejene po zadnji tretjini jezika, li~ni sluznici lenjih ustne votline ma~ke prenehajo z negovanjem koùha. ter sluznici ustnic in mehkega neba, poìralnika in `rela. Pri psu je spodnja ustnica ohlapna in tanka, njen rob je êprav so majhne, pa je njihovo število veliko, zato je nazob~an. Na spodnjo ~eljust je pripeta s frenulumom njihova sekrecija sline pomembna in veliko doprinese k (vezico) v podro~ju grabilca ter s slabo nakazanimi gubami skupni koli~ini izlo~ene sline. sluznice mediano, ki onemogo~ajo ve~je premike ustnic. • velike slinske `leze: ma~ke in psi imajo nekaj parnih velikih slinskih `lez. Zan- Jezik je je zna~ilno eno dolgo izvodilo, ki se izteka v ustno vot- Jezik je zelo gibljiva miši~na struktura, ki leì na dnu ust- lino razmeroma dale~ stran od same slinske `leze. ne votline med mandibulama in se nadaljuje v orofarinks. ~eljustna ali mandibularna (glandula mandibu- Kadar je gobec zaprt, zapolnjuje celotno ustno votlino. laris). Leì rahlo kavdalno in medialno od ~el- Jezi~na konica (apex linguae) prehaja nazaj v telo (corpus justnega kota (angulusa mandibule). Pred njo in linguae), to pa se nadaljuje v koren jezika (radix linguae). delno pod njo so lnn. mandibulares (~eljustne Pri psu igra jezik veliko vlogo pri hlajenju. V miši~ju blizu bezgavke). POZOR: Pri palpaciji prihaja velikokrat spodnje ploskve jezika je mediana vretenasta tvorba, t.i. do zamenjave in ~eljustne bezgavke ocenimo kot steklinski ~rv, lyssa, ki jo pri palpaciji jezika zlahka zatipa- pove~ane, ker dejansko otipamo ~eljustno slin- mo. Lyssa je vezivna cevka, napolnjena z maš~obnim sko `lezo!!! êljustna `leza je okroglasta, pogo- tkivom, pri psu so v srednjem delu cevke pre~noprogasta steje je ve~ja kot podušesna slinska `leza in je miši~na vlakna in hrustan~ni oto~ki. Pri ma~ki se pojavlja tudi svetleje obarvana. muskulatura le redko, hrustanec pa nikoli. Od steklin- podjezi~na ali sublingvalna (glandula sublin- skega ~rva poteka fibrozni septum do dorzalne površine gualis). Sestoji iz 2 delov, glandula sublingualis jezika in po sredini jezika in pri psu oblikuje `leb, ki pote- polystomatica in glandula sublingualis monos- ka kavdalno skozi celotno telo jezika. Pri ma~ki `leba ni. tomatica. Posebno pri psu ima jezik spredaj ostra stranska robova, tu je jezik širok in plosk, izoblikuje pa se lahko v nekakšno li~na ali zigomati~na (glandula zygomatica) – `lico za zajemanje teko~in. podušesna ali parotidna (glandula parotis) – otipamo jo le, kadar je pove~ana. To je majhna trio- Nitkaste bradavice so mehke, roène nitke na jezi~nem glata `leza, ki obdaja bazo uhlja. hrbtu, ki dajejo jeziku barùnast videz. Te nitke so majhne, zakrivljene in obrnjene proti `relu. Pri ma~ki so, za molarna – prisotna je le pri ma~ki. ê se nahaja razliko od psa, mo~no poroènele, ve~je, a manj številne. na bukalni strani spodnjega molarja, govorimo Zato daje njihov jezik videz fine ì~ne š~etke, nitkaste bra- o bukalni ali li~ni molarni slinski `lezi. Kadar se davice sluìjo predvsem za jemanje teko~in, za „ostrgan- nahaja na notranji strani spodnje ~eljusti, na je“ hrane (npr. ostankov mesa s kosti). lingvalni strani molarjev, govorimo o lingualni molarni slinski `lezi. Kakšna je specifi~na vloga S pomo~jo bradavic si ma~ke negujejo koùh, po drugi molarne slinske `leze, ni znano. Po kirurški strani pa bradavice ma~kam onemogo~ajo, da bi izvrgle odstranitvi niso opazili nobenih klini~nih spre- linearne tujke, ki jih vzamejo v ustno votlino (npr. su- memb v funkcioniranju jezika, vla`nosti ustne kanec). Dlake, ki izpadejo med negovanjem koùha, se votline ali nastajanju trdih zobnih oblog. zato nabirajo v èlodcu in iz njih nastajajo dla~ne kepe („hairballs“); pomešajo se s hrano in se izlo~ijo z iztrebki ali pa jih ma~ka izbruha. Slina Slinske `leze proizvajajo slino, ki ima zapleteno sestavo Trdo nebo in številne naloge. Odvisno od hidracijskega stanja ìvali Sluznica trdega neba tvori parne, poroènele, proti `relu in jemanja vzorca je lahko slina prozorna in vodena ali pa rahlo konkavno uslo~ene pre~ne sluzni~ne gube, nebne gosta in sluzasta. Male slinske `leze proizvajajo predvsem gube, rugae palatinae, ki jih je pri psu 8 – 12, pri ma~ki mukozno (sluzasto, èlatinasto) slino, velike slinske `leze pa 7 -8. pa bolj vodeno slino (serozno), ki vsebuje encim ptialin, ki igra pomembno vlogo pri razgradnji ogljikovih hidra- Papile na trdem nebu so zna~ilne le za ma~ke. Usmerjene tov. so kavdalno in sodelujejo pri prijemanju.

92 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Slina vlaì ustno sluznico, navlaì in oblikuje bolus hrane, ploskvami, ki sluìjo drobljenju hrane, ima ma~ka zna~ilen kar olajša `ve~enje in potovanje bolusa skozi ustno votli- ugriz, pri katerem hrano reè. Pri spodnjem molarju je no in poìranje. Slina ima pomembno zaš~itno nalogo rezilna ploskev izoblikovana z dvema skoraj enakima de- pred bakterijami, saj vsebuje encime, lizosome in imuno- loma krone, glavno in distalno grbico, ki ju podpira velika globuline. Slina tudi mehansko spira ustno votlino (sluzni- mezialna korenina, distalna pa je zelo majhna. Zgornji co in zobe) in na ta na~in zmanjšuje število prisotnih bak- ~etrti premolar, ki se imenuje tudi drobilec, zdrsne s svo- terij. Proteini, ki se nahajajo v slini, se veèjo na mikroor- jo palatinalno ploskvijo mimo bukalne ploskve spodnjega ganizme in na ta na~in prepre~ujejo njihovo lepljenje na prvega ko~nika. Skupaj delujeta kot škarje; na tem mestu tkiva ustne votline. Slina deluje proti glivicam in virusom. je stisk ~eljusti najmo~nejši. Tu ma~ke trgajo meso in drobijo kosti. Temeljito `ve~enje pri mesojedih ni potrebno, ker goltajo cele kose mesa in kosti. Zobje Pri mle~nem zobovju ni meljakov, to velja za ma~ke in Na splošno velja, da zobje pri ma~ki izrastejo 2 – 4 tedne pse. prej kot pri psu. Zobovje pri ma~ki je glede na zobovje pri psu zreducirano zaradi kratkih, stisnjenih ~eljusti in to na vsaki strani za en zgornji premolar in en zgornji molar ter na obeh straneh za dva spodnja premolarja in dva spod- Obolenja ustne votline pri ma~ki nja molarja. Ker navedeni zobje manjkajo, je zobovje pri ma~ki skrajno sekodontno (pomeni, da imajo ostre gr- bice, (izbokline) s katerimi ma~ka reè meso podobno 1.) Parodontalna bolezen giljotini. Sekodontno zobovje imajo tipi~ne zveri. Pri re- Je najpogostejše vnetno obolenje ustne votline ma~ke, zanju hrane sodelujeta predvsem prvi molar v spodnji gre za vnetje obzobnih tkiv, do ~esar pride zaradi kopi~enja ~eljusti in ~etrti premolar v zgornji ~eljusti.). Ma~ke imajo mehkih zobnih oblog na zobeh ob robu dlesni. Mehke tako kot psi heterodontno zobovje, kar pomeni, da imajo zobne obloge so sestavljene iz ostankov hrane in pred- ve~ skupin razli~no zgrajenih zob. vsem bakterij, ki se razmnoùjejo v hrani. V ustni votlini ìvali so našli ve~ kot 500 vrst razli~nih bakterij, nekatere povzro~ajo smrad, druge pa vdirajo v dlesni in druga Incizivi ali sekalci so razmeroma majhni zobje, primerni obzobna tkiva. Ko se v mehke zobne obloge vgradijo mine- za „rezanje“. Imajo le eno, dolgo korenino in kratko, os- rali, postanejo te trde in predstavljajo zobni kamen. Zob- tro zobno krono. Incizivi v zgornji ~eljusti so ve~ji od ni kamen sam ne povzro~a obolenj obzobnih tkiv, res pa incizivov v spodnji ~eljusti in po velikosti naraš~ajo od je, da postane površina zobne krone hrapava in se zato prvega do tretjega inciziva. Pes in ma~ka imata po šest nanjo še bolj lepijo ostanki hrane in bakterije. Parodontal- sekalcev v zgornji in v spodnji ~eljusti, pri ma~ki so mnogo na bolezen se za~ne kot vnetje dlesni (gingivitis). Vneta manjši. dlesen je temno rde~a, nabrekla in zelo rada krvavi. Vnetje Kaninusi ali grabilci so najdaljši zobje in imajo eno mo~no dlesni lahko povsem pozdravimo s primerno ustno korenino, ki je lahko do dvakrat daljša od zobne krone. higieno, lahko pa napreduje v globino, kjer povzro~i Zobna krona je koni~na in ukrivljena. Z grabilci pes zgrabi postopno propadanje obzobnih tkiv (vezivnega tkiva, ko- in drì plen ter trga meso, pri ma~ki pa sluìjo predvsem sti in zobnega cementa), ki drìjo zob v ~eljustni kosti. za drànje in ubijanje plena. Pes in ma~ka imata štiri gra- Takšni zobje postanejo majavi, se navidezno podaljšajo, bilce, ki so pri ma~ki mnogo ostrejši. med zobom in dlesnijo nastanejo razli~no globoki „èpi“ Predmeljaki ali li~niki imajo lahko eno, dve ali tri kore- in bole~e gnojne otekline. ê se ne zdravi pravo~asno, nine. Njihova zobna krona je koni~na in ima ve~ grbic. zobje na koncu izpadejo. Z ustreznim in pravo~asnim Odrasel pes ima šestnajst predmeljakov, po štiri levo in ukrepanjem lahko parodontalno bolezen prepre~imo ali desno v spodnji in zgornji ~eljusti, pri ma~ki pa manjkata jo nadziramo. prvi premolar v zgornji ~eljusti na obeh straneh ter prvi Mehke zobne obloge je treba s š~etkanjem odstranjevati in drugi premolar v spodnji ~eljusti na obeh straneh, tako vsak dan, veterinar pa naj po potrebi opravi zobni poseg. ima ma~ka 10 predmeljakov. Pri napredovali parodontalni bolezni je treba izdreti mo~no Meljaki ali ko~niki imajo pri psu – izvzemši prvi meljak v prizadete zobe, ki se majejo. spodnji ~eljusti – ravne grizne ploskve, primerne za drobl- jenje hrane. êprav se zobna gniloba (karies) pri psu v 2.) Resorpcija zob pri ma~ki (FORL – Feline odontoclastic primerjavi z ljudmi pojavlja zelo redko, se najpogosteje resorptive lesions ) pojavlja na griznih ploskvah meljakov. Je ena najpogostejših obolenj ustne votline pri ma~ki, V zgornji ~eljusti ima odrasel pes po dva meljaka na levi prizadene 25 – 75 % ma~k. Za bolezen ni pasemske pre- in na desni strani, v spodnji ~eljustnici pa po tri na levi in dispozicije, oba spola sta prizadeta enako, vendar število desni strani. Ma~ka ima v zgornji in spodnji ~eljusti samo prizadetih ma~k naraš~a s starostjo. Resorpcije zob ne po en meljak na vsaki strani. Ker nima zob z ravnimi smemo zamenjevati s kariesom, ki se pri ma~kah ne po-

