scott@vtx-cpd.com
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Replying to pippa coupe 16/08/2021 - 16:54
Thank you for your reply Pippa.
Really helpful. I hope you are safe and well.
Sx
Replying to pippa coupe 16/08/2021 - 16:54
Thank you for your reply Pippa.
Really helpful. I hope you are safe and well.
Sx
Replying to Ekaterina Stadnik 08/08/2021 - 14:19
This is a great question.
The short answer is that these parameters can very, regardless of the type of liver disease. Post prandial bile acids are normally increases in cases of cPSS, but there can be some outliers. This was highlighted in a recent paper:
https://pubmed.ncbi.nlm.nih.gov/33955592/
Postprandial SBAs are more sensitive but less specific than resting SBAs for the diagnosis of liver disease. There were dogs in all categories of liver disease with resting SBAs <10 and >90 μmol/L. Therefore, careful interpretation of both normal and elevated values is required.
Ammonia can be even more variable. It can absolutely be used as a guide for the diagnosis of cPSS and encephalopathy, but it is not absolute.
I would be suspicious your cases does have a cPSS… could you mind sharing the results with us?
We will pop up the recording of the Q&A so you can review the content.
Scott 🙂
Replying to austeja Zykute 26/07/2021 - 16:40
Hey.
Just wanted to keep you updated. I have spoken to a number of colleagues and I am still not sure that people are using the higher doses reported in this webinar. I am still waiting to hear back from the presenter of the webinar and I have bought the webinar to watch myself. I will keep you posted on it all.
Thanks again for the brilliant question.
Scott 🙂
Replying to Simon Patchett 01/08/2021 - 12:16
Yes!
Took me a minute to see it as the pathology is mainly over the heart. Once you see it, I think it is a really good example of an alveolar pattern.
It was a real shame with this dog, it did really well recovering from heat stroke and AKI, just as he was about to go home, he aspirated!!!!!!!
Sadly was PTS due to finance.
Scott
Replying to austeja Zykute 02/08/2021 - 13:19
Hey.
Really interesting. I am pleased there is a glimmer of hope here with this option. Here is the link again:
https://drive.google.com/file/d/13W_y0grU-WFICLGvq356u1Z2QAY-eGPg/view?usp=sharing
Scott 🙂
Replying to scott@vtx-cpd.com 24/07/2021 - 18:38
Hey.
Happy for you to post cases at any time.
Pop it in the forum as any other post and you can upload images here:
This will generate an image link that you can pop in the post!
Scott 🙂
Hello.
1. I have no experience of using higher doses of UDCA in this way. I have had a look and I am not able to find any references for this. Do you have any references from the lecture. I will have a chat to colleagues and have also dropped Mike an email. I will keep you posted.
2. The main issue with metronidazole and liver disease is the increased possibility of side effects. I would be careful not to use high doses, but it does not mean that metronidazole is totally off the cards. I would try and base antibiotic selection on culture as much as possible. Treatment with a broad‐spectrum antibiotic is indicated for bacterial hepatobiliary disease with coverage for Gram‐positive and Gram‐negative aerobes and anaerobes, as evidenced by the bacteriological culture results. These findings, along with the results of antimicrobial sensitivity testing, underscore the importance of this type of evaluation. While empirical coverage with either a fluoroquinolone and amoxicillin clavulanate or a fluoroquinolone, metronidazole, and a penicillin could be suggested based on the likely organisms involved, resistance remains a potential problem. Significant resistance to both amoxicillin clavulanate and fluoroquinolones among E. coli and Enterococcus spp. isolates, along with examples of changing resistance over time in isolates from individual cases, highlights that an empirical approach to antimicrobial treatment should be used with caution.
3. We will chat more regarding when to remove the gallbladder in that lesson, this decision making can be challenging. Poor resolution with medical management and continued thickening may indeed be an indication.
I hope that helps. Let me know if I can do anything else to help.
Scott 🙂
Replying to austeja Zykute 21/07/2021 - 10:40
Austeja and Lucy!
I have popped your questions in separate posts so they don’t get lost.
Hope that is OK.
Scott 🙂
Replying to Areti Tsioka 19/07/2021 - 20:18
Hey.
I honestly think I would be nervous too… but not sure there is a right or wrong answer here.
I suppose, depending on how badly controlled, you would need to give time for the potassium bromide to take effect.
Other drug considerations would be imepitoin or zonisamide. I would give the potassium bromide time in the first instance and maximise the dose of the levetiracetam in the short term to bridge the gap.
Interesting case. Let us know how things go!
Scott 🙂
Replying to Hannah B. 20/07/2021 - 20:40
Hi Hannah!
Hope you are well. Thank you for your question! It is a good one!
Let me have a chat with my surgical colleagues and I will get back to you ASAP!
Scott 🙂
Hello everyone.
This is an interesting case. Thanks for sharing the article Emma.
I totally agree that it sounds like removing the offending drug, in this case, is the most sensible first step. With almost all other haematological abnormalities I would say wait and see. My only thought here is the fact that it is platelets and there are none. I suppose the biggest issue is the high risk of really serious bleeding (brain and lungs). I honestly might be inclined to start immunosuppression (steroids) while we wait for a rebound after drug removal. Other options would be one-off vincristine or human intravenous immunoglobulin. I may be overreacting but I worry about the 0 platelets and the wait for them to normalise. This would be