93 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010 javlja. Resorpcija zob se pojavlja tudi pri starejših psih, a veliko redkeje. Navadno se pri~ne na skleninsko cementni meji ali pod njo, navadno na li~ni strani zoba. FORL je bolezen so- dobnega ~asa, saj je na zobeh pri najdenih lobanjah iz- pred leta 1950 skoraj ni najti.

3.) Kroni~ni gingivostomatitis pri ma~ki, tudi limfocitno plazmocitni gingivostomatitis Stomatitis (vnetje ustne sluznice zaradi katerega koli vzroka) je zelo pogosto obolenje pri ma~kah, medtem ko se pri psih pojavlja le pri ìvalih z oslabljenim imunskim sistemom, navadno ob kontaktu sluznice z zobmi, ki so prekriti z zobnim plakom. Pri ma~kah opazimo lokalno ali difuzno kroni~no vnetje dlesni in ustne sluznice. Za enkrat ni znano, kaj je povzro~itelj tega obolenja. Opazimo razli~ne stopnje vnetja dlesni (gingivitis), li~ne sluznice, podro~ij lateralno od glosopalatinalnih gub, ki se ga pogosto napa~no poimenuje „faucitis“, jezika (glositis), trdega in mehkega neba ali kombinacije teh. Poškodbe so navadno simetri~ne in ve~krat izraène na mehkih tkivih v podro~ju premo- larjev in molarjev kot pa incizivov in grabilcev. Prizadete ma~ke te`ko jemljejo hrano, imajo teàve pri poìranju, se slinijo in so brez apetita. Zanimivo je, da so bolj prizadete ma~ke, ki ìvijo skupaj z drugimi ma~kami, kot tiste, ki ìvijo same. Pri klini~nem pregledu ugotovimo zna~ilno vneto ustno sluznico, ìval ima lahko tudi pove~ane bezgavke. Pregled krvi mnogokrat pokaè hi- pergamaglobulinemijo, ki je posledica kroni~ne antigen- ske stimulacije. Pri prizadetih ma~kah opravimo test za FeLV/FIV, da izklju~imo moèn vzrok obolenja.

Literatura 1. Bonello D. Feline inflammatory, infectious and other oral conditions. V: Tutt C, Deeprose J, Crossley DA, eds. BSAVA Manual of canine and feline dentistry. Glouchester: BSAVA, 2007: 126–47. 2. Gorrel C. Oral examination and recording. V: Gorrel C ed. Veterinary dentistry for the nurse and technician. Edinburg: Elsevier, 2005: 41–54. 3. Gracis M. Orodental anatomy and physiology. V: Tutt C, Deeprose J, Crossley DA, eds. BSAVA Manual of canine and feline dentistry. Glouchester: BSAVA, 2007: 1–21. 4. König HE, Sautet J, Liebich HG. Digestive system (apparatus digestorius). V: König HE, Sautet J, eds. Veterinary anatomy of domestic mammals. Stuttgart: Schattauer, 2004: 277-342. 5. Rigler L. Anatomija doma~ih `ivali. Splanhnologija. Ljubljana: Veterinarska fakulteta,1987: 22–53. 6. Rothuizen J, Schrauwen E, Theyse LFH, Verhaert L. Digestive tract. V: Rijnberk A, van Sluijs FJ, eds. Medical history and physical examination in companion animals. Edinburg: Elsevier, 2009: 86–100.

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MAJHNE SKRIVNOSTI ZA BOLJŠE PO^UTJE MA^K

Sara Suhadolc Scholten

Ma~ke veljajo za misteriozna in fascinantna bitja, ki v lju- Z ma~kami rokujemo ne`no, previdno in brez strahu. Ko deh, ki jih ne poznajo, vzbujajo strah ali celo nelagodje. se jim pribliùjemo, jih nagovarjamo, in ko smo se Zgodovina jih povezuje s ~arovnicami, zato so bile dolgo prepri~ali, da se ji lahko pribliàmo, to tudi storimo. Ker ~asa tako ma~ke, kot ~arovnice preganjane. Ko pa so se so to ~iste ìvali, zahtevajo tudi v okolju, kot je veterinar- ma~ke prikradle, bolje re~eno »pripredle« v naše domove, ska klinika, red in ~isto~o. Svojega novega domovanja na so se nam za~ela postavljati nova vprašanja, kakšne te kliniki se morajo privaditi, tako vizualno, kot tudi olfak- ìvali sploh so. torno. Vonjave razkuìl, dišav, drugih ìvali, neo~iš~enih Prvi znani predniki iz druìne ma~k (znanstveno ime Feli- straniš~ in stare hrane so za njih zelo mote~e. Kletka, dae) segajo 45 milijonov let nazaj. Predniki ma~ke, kakrš- posode, straniš~e morajo biti vsaj enkrat dnevno no poznamo danes, pa segajo “samo” 8 do 10 milijonov o~iš~ene. Njihovo vidno polje iz kletke naj bo ~im širše, let nazaj. Podatki o za~etkih udoma~evanja ma~k so razli~ni omogo~imo jim opazovanje z višine, ponudimo jim vendar nekatere teorije predpostavljajo da se je to doga- skrivališ~e, kamor se lahko umaknejo. Ob vsakem hran- jalo è 7000 let pred Kristusom.Nekateri pravijo, da ma~ke jenju ma~ko vzamemo iz kletke, ~e je le mogo~e ji za~asno ne bodo nikoli popolnoma udoma~ene, ker so samoza- odstranimo zaš~itni ovratnik, ponudimo ji ve~ razli~nih dostne. Ljudje so ma~ke tolerirali, nikoli pa popolnoma vrst hrane, se z njo ukvarjamo. Po kon~anem hranjenju sprejeli. Zgodovinsko je trajalo kar nekaj let, da so zav- ma~ko o~istimo. ê jo hranimo prisilno, lahko uporabi- zele takšno pozicijo in ugled, kot ga uìvajo danes (1). mo ovratnik ali slin~ek, ki omogo~ata, da ostane dlaka in okolica ma~ke ~ista. Lastniki, ki ma~ko na kliniki obiš~ejo, Svetovni splet nam ponudi nekaj zanimivih številk o raz- naj bodo z njo sami. ê je le mogo~e, jih namestimo v širjenosti ma~k: drug prostor, kjer se ma~ka druga~e ne zadrùje. - na svetu je pribli`no 200 milijonov ma~k Higiena venske kanile in njene obveze se izvaja vsaj en- - naši sosedje Italijani jih imajo 7 milijonov krat dnevno, obvezo odvijemo, preverimo stanje koè pod Razmerja v številu ljudi in ma~k so slede~a: obvezilnim materialom, preverimo ote~enost šape. ê bolezen in karakter ma~ke dopuš~ata, ji omogo~imo spre- - svet 1:34 hod po prostoru. Za nekatere ma~ke je priporo~ljivo, da - Avstrija 1:1 jih opazujemo na daljavo. Kontaktov z drugimi ma~kami - Evropa, Amerika 1:4 (2). ali ìvalskimi vrstami se izogibamo pa ~eprav v doma~em V ZDA je leta 2007 ìvelo pribli`no 81 milijonov ma~k, okolju z nekaterimi sobivajo. povpre~no število ma~k na gospodinjstvo je 2,2 in za Torej, za ma~ko, ki biva pri nas, si moramo vzeti ~as. obiske pri veterinarju so porabili 81 dolarjev (3). V Veliki Britaniji ìvi pribli`no 8 milijonov ma~k, od tega 92 % nepasemskih. Glavna razloga, zaradi katerih imajo ljudje na Otoku ma~ke, sta ljubezen do ma~k (27%) in uìvanje v njihovi dru`bi (27%) (4).

Literatura 1. Introduction to Feline Behaviour.In: Bonnie V. Beaver. Feline behaviour:a guide for veterinarians,second edition.St. Louis, Missouri:Saunders,2003:p.1-7 Sara Suhadolc Scholten, dr.vet.med. 2. http://www.suite101.com/blog/shaya_weaver/ how_many_cats_are_there Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male `ivali, Gerbi~eva 60, 3. http://www.avma.org/reference/marketstats/ownership.asp SI-1000 Ljubljana 4. http://www.pfma.org.uk/overall/pet-population-figures-.htm [email protected]

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CELOSTNA OBRAVNAVA GERIATRI^NEGA STOMATOLOŠKEGA PACIENTA – KLINI^NI PRIMER

Martina Krofi~, Nina Mlakar, Katerina Tomsi~, Alenka Seliškar, Zlatko Pavlica, Nataša Tozon

UVOD ANESTEZIJA IN POOPERACIJSKA OSKRBA Adultna parodontalna bolezen (AP) je najpogostejša Deset dni po prvem pregledu smo opravili stomatološki bolezen ustne votline odraslih ma~k, saj prizadene poseg v splošni anesteziji. Ma~ka smo premedicirali z pribli`no 85 % populacije (1), sledi ji odontoklasti~na re- metadonom (Heptanon, Pliva) 0.125 mg/kg s.c. in po sorptivna poškodba (ORL), ki prizadene okoli 29 % popu- preoksigenaciji s 100 % kisikom uvedli v anestezijo s pro- lacije (2, 3). V prispevku je opisana celostna obravnava pofolom (Propofol 1%, Fresenius Kabi) 6,25 mg/kg i.v. ma~ka z napredovalo parodontalno boleznijo in ORL. Anestezijo smo vzdrèvali z izofluranom (Forane, Abbott Laboratories Ltd.) v 100 % kisiku. Med anestezijo smo KLINI^NI PREGLED IN PREDOPERACIJSKA ma~ku i.v. injicirali Hartmanovo raztopino v odmerku 5 ml/kg/h. Zaradi sistoli~nega šuma na srcu smo odmerek PRIPRAVA izotoni~ne raztopine med anestezijo prepolovili, saj bi z Zaradi zmanjšanega apetita in ìvahnosti so na pregled ve~jim odmerkom lahko preobremenili sr~noìlni sistem pripeljali ma~ka, kastrata, starega 20 let, s telesno maso in povzro~ili plju~ni edem. Po uvodu v anestezijo smo 5,6 kg. Ma~ek je shujšal, v zadnjem mesecu ve~ pil in ma~ku aplicirali antibiotik amoksicilin s klavulansko kisli- uriniral ter imel zadah iz gob~ka. Pri pregledu smo ugo- no (Augmentin, GSK) 20 mg/kg i.v. Med anestezijo smo tovili dehidracijo, tahikardijo, levostranski sistoli~ni šum spremljali delni tlak izdihanega CO2 (ETCO2), koncentracijo II. stopnje, vnetje dlesni in trde zobne obloge. vdihanega in izdihanega izoflurana ter telesno tempera- Hematološki, biokemi~ni (se~nina, kreatinin, alkalna fos- turo. Elektri~no aktivnost srca smo merili z elektrokar- fataza, alanin aminotransferaza, skupne beljakovine, al- diografom, z Dopplerjevim merilcem pa smo neinvazivno bumini, koncentracija kalcija) in urinski parametri (kemi~na merili sistoli~ni arterijski tlak. Frekvenca srca je bila med analiza urina s testnim trakom, specifi~na teà urina, posegom med 120 in 140 utripov na minuto. Ma~ek je merjena z refraktometrom in urinski sediment) ter raven med anestezijo dihal spontano s frekvenco okoli 20 vdi- skupnega tiroksina (T4) v serumu so bili znotraj referen~nih hov na minuto, ETCO2 pa je bil med 33 in 40 mmHg. vrednosti, test na prisotnost specifi~nih protiteles proti Arterijski tlak je bil po uvodu v anestezijo nizek (70 mmHg), virusu ma~je imunske pomanjkljivosti (FIV) in prisotnost verjetno zaradi vazodilatativnega u~inka propofola in izof- virusa ma~je levkoze (FeLV) je bil negativen. Ma~ku smo lurana, zato smo ma~ku aplicirali sinteti~ni koloid (Gelo- s.c. aplicirali 100 ml izotoni~ne infuzijske raztopine (Hart- fusine, B Braun Melsungen AG) v odmerku 0,3 ml/kg v manova raztopina, B Braun Melsungen AG) in nesteroid- 10 min. Po tem se je arterijski tlak zve~al na 90 mmHg. ni analgetik meloksikam (Metacam, Boehringer Ingelheim Med prebujanjem smo ma~ku aplicirali meloksikam v Vetmedica) 0,2 mg/kg. Zdravljenje z meloksikamom smo odmerku 0,1 mg/kg i.v., 6 ur po premedikaciji pa smo nadaljevali 2 dni v odmerku 0,1 mg/kg p.o. Za zmanjšan- ponovili aplikacijo metadona. Aplikacijo antibiotika smo je števila bakterij v ustni votlini smo predpisali mazanje ponovili 2 in 8 ur po prvem odmerku. Teko~insko ho- dlesni z gelom s klorheksidinom (Stomodine gel, ICF). @e meostazo smo po posegu vzdrèvali z injiciranjem Hart- po enem dnevu se je ma~ku klini~no stanje izboljšalo, manove raztopine v odmerku 2 ml/kg/h i.v. Ma~ka smo samostojno je za~el jesti in postal je ìvahnejši. odpustili v doma~o oskrbo še isti dan in mu predpisali analgetika meloksikam v odmerku 0,075 mg/kg/24 h p.o. Martina Krofi~, dr.vet.med., Nina Mlakar, dr.vet.med., Katerina Tomsi~, dr.vet.med., doc.dr. in tramadol (Tramal, Krka) 2,5 mg/kg/12 h p.o. za dva Alenka Seliškar, dr.vet.med., prof.dr. Zlatko Pavlica, dr.vet.med., prof.dr. Nataša Tozon, dni. Antibioti~no zdravljenje smo nadaljevali deset dni z dr.vet.med. amoksicilinom s klavulansko kislino (Synulox, Pfizer) 20 Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, SI-1000 Ljubljana mg/kg p.o Lastnici smo svetovali, naj ma~ka pribli`no teden dni hrani z mehko hrano. [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]

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STOMATOLOŠKI POSEG pozni fazi, ko zajame sklenino ali vrat zoba, saj je pogos- to pokrita z vneto in hiperplasti~no dlesnijo. Lahko vodi Ma~ek je imel kljub visoki starosti še vse zobe, ki so bili tudi do zloma krone oz. njene popolne resorpcije in pokritja prekriti z mehkimi in trdimi zobnimi oblogami. Na neka- ostanka zoba z dlesnijo (6). Najpogosteje sta prizadeta terih zobeh smo z zobno sondo odkrili erozije sklenine, spodnja tretja li~nika. Pri ve~ini ma~k se ORL pojavlja ki so segale tudi v dentin. Dlesen ob njih je bila mo~no simetri~no (7). Do danes še ni u~inkovite preventive ORL, pordela in je ob dotiku z inštrumentom zakrvavela. Vi- zato moramo prizadete zobe najve~krat izdreti. V prime- zualno in s pomo~jo parodontalne sonde smo dolo~ili ru ankiloze koreninskega dela zoba pa se lahko na podla- indeks vnetja dlesni in indeks mehkih ter trdih zobnih gi rentgenskega izvida odlo~imo le za amputacijo krone oblog, izmerili globino dlesninega èpa, hkrati pa ugo- (4). tovili mo`no razkrito razcepiš~e korenin in majavost zob. Na vseh grabilcih je bila vidna recesija dlesni in posledi~no Ma~ek je ob prvem pregledu kazal nezna~ilne klini~ne izpostavljene korenine. Vsi li~niki in ko~niki, z izjemo spod- znake. V primeru take klini~ne slike moramo predvsem njega desnega ~etrtega li~nika in prvega ko~nika, so imeli pri geriatri~nih pacientih izklju~iti kroni~no ledvi~no globino sondiranja 2 mm ali ve~. odpoved in bolezni jeter, kar smo izklju~ili na osnovi laboratorijskih preiskav krvi in urina (8). Pri starejših ma~kah Zaradi brezupne napovedi izida zdravljenja AP in ORL smo pogosteje pri~akujemo hipertireoidizem, še posebej, ~e se odlo~ili za izdrtje vseh grabilcev in vseh li~nikov razen se pojavijo nekateri ali vsi od naštetih klini~ni znakov: ta- 408 ter ko~nikov 209 in 309. Najprej smo z zvo~nim hikardija, sistoli~ni sr~ni šum, poliurija, polidipsija in luš~ilcem odstranili mehke in trde zobne obloge nad in neješ~nost (9). Ker je bil ma~ek v stiku z drugimi ma~ki, pod dlesnijo ter ustno votlino temeljito sprali z vodnim smo opravili test na FeLV in FIV, saj se kroni~ni gingivitis, sprejem. Enokoreninske li~nike in ko~nike smo izdrli z stomatitis in parodontitis lahko pojavijo tudi v povezavi s metodo zaprte tehnike izdiranja, ve~koreninske li~nike ter tema boleznima. FeLV in FIV sta pogostejši pri mlajših ko~nike pa smo najprej razdelili v enokoreninske frag- ma~kah, kljub temu pa je poznavanje stanja pomembno mente in jih nato izdrli z metodo odprte tehnike izdiranja. za prognozo zdravljenja sprememb v ustni votlini (10, Prav tako smo z odprto tehniko izdrli grabilce, kjer smo 11). pri spodnjih odstranili del kosti z lingvalne strani. Glede na slabo splošno stanje ma~ka ob prvem pregledu smo ga najprej rehidrirali in mu nudili ustrezno analgezi- RAZPRAVA jo, zaradi ~esar je ma~ek pri~el jesti è naslednji dan. Po Parodontalno bolezen predstavljajo vnetne spremembe stomatološkem posegu smo teàve v ustni votlini odpravili. parodoncija (dlesni, alveolarne kosti, cementa in pozob- Vzrok vnetja in bole~ine je bil dokon~no odstranjen, ìval nice) povzro~ene z mehkimi zobnimi oblogami (4). Paro- pa je lahko ponovno zaìvela kvalitetno ìvljenje. dontitis odraslih ma~k AP je ena od oblik te bolezni, ki se pri~ne è kmalu po erupciji stalnih zob, vendar se zaradi po~asnega napredovanja klini~no pokaè šele kasneje (1). Pri ma~ki z omenjeno boleznijo klini~no opazimo mehke in trde zobne obloge, razli~ne stopnje vnetja dlesni, majavost zob, lahko pa tudi è izpostavljeno koreninsko razcepiš~e. Na podlagi ocene parodontalnega statusa se odlo~imo za obseg zdravljenja, saj bolezen predstavlja vir kroni~ne oku`be organizma. Sistemski u~inki se pojavijo zaradi delovanja eksotoksinov in endotoksinov ter pre- hodne bakteriemije ob grizenju in stomatoloških posegih. Zaradi parodotitisa se lahko pojavijo bolezni srca in oìlja (endokarditis, okluzije koronarnih arterij, miokard- ni infarkt, diseminirana intavaskularna koagulacija, šok), bolezni dihal (kroni~ni bronhitis, kroni~no obstruktivno obolenje plju~, fibroza, emfizem), ledvic (degeneracija tubulov, limfoplazmocitni intersticijski nefritis, pielitis), jeter (vnetje parenhima, fibrozacijske spremembe portal- nega sistema), sladkorna bolezen in druge (5). ORL je do danes znana kot idiopatska resorpcija zobnih struktur z odontoklasti, ki se pri~ne na koreninskem ce- mentu, nadaljuje v dentin, prizadene pa tudi sklenino. Uni~en cement in pozobnico nadomesti kosti podobno tkivo, kar privede do zraš~anja zoba z okolno kostjo (anki- loza zoba) (4). Poškodba na zobu postane vidna šele v

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LITERATURA 1. Wiggs RB, Lobprise HB. Domestic feline oral and dental disease. In: Wiggs RB, Lobprise HB, eds. Veterinary Dentistry Principles and Practice. Philadelphia: Lippencott-Raven, 1997; 485. 2. Ingham KE et al. Prevalence of odontoclastic resorptive lesions in a population a clinically healthy cats. JSAP 2001; 42, 439-443. 3. Reiter AM, Nachreiner RF. Evaluation of calciotropic hormones in cats with odontoclastic resorptive lesions. American Journal of Veterinary Research 2005; 66, 1446-1452. 4. Gorrell C. Small animal dentistry, Saunders solutions in veterinary practice. Elsevier Health Sciences, 2008. 5. Pavlica Z. Sistemski u~inki parodontalne bolezni pri psih. Veterinarske novice 2002; 28: 53- 61. 6. Dumais Y. Feline odontoclastic resorptive lesions. WSAVA, Vancouver, 2001. 7. Gorrel C. Feline odontoclastic resorptive lesions. WSAVA, Bangkok 2003. 8. Feldman EC. Polyuria and polydipsia. In: Ettinger SJ, Feldman EC, editors: Textbook of veterinary internal medicine, 6th ed., Philadelphia: Elsevier, 2006; 102-105. 9. Rijndberk, A. Thyroids. In: Rijndberk A, Kooistra H, eds. Clinical endocrinology of dogs and cats. 2nd edition, Hannover: Schlutersche, 2010; 73. 10. Sellon RK., Hartmann K. Feline Immunodeficiency virus infection. In: Greene CE: Infectious diseases of the dog and cat. Georgia: Saunders, 2006; 131-143. 11. Hartmann K.. Feline Viral Leukemia virus infection. In: Greene CE: Infectious diseases of the dog and cat. Georgia: Saunders, 2006; 105-130.

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KVANTITATIVNO DOLO^ANJE KONCENTRACIJE CRP PRI PSIH Z UPORABO NOVE IMUNOKEMIJSKE METODE

Alenka Nemec Svete, Barbara Lukanc, Katerina Tomsi~, Alenka Seliškar

Izvle~ek Uvod C-reaktivni protein (CRP) je najpomembnejši protein akutne C-reaktivni protein (CRP) spada med najpomembnejše faze vnetja, tako pri ljudeh kot tudi pri psih. Pove~ano proteine akutne faze vnetja, tako pri ljudeh kot tudi pri koncentracijo CRP pri psih so ugotovili po kirurških po- psih. Sintetizira in sproš~a se iz hepatocitov kot odgovor segih, pri infekcijskih in vnetnih boleznih. Za dolo~anje na pove~an nivo proinflamatornih citokinov (IL-6, TNF- koncentracije pasjega CRP obstajajo številne imunoke- α) v sistemskem krvnem obtoku. Ime je dobil zaradi svoje mijske metode. Ve~ina teh je zelo zamudnih in zahtevajo lastnosti, da reagira s somatskim C-polisaharidom posebej izurjeno osebje in aparature. V naši raziskavi smo pnevmokoka (Streptococcus pneumoniae) (1,2,3). V hu- preizkusili najnovejšo imunokemijsko metodo, osnovano mani medicini slu`i dolo~anje CRP kot pokazatelj vnetne- na merjenju magnetne permeabilnosti, ki omogo~a doga dogajanja. Koncentracija CRP se zna~ilno pove~a pri lo~anje koncentracije CRP v serumu psov v samo 11 minu- poškodbah tkiva zaradi bakterijske infekcije in po opera- tah cijah. Pri virusnih oku`bah praviloma ni povišanja CRP, zato lahko pri ljudeh hitro in zanesljivo razlikujemo med Abstract bakterijskimi in virusnimi infekcijami (1). Pri zdravih psih je CRP prisoten v nizkih koncentracijah. C-reactive protein (CRP) is the major acute phase protein Koncentracija CRP se zna~ilno pove~a pri psih po kirur- in man and dog. Increased concentration of CRP was ških posegih, pri infekcijskih in vnetnih boleznih (2,4). determined in dogs after surgery and dogs with infec- Študije potrjujejo uporabnost dolo~anja CRP pri sprem- tious disease and chronic inflammatory disease. There ljanju poteka zdravljenja s kortikosteroidi, saj le-ti vpliva- are several immunochemistry methods for determination jo na število levkocitov in absolutno število nevtrofilcev, of canine serum or plasma CRP concentration, majority na parametra, ki se sicer uporabljata za spremljanje pote- of them are time consuming, require well-trained per- ka vnetnih bolezni (5,6). Za dolo~anje serumske oziroma sonnel and specialized equipment. New immunochemis- plazemske koncentracije CRP pri psih obstajajo številne try method, based on the measurement of magnetic per- komercialno dostopne imunokemijske metode (7,8,9), ki meability, which enables the determination of canine CRP pa so zaradi na~ina izvajanja zelo zamudne, zahtevajo concentration in 11 minutes, was used in the present ustrezne aparature in so namenjene analizi ve~jega števila study. vzorcev hkrati, kar je za klini~no prakso nesprejemljivo. Uporaba humanih imunokemijskih metod ni priporo~ljiva zaradi razli~nih antigenskih lastnosti pasjega in ~loveškega CRP (10). V okviru preliminarne raziskave smo preizkusili najnovej- šo imunokemijsko metodo, osnovano na merjenju magnetne permeabilnosti, ki omogo~a dolo~anje koncentracije CRP v serumu psov v samo 11 minutah (11). doc.dr. Alenka Nemec Svete, univ.dipl.in`.kem.in`., asist.dr. Barbara Lukanc, dr.vet.med., Katerina Tomsi~, dr.vet.med., doc.dr. Alenka Seliškar, dr.vet.med. Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male `ivali, Gerbi~eva 60, SI-1000 Ljubljana [email protected]; [email protected]; [email protected]; [email protected]

99 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

Materiali in Metode Rezultati in Razprava V raziskavo smo vklju~ili 18 psov razli~nih pasem, spola Koncentracija CRP je bila pri psih (n=12), pri katerih s in starosti, pri katerih smo opravili razli~ne kirurške in klini~nim pregledom in laboratorijskimi preiskavami ni- stomatološke posege (Tabela 1). Zdravstveni status smo smo ugotovili sprememb splošnega zdravstvenega sta- dolo~ili na osnovi klini~nega pregleda ter rezultatov he- tusa, v mejah normalnih vrednosti (7,8,12) to je v raz- matoloških in biokemijskih preiskav (podatki, razen števila ponu od < 10 mg/L do 17 mg/L (Tabela 1). Pri ostalih levkocitov, niso prikazani). Serumsko koncentracijo CRP psih smo, v skladu z literaturnimi podatki, dolo~ili smo dolo~ali z imunokemijsko metodo (LifeAssays Ca- pove~ano koncentracijo CRP (2). nine CRP Test Kit, Sweden). Spodnja meja detekcije metode je 10 mg/L, zgornja pa 140 mg/L.

Tabela 1: Koncentracija CRP in število levkocitov pri zdravih in bolnih ìvalih Podatki o psu Poseg CRP (mg/L) levkociti (x 109/L) 1 psica, X, 5 mesecev, zdrava ovariektomija 17,0 8,98 2 pes, X, 10 let, zdrav higiena ustne votline in orhiektomija 70,0 9,62 3 psica, X, 2 leti, zdrava ovariektomija 13,0 6,69 4 psica, YT, 4 leta, zdrava ovariektomija 16,0 7,24 5 pes, YT, 7 let, parodontalna bolezen, higiena ustne votline, ekstrakcija zob 76,0 9,28 epileptik 6 pes, TM, 2 leti, zdrav zobna akrilatna opornica 32,0 / 7 psica, GR, 6 let, ileus mediana laparotomija, gastrotomija, 270,0 22,19 resekcija dela ~revesja 8 pes, X, 11 let, lumbosakralna stenoza dorzalna laminektomija <10,0 6,04 9 psica, X, 8 let, kroni~ni apikalni ekstrakcija zoba <10,0 8,25 parodontitis 208 10 psica, NB, 4 leta, ruptura kolenskih tehnika »over the top« ter delna <10,0 10,18 kri`nih vezi levo, kroni~ni gonitis odstranitev ve~jih kostnih izrastkov 11 psica, JKP, 5 let, raztrganina na šivanje rane <10,0 / levem stegnu 12 psica, X, 14 let, ruptura kolenskih tehnika po Gambardelliju, <10,0 13,34 kri`nih vezi levo, epileptik oànje kapsule 13 pes, IS, 14 let, atrofija mod in orhiektomija in elektrokemoterapija <10,0 9,18 nadmodkov ter vaskularni hamartom desnega nadmodka 14 psica, X, 7 let, ugrizne rane šivanje ran 78,0 18,94 15 pes, BS, 8 let, ko`ni hemangiopericitom odstranitev novotvorbe, torakalni <10,0 12,57 na desnem komolcu aksialni dorzalni reènj 16 pes, GR, 12 let, prostati~na cista orhiektomija, biopsija prostate 16,0 12,37 17 pes, MO, 5 let, parodontalna bolezen, higiena ustne votline, gingivektomija 21,0 13,24 osteomielitis susp. 18 pes, X, 9 let, ruptura kolenskih tehnika »over the top«, meniskotomija <10,0 8,99 kri`nih vezi desno 19 psica, X, 13 let, gnojno vnetje maternice ovariohisterektomija 155,0 30.37 20 psica, CAT, 12 let, gnojno vnetje ovariohisterektomija 92,0 22,29 maternice

100 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

Zaklju~ek Nova imunokemijska metoda za dolo~anje CRP v serumu psov je enostavna in hitra za uporabo. Za ugotavljanje diagnosti~ne uporabnosti metode pri razli~nih boleznih oziroma spremljanja poteka zdravljenja bodo potrebne nadaljnje študije.

Literatura 1. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003; 111: 1805-1812. 2. Nakamura M, Takahashi M, Ohno K, e tal. C-reactive protein concentration in dogs with various diseases. J Vet Med Sci 2008; 70: 127-131. 3. Yamashita K, Fujinaga T, Miyamoto T, Hagio M, Izumisawa Y, Kotani T. Canine acute phase response: relation between serum cytokine activity and acute phase response. J Vet Med Sci 1994; 56: 487-492. 4. Yamamoto S, Shida T, Miyaji S, et al. Changes of serum C-reactive protein levels in dogs with various disorders and surgical traumas. Vet Res Commun 1993a; 17: 85-93. 5. Ohno K, Yokoyama Y, Nakashima K, Setoguchi, Fujino Y, Tsujimoto H. C-reactive protein in canine idiopathic polyarthritis. J Vet Med Sci 2006; 68: 1275-1279. 6. Kjelgaard-Hansen M, Jensen AL, Houser GA, Jessen LR, Kristensen AT. Use of serum C-reactive protein as an early marker of inflammatory activity in canine type II immune-mediated polyarthritis: a case report. Acta Vet Scand 2006; 48:9 doi:10.1186/1751- 0147-48-9 7. Kjelgaard-Hansen M, Kristensen AT, Jensen AL. Evaluation of a commercially available enzyme-linked immunosorbent assay (ELISA) for the determination of C-reactive protein in canine serum. J Vet Med 2003; 50: 164-168. 8. Yamamoto S, Shida T, Okimura T, Otabe K et al. Determination of C-reactive protein in serum and plasma from healthy dogs and dogs with pneumonia by ELISA and slide reverse passive latex agglutination test. Vet Q 1994; 16: 74-7. 9. Eckersall PD, Conner JG, Harvie J. An immunoturbidimetric assay for canine C-reactive protein. Vet Res Commun 1991; 15: 17-24. 10. Yamamoto S, Miyaji S, Abe N, Otabe K, Furukawa E, Naiki M. Canine C-reactive protein (CRP) does not share common antigenicity with human CRP. Vet Res Commun 1993b; 17: 159-66. 11. Ibraimi F, Kriz K, Merin H, Kriz D. Magnetic permeability based diagnostic test for the determination of the C-reactive protein concentration in undiluted whole blood. J Magn Mahn Mater 2009; 321: 1632-1634. Otabe K, Sugimoto T, Jinbo T, et al. Physiological levels of C-reactive protein in normal canine sera. Vet Res Commun 1998; 22: 77-85.

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HEMOBARTONELOZA PRI MA^KI – KLINI^NI PRIMER

Urška Ravnik, Sara Suhadolc Scholten, Nataša Tozon

Hemobartonelozo povzro~ajo gram – negativni epicelu- roskopskega pregleda la`no negativen v do 50 % prim- larni mikroorganizmi, uvrš~eni v rod Mycoplasme. Zara- erov, zato je pri mo~nem sumu ob negativnem rezultatu di afinitete do eritrocitov jih ozna~ujemo s predpono hemo potreben dnevni pregled krvnih razmazov 7 dni zapored. – hemoplazme oziroma hemotrofne mikoplazme. S Zanesljivejša metoda dokaza oku`be je PCR, ki je pomo~jo molekularnih metod so pri ma~kah potrdili dve ob~utljivejša in s katero lahko lo~imo med posameznimi razli~ni vrsti: Haemobartonela felis large = Mycoplasma vrstami povzro~itelja. haemofelis (M. haemofelis) in Haemobartonela felis small = Mycoplasma haemominutum (M. haemominutum). V prispevku opisujemo klini~ni primer oku`be z M. Ve~ino klini~no zaznavnih oku`b povzro~a M. haemofe- haemofelis pri doma~em kratkodlakem ma~ku, starem 2 lis, medtem ko oku`ba z M. haemominutum obi~ajno leti, ki je bil na Kliniki za kirurgijo in male ìvali sprejet poteka klini~no nezaznavno in/ali z minimalnimi labora- zaradi apati~nosti, inapetence in kaheksije. V anamnezi torijskimi odstopanji, razen pri so~asni oku`bi z virusom so lastniki povedali, da je ma~ek kastriran, prete`no zunan- FeLV. ji, cepljen proti panlevkopeniji in oku`bam zgornjih dihal, Najpogostejša pot oku`be naj bi bila s krvosesnimi zaje- redno razglisten, FeLV/FIV negativen. Prve teàve so opa- dalci (bolhe, klopi), vendar omenjenega na~ina prenosa zili pred štirimi meseci, ko je bil ma~ek sprejet pri dru- eksperimentalno niso mogli potrditi. Opisujejo tudi gem veterinarju, kjer so ugotovili povišano telesno tem- mo`nost vertikalnega prenosa, ki ravno tako ostaja nepo- peraturo, pove~ane površinske bezgavke in anemijo. Ob trjen. sprejemu na naši kliniki je bil ma~ek afebrilen, apati~en, Ni povsem raziskano, ali je Mycoplasma haemocanis (M. kahekti~en, tahikarden, z izrazito anemi~nimi sluznicami haemocanis), prej Haemobartonela canis, samo izolat M. in ikteri~nimi belo~nicami. haemofelis, ali gre za drugo vrsto. Bolezen, ki jo povzro~a, Vzorec polne krvi z EDTA smo analizirali s hematološkim pa je pri psih bistveno redkejša in manj pomembna. analizatorjem (Technicon H-1TM System). Prvi rezultati Klini~ni znaki hemobartoneloze pri ma~kah so odvisni od hematološke analize krvi pri ma~ku so pokazali levkocito- 9 9 stopnje anemije, faze bolezni in imunskega statusa ìvali. zo (19,40x10 g/L; referen~na vrednosti 5,5-19,5x10 g/ 12 Najpogostejši klini~ni znaki so neposredno povezani z L) in anemijo (število eritrocitov 0,66x10 /L; referen~na 12 anemijo: blede sluznice, depresija, neješ~nost, oslabelost, vrednost 5-10x10 /L, hematokrit 0,05 L/L; referen~na lahko ikterus in splenomegalija. Akutno oku`bo obi~ajno vrednost 0,30-0,45L/L). Odstotek retikulocitov v razma- spremlja povišana temperatura, ki se lahko intermitentno zu polne krvi je znašal 0,4 %, dejanska vrednost, poprav- pojavlja tudi pri kroni~ni oku`bi. Ma~ke v kroni~ni fazi so ljena na obstoje~i hematokrit, je torej 0,04 %, kar kaè na lahko subklini~no okuène. Pri njih lahko pride do izbru- neregenerativno anemijo (referen~na vrednost 0,4-6,4%). ha klini~ne oblike bolezni po razli~nih stresnih stanjih ali Mikroskopska preiskava krvnega razmaza je pokazala pri- ob so~asnem pojavu druge bolezni. sotnost zna~ilno razporejenih epieritrocitnih mikroorga- nizmov, kar potrjuje sum na M. haemofelis. Diagnozo postavimo z mikroskopskim pregledom razmaza periferne krvi pobarvanega s klasi~nimi metodami bar- Ma~ek je bil hospitaliziran, pri~eli smo s terapijo z dok- ® vanja, pri katerem vidimo povzro~itelja na površini eritroci- siciklinom (Clinofug D 50 mg , Dr. August Wolff) 10 tov. Ker število organizmov variira, je lahko rezultat mik- mg/ kg tt/24 ur. Dnevno spremljanje hematokrita ni poka- zalo bistvenega porasta, zato smo ma~ku kljub izboljšan- ju klini~nega stanja po šestih dneh dali transfuzijo polne Urška Ravnik, dr.vet.med., Sara Suhadolc Scholten, dr.vet.med., prof.dr. Nataša Tozon, krvi (30 ml). Hematokrit je bil dan po transfuziji ni`ji od dr.vet.med. pri~akovanega, zato smo terapijo dopolnili z metilpredni- Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, zolonom (Medrol®, Pfizer Luxemburg) v imunosupresiv- SI-1000 Ljubljana ni dozi 2mg/kg tt/24 ur. Ma~ek se je na terapijo dobro [email protected]; [email protected]; [email protected]

102 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 odzval in bil po dveh dneh odpuš~en v doma~o oskrbo. Antibioti~no zdravljenje je nadaljeval še 3 tedne, imunosupresivno pa do prve kontrole, 10 dni po pri~etku zdravljenja. Prva kontrola hematokrita je pokazala porast, klini~no stanje ma~ka je bilo odli~no, zato smo se odlo~ili, da imunosupresivno zdravljenje postopno zmanjšamo (2mg/kg tt/48ur) in po enem mesecu popolnoma uki- nemo. Ob popolni ukinitvi terapije je prišlo do relapsa. Ma~ek tako ostaja na terapiji z metilprednizolonom v dozi 1mg/kg tt/24 – 48 ur od novembra 2008, se odli~no po~uti, hematokrit je v mejah referen~nih vrednosti. V obdobju zdravljenja pa do danes prejema ma~ek še pod- porno terapijo, ki vsebuje vitamine in makro elemente (Hemolitan pet®, Vetnil Brazilija) v dozi 1gtt/kg tt/12 ur.

Anemija pri hemobartonelozi se obi~ajno pojavlja cikli~no, kar je rezultat cikli~nega pojavljanja povzro~itelja v krvnem obtoku. Epizode anemije so obi~ajno povezane s povi- šano temperaturo in levkocitozo ter nastanejo kot posledica sekvestracije okuènih eritrocitov v retikuloendot- elnem sistemu in skrajšani ìvljenjski dobi celic. Pomem- bnejša od neposredne poškodbe eritrocitov pa je imuns- ko pogojena poškodba, ki je posledica vezave povzro~itelja na steno eritrocita, kar lahko razkrije ali spremeni eritrocitne antigene, zaradi ~esar pride do nastanka antieritro- citnih protiteles. Razvije se sekundarna avtoimuna hemoliti~na anemija (sAIHA), ki zaradi mo`nosti prehoda bolezni v kroni~no obliko lahko zahteva doìvljenjsko zdravljenje. Zdravljenje hemobartoneloze s hujšo obliko anemije je sicer priporo~ljivo è v za~etni fazi kombinirati z imuno- supresivnimi zdravili, s katerimi zmanjšamo eritrofagoc- itozo. Po zvišanju hematokrita poskusimo imunosupre- sivna zdravila postopno ukiniti, vendar moramo pacienta spremljati. Kljub morebitnemu negativnemu krvnemu razmazu na prisotnost povzro~itelja je namre~ lahko prisoten imunski odgovor organizma in posledi~no sAIHA, kar zmanjša mo`nost popolne ukinitve zdravil. Brez ustreznega zdravljenja zaradi anemije pogine pribli`no tretjina ma~k z akutno hemobartonelozo. Tiste, ki akutno fazo preìvijo, imajo dobro prognozo, vendar lahko doìvijo relaps ob pojavu druge bolezni oziroma stresnega stanja. Zato je pomembno, da pri pacientu, pri katerem diagnosticiramo hemobartonelozo, ne zanemari- mo morebitne prisotnosti primarne bolezni, ki je potencialno pripeljala do akutizacije hemobartoneloze.

LITERATURA 1. Harvey JW. Haemobartonellosis. In: Greene CE, ed. Infectious Diseases of the Dog and Cat, 2nd edition, Philadelphia: Saunders Company, 1998: 166 – 71. 2. Geiger U. Regenerative Anemias Caused by Blood Loss or Hemolysis. In:Ettinger SJ, Feldman EC, eds. Veterinary Internal Medicine, 6th edition, Missouri: Elsevier Saunders, 2005:1902 – 4.

103 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

HIPERALDOSTERONIZEM PRI MA^KAH – POGOSTEJŠI KOT SI MISLIMO ?

Tanja Plavec

UVOD ta v pove~ano izlo~anje aldosterona, ki ni ve~ pod vplivom fizioloških spodbujevalnih/zaviralnih mehanizmov. In ker Primarni hiperaldosteronizem je posledica novotvorbe ali je aldosteron glavni regulator homeostaze natrija hiperplazije klob~i~aste plasti nadledvi~ne `leze, ki vodi v (pove~ano zadrèvanje v organizmu in posledi~no pove~ano izlo~anje aldosterona in posledi~no motnjo ho- pove~anje ekstracelularne prostornine teko~ine) in kalija meostaze natrija in kalija. Klini~ni znaki so ve~inoma odraz v organizmu (pove~ana kaliureza), so klini~ni znaki pos- hipokaliemije ter hipernatriemije. Bolezen diagnosticira- ledica motnje homeostaze teh dveh mineralov (2). mo klini~no, laboratorijsko in s pomo~jo slikovne diagnostike. Zdravljenje je v primeru enostranskega tumorja V veterinarski literaturi je trenutno opisanih 31 primerov kirurško, v primeru obojestranske hiperplazije pa medika- PHA pri ma~kah. Le-to povzro~ajo unilateralni karcinomi mentozno. skorje nadledvi~ne `leze (10/31), manj je unilateralnih adenomov skorje (6/31), bilateralnih adenomov (2/31) in bilateralne hiperplazije skorje nadledvi~ne `leze (3/31); pri Izlo~anje aldosterona iz klob~i~aste plasti (cone glomeru- ostalih primerih vzrok ni opisan (6). loze) nadledvi~ne `leze v fizioloških pogojih poteka pod Klini~ni znaki, ki se ob primarnem hiperaldosteronizmu vplivom stimulacije sistema renin-angiotenzin-aldoster- pojavijo, so tipi~no posledica sistemske hipertenzije zaradi on (RAAS) (1-3), kalija in ACTH (1,4). Aldosteron je glavni volumske ekspanzije krvi (z o~esnimi krvavitvami, slepo- mineralokortikoid, ki deluje na mineralokortikoidne recep- to, odstopom mre`nice, nevrološkimi znaki in motnjami torje v distalnih tubulih ledvic, v kolonu in slinskih `lezah obnašanja) in/ali polimiopatije zaradi hipokaliemije (ven- ter s tem vzpodbuja reabsorbcijo natrija ter izlo~anje kali- trofleksija glave, oslabelost okon~in, ataksija) (2,3), po- ja in vodika. Retencija natrija vodi v ekspanzijo volumna javljajo se tudi poliurija, podipsija, polifagija in hujšanje ekstracelularne teko~ine (1,3). (7); hipokaliemija pa lahko vodi tudi v razli~ne sr~ne arit- Poznamo primarni ali sekundarni hiperaldosteronizem. Pri mije ali kaliopeni~ne nefropatije. Ti znaki so lahko hudi in primarnem hiperaldosteronizmu (PHA), tumorske ali se pojavijo akutno, lahko pa se znaki pojavijo intermitent- hiperplasti~ne celice klob~i~aste plasti avtonomno izlo~ajo no in v bla`ji obliki (2). aldosteron. Mehanizem negativne povratne zveze vodi v Bolezen diagnosticiramo na podlagi klini~nih znakov, labo- nizko ali normalno aktivnost plazemskega renina (PRA) ratorijske potrditve kipokaliemije, povišane vrednosti kreat- (2,5,6), sekundarni hiperaldosteronizem pa se pojavi kot in kinaze, hipernatriemije, povišane koncentracije plazem- odgovor na aktivacijo sistema renin-angiotenzin-aldos- skega aldosterona in zniàne aktivnosti plazemskega reni- teron, ki ga sproì hipovolemija ali zmanjšanje u~inko- na ter povišanim razmerjem med tema dvema vrednost- vitega volumna krvi, pri ~emer pri~akujemo visoko PRA ma (3), pojavljajo se lahko tudi alkaloza, hipofosfatemija, (6). Stanja so lahko posledica jetrne ciroze, popuš~anja ter hipomagnezemija (8). Referen~ne vrednosti za PAC ledvic ali kongestivnega popuš~anja srca (3). so 110 – 540 pmol/l oziroma 40 – 195 pg/ml, za PRA 60 Primarni hiperaldosteronizem (tudi Connova bolezen) lah- – 630 fmol/l/s oziroma 0,3 – 3 ng/ml/s, za razmerje ko delimo na dva glavna podtipa: enostranski, ki je pos- PAC:PRA pa 0,3 – 3,8 (9). V študiji, kjer je bilo opisanih ledica adenoma ali adenokarcinoma nadledvi~ne `leze, ali 11 ma~k s primarnim hiperaldosteronizmom najverjet- obojestranski, ki je posledica hiperplazije nadledvi~ne `leze neje zaradi bilateralne hiperplazije klob~i~aste plasti (his- (tudi idiopatski hiperaldosteronizem). Obe patologiji vodi- tološka diagnoza potrjena samo pri treh ma~kah v tej študiji) vrednosti aldosterona niso bile tako povišane kot pri ma~kah s tumorji nadledvi~ne `leze in tudi vrednosti asist.dr. Tanja Plavec, dr.vet.med. PRA niso bile toliko zniàne kot v primeru tumorjev (4). Univerza v Ljubljani, Veterinarska fakulteta, Klinika za kirurgijo in male ìvali, Gerbi~eva 60, Ultrazvo~no ali s pomo~jo ra~unalniške tomografije ali SI-1000 Ljubljana magnetne resonance lahko ugotovimo pove~anje ene ali [email protected] obeh nadledvi~nih `lez, z venografijo preko vene saphe-

104 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 nae lateralis pa lahko ugotovimo potencialno invazivno rast v v. cavo caudalis (3,5). Normalna dolìna nadledvi~ne `leze pri odraslih, zrelih ma~kah je 10,7 ± 0,4 mm, mak- simalni premer oziroma debelina pa 4,34 ± 0,3 mm (10). Zdravljenje je v primeru enostranskega pove~anja nadledvi~ne `leze kirurško (enostranska adrenalektomija in po potrebi trombektomija) (7), v primeru obojestranske hiperplazije ali tumorja nadledvi~ne `leze z zasevki pa simptomatsko: nadomeš~anje kalija v obliki kalijevega glukonata (2 6 mmol PO BID) in/ali kalijevega klorida, aplikacija antagonistov aldosterona (npr. spironolakton 2 4 mg/kg PO SID) in zdravil za zniànje krvnega tlaka (npr. amlodipin 0,125 mg/kg PO SID – BID). Klini~ni znaki polimiopatije se dobro odzovejo na nadomeš~anje kalija in zdravljenje s spironolaktonom, ~eprav serumska koncentracija kalija v veliki ve~ini primerov ostane pod referen~nimi vrednostmi (3). Prognoza ma~k, ~e preìvijo akutno perioperativno obdobje, kjer je glavna komplikacija krvavitev, je dobra in ni odvisna od tipa tumorja (adenom ali karcinom) (3).

ZAKLJU^EK Primarni hiperaldosteronizem moramo vklju~iti med diferencialne diagnoze pri vseh srednje starih in starih ma~kah s hipokaliemi~no polimiopatijo in/ali sistemsko hipertenzijo in je ne smemo ve~ smatrati za redko bolezen. Po adrenalektomiji lahko dose`emo zelo dobre ~ase remisije (do pet let), vendar sam poseg s sabo nosi precejšnje tveganje med in postoperativnih krvavitev. Medikamen- tozno zdravljenje s spironolaktonom in nadomeš~anjem kalija v ve~ini primerov odpravi znake polimiopatije, zdravljenje z amlodipinom pa znake arterijske hipertenzije, ~eprav je ta v nekaterih primerih refrakterna na zdravljenje (3).

LITERATURA 1. Flood SM, Randolph JF, Gelzer ARM, Refsal K. Primary hyperaldosteronism in two cats. J Am Anim Hosp Assoc 1999; 35: 411-6. 2. MacKay AD, Holt PE, Sparkes AH. Successful surgical treatment of a cat with primary aldosteronism. Case report. Journal of Feline Medicine and Surgery 1999; 1: 117-22. 3. Ash RA, Harvey AM, Tasker S. Primary hyperaldosteronism in the cat: a series of 13 cases. Journal of Feline Medicine and Surgery 2005; 7: 173-82. 4. Javadi S, Djajadiningrat-Laanen SC, Kooistra HS et al. Primary hyperaldosteronism, a mediator of progressive renal disease in cats. Domestic Animal Endocrinology 2005; 28: 85-104. 5. Moore LE, Biller DS, Smith TA. Use of abdominal ultrasonography in the diagnosis of primary hyperaldosteronism in a cat. J Am Vet Med Assoc 2000; 217 (2): 213-5. 6. Briscoe K, Barrs VR, Foster DF, Beatty JA. Hyperaldosteronism and hyperprogesteronism in a cat. Case report. Journal of Feline Medicine and Surgery 2009; 11: 758-62. 7. Rose SA, Kyles AE, Labelle P et al. Adrenalectomy and caval thrombectomy in a cat with primary hyperaldosteronism. J Am Anim Hosp Assoc 2007; 43 (4): 209-14. 8. DeClue AE, Breshears LA, Pardo ID, Kerl ME, Perlis J, Cohn LA. Hyperaldosteronism and hyperprogesteronism in a cat with an adrenal cortical carcinoma. J Vet Intern Med 2005; 19: 355-8. 9. Javadi S, Slingerland LI, van de Beek MG et al. Plasma renin activity and plasma concentrations of aldosterone, cortisol, adrenocorti cotropic hormone, and á-melanocyte-stimulating hormone in healthy cats. J Vet Intern Med 2004; 18: 625-31. 10. Barthez PY, Nyland TG, Feldman EC. Ultrasonography of the adrenal glands in the dog, cat, and ferret. Vet Clin North Am Small Anim Pract 1998; 28 (4): 869-85.

105 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

DIAGNOSTIKA KLAMIDIJSKIH OKU@B PRI MA^KAH

Cvetka Marhold1, Brigita Slavec1, Jo`ko Ra~nik1, Marko Zadravec1, Maja ^on~, Marko Oman2 in Alenka Dov~1

1. UVOD 3. DIAGNOSTIKA KLAMIDIJ Z imenom klamidije (gr.: chlamys -÷ëáìõó - plaš~) Oku`be s klamidijami lahko ugotovimo z razli~nimi labo- poimenujemo razli~ne skupine bakterij iz druìne Chlamy- ratorijskimi metodami za dokazovanje klamidijskih an- diaceae. Sprva so klamidije uvrš~ali med viruse, saj so tigenov in protiteles proti klamidijam. Uporaba dolo~ene organotrofni obligatni znotrajceli~ni organizmi evkari- diagnosti~ne metode je odvisna od vrste in koli~ine vzor- ontskih gostiteljev. Klamidije so majhne, kokoidne po ca ter opreme posameznega laboratorija. Gramu negativne bakterije (1). 3.1 Metode za dokazovanje klamidijskih antigenov Znotraj druìne Chlamydiaceae sta dva rodova: Chlamy- Ob~utljivost in specifi~nost diagnosti~nega testa za dokaz dophila (Cp) in Chlamydia (C). V rod Chlamydia uvrš~amo klamidijskega antigena je posredno odvisna od ustreznosti C. trachomatis, C. muridarum in C. suis. V rod Chlamy- vzorca. Za diagnostiko so primerni izlo~ki in eksudati, ki dophila pa so uvrš~ene Cp. psittaci, Cp. pneumoniae, Cp. vsebujejo epitelne in mukozne celice. Pri ma~kah se pecorum, Cp. abortus, Cp. felis in Cp. caviae. Infekcije odvzame bris vnete o~esne veznice in/ali vnete nosne povzro~ene s Cp. psittaci, Cp. abortus in Cp. felis pred- sluznice. Najprimerneje je, da se vzorec po odvzemu in stavljajo potencialna zoonozna obolenja (1). med prenosom v laboratorij hrani v prenosnem gojiš~u saharozno fosfatni pufer (2SP) pri 4º C. ê vzorcev ne 2. KLAMIDIJSKE OKU@BE PRI MA^KAH moremo prenesti v laboratorij znotraj 48 ur, jih zamrznemo (3). Klamidijske oku`be pri ma~kah najpogosteje povzro~ajo izolati Cp. felis. Primarni gostitelj te bakterije je doma~a ma~ka in je endemi~no razširjena po vsem svetu. Pri a) Hitri komercialni encimsko imunski testi ma~kah povzro~ajo obolenja zgornjih dihalnih poti, kar S hitrimi komercialnimi encimsko imunskim testi (naj- se klini~no zazna z nosnim izcedkom, kihanjem in vnetjem pogosteje se uporablja Clearview® Chlamydia MF) lahko o~esne veznice. Pri samicah oku`ba s Cp. felis lahko v brisu ku`nine zaznamo klamidijski antigen. Slabost teh povzro~i tudi kroni~no vnetje rodil (2). testov so številni la`no pozitivni rezultati. Da se ovrèjo Klamidijske oku`be se z ma~k lahko neposredno z o~esnim morebitni la`no pozitivni rezultati, se za potrditev rezul- in nosnim izcedkom prenese na ljudi, pri katerih najpogo- tatov hitrih testov uporabljajo specifi~ne diagnosti~ne steje povzro~ijo vnetje o~esnih veznic, redkeje tudi metode, kot so direktna imunoflourescenca in moleku- plju~nice. Za obolenje klamidijskih oku`b so dovzetnejši larne metode veri`ne reakcije s polimerazo (4). ljudje z oslabelim imunskim sistemom (2). b) Direktna imunofluorescenca (DIF) Z DIF ugotavljamo antigen s pomo~jo specifi~no ozna~enih protiteles in dolo~imo poloàj antigena v tkivu Cvetka Marhold, dr.vet.med., asist.dr. Brigita Slavec, dr.vet.med., ali celici. Strogo specifi~na vezava omogo~a, da komple- asist.dr. Jo`ko Ra~nik, dr.vet.med., Marko Zadravec, dr.vet.med., ks antigen–protitelo ostane ~vrsto vezan tudi v nadaljnj- Maja ôn~, študentka VF LJ, asist. Marko Oman, dr.vet.med., doc.dr. Alenka Dov~, dr.vet.med. em postopku obdelave. Pri spiranju se odstranijo neveza- na protitelesa, ki motijo pri ocenjevanju reakcije. Metoda 1Univerza v Ljubljani, Veterinarska fakulteta, Inštitut za zdravstveno varstvo perutnine, Gerbi~eva 60, SI-1000 Ljubljana je hitra, vendar manj ob~utljiva kot molekularna metoda 2 Zavetiš~e za zapuš~ene ìvali Ljubljana, Gmajnice 30, SI-1000Ljubljana veri`ne reakcije (5). [email protected]; [email protected]; [email protected]; c) Molekularne metode veri`ne reakcije [email protected]; [email protected]; Zaradi znotrajceli~nega na~ina ìvljenja, klamidij ne more- [email protected]; [email protected]

106 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 mo gojiti na umetnih gojiš~ih. Razmnoùjemo jih lahko v 4. ZAKLJUÊK celi~nih kulturah, v kokošjih embrijih in v laboratorijskih Klamidije povzro~ajo številne bolezni pri ljudeh in ìvalih. ìvalih. Do razvoja molekularnih diagnosti~nih testov je Nekatere med njimi so povzro~itelji zoonoz. Hitra in zanes- bila izolacija „zlati standard“ med neposrednimi metodami ljiva laboratorijska diagnostika klamidij v veterinarski medi- za dokaz oku`be s klamidijami (6). cini ni pomembna le za spremljanje zdravstvenega stanja Dokazovanje povzro~itelja oku`b z metodo veri`ne reakcije ìvali, temve~ tudi za preventivno ukrepanje pred preno- s polimerazo (PCR) ima številne prednosti pred drugimi som oku`b z ìvali na ljudi (2). metodami, s katerimi dokazujemo antigene. Izolacija na tkivnih kulturah in kokošjih embrijih zahteva infektivno obliko bakterij, vzorec pa lahko razglasimo za negativne- ga šele po enem tednu. Pri tem pa je izvajalec izpostavl- jen ve~ji nevarnosti oku`bi s patogeni. Z metodo PCR lahko teoreti~no zaznamo è eno samo klamidijo v vzorcu. Test PCR je hiter in ga lahko zaklju~imo è v dveh dneh. Pridobivanje rezultatov še v krajšem ~asu omogo~a metoda PCR v realnem ~asu. Njena uporaba mo~no naraš~a, saj postaja dostopna tudi za manjše diagnosti~ne laboratorije. Metoda daje hkrati kvalitativno in kvantitativno informacijo ter ne zahteva dodatne obdelave vzorcev po pomnoèvanju, kot je npr. lo~evanje amplikonov na gelu. Na ta na~in se mo~no zmanjša mo`nost laboratorijske kontaminacije s PCR produkti (7).

3.2 Serološke metode Pri seroloških testiranjih ima ve~ji diagnosti~ni pomen porast titra protiteles pri ponovnem pregledu iste ìvali, kot pa sama ugotovitev pozitivnih titrov protiteles. Sero- loški testi dopolnjujejo molekularno diagnostiko in so pomembni tudi za epidemiološke študije. Specifi~na in hitro izvedljiva serološka reakcija je indirektna imunofluorescenca (2). a) Indirektna imunofluorescenca (IIF) Osnova pri IIF metodi je vezava serumskih protitels s specifi~no ozna~enimi kompleksi. Pozitiven serološki test kaè, da je bila ìval okuèna s klamidijami, ni pa nujno, da pri ìvali tudi trenutno poteka aktivna oku`ba. La`no negativni rezultati pri ìvalih z akutno oku`bo se pokaèjo, kadar so vzorci odvzeti pred serokonverzijo. Zdravljenje s protimikrobno u~inkovino lahko zmanjša odgovor protiteles. Povišan titer protiteles pri parnih serumskih vzorcih ali kombinacija titra protiteles in dokaz antigena potrjuje oku`bo s klamidijjo (5).

LITERATURA 1. Everett K. D., Bush R. M., Andersen A. A. 1999. Emended description of the order Chlamydiales, proposal of Parachlamydiaceae fam. nov. and Simkaniaceae fam. nov., each containing one monotypic genus, revised taxonomy of the family Chlamydiaceae, including a new genus and five new species, and standards for the identification of organisms. Int. J. Syst. Bacteriol. 49: 415-40 2. Rodolakis A, Mohamed K. Y. 2010. Zoonotic potential of Chlamydophila. Veterinary Microbiology 140: 382-91 3. Keše D., Petrovec M., Avši~-@upanc T. 1999. Posebnosti pri odvezmu in prenosu ku`nin za dokaz klamidij, rikecij in erlihij. V: Mikrobiološka analiza ku`nin. Nova Gorica, Zavod za zdravstveno varstvo: 55-56 4. Greguri} G. G.., Vlahovi} K., Slavec B., Gra~ner D., Dov~ A. 2010. PCR confirmation of Chlamydophila felis from nasal and conjunctival swab samples of a domestic cat in Croatia. Acta vet. (Beogr.), vol. 60, no. 1: 23-29 5. Dov~ A. 1998. Klamidioza (Chlamydia psittaci) pri doma~ih in divjih pernatih `ivali v Sloveniji. Doktorska disertacija. Ljubljana. Veterinarska fakulteta: 157 6. Everett K. D. E. 2000. Chlamydia and Chlamydiales: more than meets the eye. Veterinary Microbiology. 75: 109-126 7. Berg H. F., Maraha B., Bergmans A. M., van der Zee A., Kluytmans J. A., Peeters M. F. 2003. Extraction of Chlamydia pneumoniae DNA from vascular tissue for use in PCR: an evulation of four procedures. Clinical Microbiology and Infection, 9, 2: 135-139

107 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

ZDRAVSTVENA PROBLEMATIKA ZAPUŠ^ENIH MA^K V LJUBLJANI

Marko Oman1, Alenka Dov~2, Pavel Kvapil1, Marjan Kastelic3, Barbara Miheli~1

UVOD Projekt se izvaja ob sodelovanju s ~lani interesnih zdruènj (društvo Ma~jelovka in drugi), zainteresiranimi fizi~nimi Za zapuš~ene ma~ke na obmo~ju Mestne ob~ine Ljublja- osebami ter najditelji. Zavetiš~e jim nudi opremo za ulov na (MOL) skrbi Zavetiš~e za zapuš~ene ìvali Ljubljana in transport ma~k, prevoz ma~k ter hrano. Vsak najditelj (zavetiš~e). Zavetiš~e zapuš~enim ma~kam nudi potreb- ob predaji ma~ke v zavetiš~e poda osebne podatke in no veterinarsko oskrbo v skladu z minimalnim zdravstve- podatke o ma~ki, vklju~no s to~no lokacijo mesta najdbe, nim varstvom, ki je opredeljeno v Pravilniku o pogojih za ki jo ozna~imo s koordinatami (2). Podatke vpišemo v zavetiš~a za zapuš~ene ìvali (1). evidence. Zakon o zaš~iti ìvali definira zapuš~ene ìvali kot ìvali, Na podlagi obdelave pridobljenih podatkov smo izdelali ki so najdene, oddane ali odvzete hišne ìvali, kamor spada- karto naseljenosti ma~k. Najve~ ma~k (med 50 in 86) je jo tudi doma~e ma~ke. Posebna kategorija so “prosto- bilo v letih 2008 in 2009 ulovljenih na posameznih ìve~e ma~ke” – ma~ke potomke udoma~enih in za- obmo~jih: Trata, ~rnuški vrti~ki, Fuìne, Moste – Toplar- puš~enih ma~k, ki nimajo lastnika in ìvijo prosto v okoli- na, Moste, KC, Trnovo, Spodnja Šiška in Podutik. Ma~ke ci, so najdene in se štejejo kot zapuš~ene ma~ke. Ulov in so bile lovljene na 379 mestih, to je skupaj na 133 razli~nih oskrbo prostoìve~ih ma~k izvajamo po rednem progra- lokacijah. V obdelavo smo vklju~ili tudi pridobljene pozi- mu in v okviru projekta “Prostoìve~e ma~ke v Mestu tivne rezultate hitrih komercialnih testov za ugotavljanje Ljubljana”. prisotnosti protiteles proti FIV in antigena FeLV. Najve~ (med 8 in 12 ma~k) FIV pozitivnih ma~k smo ugo- PROJEKT PROSTO@IVEÊ MA^KE tovili na obmo~jih Trata, Dravlje, ~rnuški vrti~ki, Zelena Program je nastal na podlagi pobude ob~anov MOL. Glavni jama, KC in Trnovo, skupno na 85 lokacijah. Menimo, da namen projekta je vzpostaviti nadzor nad populacijo z pogostnost primerov sovpada z ve~jo gostoto populacije. uvedbo registriranih hranilnih mest in prepre~evati nenad- V okviru zavetiš~a se je ma~ke steriliziralo oz. kastriralo zorovano razmnoèvanje ter širjenje ku`nih bolezni z vete- in vra~alo v okolje è od leta 2004 (do leta 2008 skupaj rinarsko oskrbo prostoìve~ih ma~k. V tem prispevku 1.983 ma~k). Zaradi nepopolnosti podatkov o dejanski prikazujemo rezultate prevalence prisotnosti protiteles števil~nosti populacije ne moremo govoriti, saj je neznano proti ma~jemu virusu imunske pomanjkljivosti (FIV) in število ma~k oskrbljenih tudi s strani zasebnih veterinar- antigena virusa ma~je levkoze (FeLV). skih organizacij. Na podlagi neuradnih podatkov naj bi Projekt smo v okviru rednega programa izvajali è leta bilo od leta 2004 skupno steriliziranih oz. kastriranih ok- 2008. Na podlagi pridobljenih dodatnih sredstev za na- rog 5.000 ma~k. men projekta smo v letu 2009 obseg oskrbe ma~k pod- Najve~ (med 4 in 7 ma~k) FeLV pozitivnih primerov smo vojili. V letu 2008 je bilo steriliziranih oz. kastriranih in ugotovili na posameznih obmo~jih: Stegne, ~rnuški vrti~ki, vrnjenih v okolje 688 ma~k, v letu 2009 pa 1165. Nove Jarše, Zgornja Zadobrova, Zavoglje in Kosovo polje, skupno na 38 lokacijah. Najmo~nejše prekrivanje FeLV s FIV je na obmo~ju ~rnuških vrti~kov, kar je verjetno posledica koncentracije populacije zaradi rušenja tamka- jšnjih objektov. asist. Marko Oman, dr.vet.med., doc.dr. Alenka Dov~, dr.vet.med., asist. Pavel Kvapil, dr.vet.med., asist. Marjan Kastelic, dr.vet.med., Barbara Miheli~, uni.dipl.biol. 1 ZOO Ljubljana, Ve~na pot 70, SI-1000 Ljubljana FIV IN FeLV 2 Univerza v Ljubljani, Veterinarska fakulteta, Inštitut za zdravstveno varstvo perutnine, FIV se ve~inoma prenaša s parenteralno inokulacijo viru- Gerbi~eva 60, SI-1000 Ljubljana sa iz sline ali krvi, to je najpogosteje pri ugriznih ranah ob 3 Ambulanta BUBA d.o.o. Ro`na dolina 5, SI-1290 Grosuplje pretepih; posledi~no je prevalenca oku`b višja pri sam- [email protected]; [email protected]; [email protected]; [email protected]; cih. Poro~ajo tudi o oku`bah preko sluznice ob spolnem [email protected]

108 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010 kontaktu, vertikalno preko placente in s sesanjem pri no- ma~kah na obe bolezni. Glede na vse v letu 2009 oskrbo- vorojenih mladi~ih. Po vdoru v organizem sledi viremija vane prostoìve~e ma~ke je prevalenca FIV 8,4 % in je in v dveh do osmih tednih nastanejo specifi~na protitele- višja kot v letu 2008, prevalenca FeLV 1,6 % (ni`ja kot v sa (3). letu 2008) in prevalenca dvojne oku`be 0,5 %. FeLV se prenaša se enako kot FIV, oziroma tudi z urinom Od 141 bolnih samcev je bil ugotovljen pozitiven rezultat in blatom. Po za~etni infeciji, ki je ve~inoma po orona- na FIV v 53 %, na FeLV v 6,3 %, na obe bolezni v 3,5 %. zalni poti, se virus replicira v limfati~nem tkivu orofarin- Od 136 bolnih samic je bil pozitiven rezultat na FIV ksa. Pri ve~ini imunokompetentnih ma~k se virusna rep- ugotovljen v 25,7 %, na FeLV v 9,6 % in na obe bolezni v likacija ustavi zaradi mo~nega imunskega odgovora. ê 1,5 %. pa imunski odziv ni zadosten, se FeLV znotraj mononu- Glede na vse oskrbovane samce (530) je prevalenca FIV klearnih celic razširi sistemsko. Tar~na tkiva so timus, pri njih 14,1 % (višja kot v letu 2008), FeLV 1,7 % in na vranica, bezgavke in slinske `leze (primarna viremija). obe bolezni 0,9 %. Pri samicah (774) je prevalenca FIV Lahko se virus razširi v kostni mozeg in inficira hemato- 4,5 % (ostaja na ravni leta 2008), FeLV 1,7 % in na obe poetske prekurzorske celice. Okuèni trombociti in granu- bolezni 0,2 %. lociti cirkulirajo v krvi in predstavljajo sekundarno viremi- Rezultati potrjujejo v literaturi navedeno ve~jo prevalenco jo. ê gostitelj ni sposoben eliminirati virusa, lahko prei- za FIV pri samcih. Tudi v naši raziskavi se je v primerjavi de v stanje latentne infekcije oziroma lahko se razvije perz- z letom 2008 prevalenca pri samcih pove~ala, pri sami- istentna viremija (4). cah pa ostaja na enaki ravni. Rezultati potrjujejo tudi V letu 2008 smo, kot prejšnja leta, vse ma~ke testirali s navedeno ve~jo prevalenco pri bolnih ma~kah. Verjetno hitrim imunokromatografskim testom za ugotavljanje FIV bi bila prevalenca FIV še višja, ~e bi virus ugotavljali s in FeLV. V letu 2009 smo testirali le ma~ke, ki kaèjo PCR metodo, ki je bolj ob~utljivejša in bolj specifi~na kot kakršnakoli klini~na znamenja bolezni. Literatura navaja, komercialni hitri testi (3, 5, 6, 7). da je prevalenca FIV in FeLV precej višja pri ma~kah, ki Pri FeLV je zanimivo, da smo ugotovili enako prevalenco kaèjo klini~ne znake, zato je ta odlo~itev smiselna. Pri pri obeh spolih glede na celotno populacijo. Razlogi za ma~kah mlajših od 6 mesecev smo testirali le FeLV. Upo- tak pojav nam niso znani. Prav tako nam niso znani ra- rabljamo Speed Duo FeLV – FIV, BVT (Virbac Group), ki zlogi za precej ni`jo prevalenco FeLV, kot jo navaja litera- je primerljiv z drugimi podobnimi testi (4). Velika pred- tura, po kateri naj bi bilo 61,1 % zunanjih ma~k pozi- nost testa je enostavno skladiš~enje in preprosta upora- tivnih. Z uporabo PCR metode bi verjetno prišli do rezul- ba. tatov, bolj podobnih študijam drugih avtorjev (3). V letu 2008 je bilo testiranih 775 prostoìve~ih ma~k (241 samcev in 447 samic). Pozitiven rezultat na FIV je bil ugotovljen pri 7,2 % ma~kah. Pri samcih je bil FIV ugotovljen v 11,8 %, pri samicah pa v 4,5 %. FeLV je bil ugotovljen pri 3,2 %, pri 1,7 % samcev in 1,5 % samic. FIV in FeLV sta bila ugotovljena pri 0.8 %, pri samcih v 0,1 % in pri samicah v 0,7 %. V letu 2009 smo testirali samo klini~no obolele ma~ke. Od skupno 1304 ma~k smo testirali le 277 (21,2 %) ma~k. Pri 50,2 % bolnih ma~kah je bil ugotovljen pozitiven rezultat. Od tega je bil pri 39,7 % bolnih ma~kah ugotovljen pozitiven rezultat na FIV. Pri 7,9 % bolnih ma~kah je bil ugotovljen pozitiven rezultat na FeLV in pri 2,6 % bolnih

LITERATRURA 1. Veterinarska zbornica. Oman M, Lindtner Knific R et al. (2010). Zbornik 6. Podiplomskega izpopolnjevanja veterinarske zbornice, 139- 44. 2. Geopedia - interaktivni spletni atlas in zemljevid Slovenije: http://www.geopedia.si 3. Tozon N, Nemec Svete A, Zemlji~ M, Zakošek M , Barli~ Magajna D, (2008). High Prevalence of feline Imunodeficiency virus (FIV) and feline leukemia virus (FeLV) in Slovenia. Acta vet. (Beogr.), 58(2-3): 191-201. 4. Greene C E, (2006), Infectous Diseases of the dog and cat, Third edition, 105-31. 5. Hartmann K, Griessmayr P, Schulz B, Greene C E, Vidyashankar A N, Jarrett O, Egberink H F (2007), Quality of different in-clinic test system for feline immunodeficiency virus and feline leukemia infections virus J Feline Med Surg. 9: 439-45. 6. Muraj J K, Roberts M A, Skillings E, Morrow L D, Gruffydd-Jones T J (2009), J Feline Med Surg. 11 (6): 467-73. 7. Lara V M, Taniwaki S A, Araujo jr. J P (2008), Occurrrence of feline immunodeficiency virus infection in cats. Ciencia Rural, Santa Maria 38 (8) 2245-49.

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113 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

114 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

115 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

116 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

117 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

118 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

119 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

120 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

121 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

122 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

123 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

124 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

125 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

126 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

127 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

128 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

129 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

130 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

131 XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI ZBORNIK REFERATOV Dolenjske Toplice, 22. - 24. april 2010

132 ZBORNIK REFERATOV XXIII. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH @IVALI Dolenjske Toplice, 22. - 24. april 2010

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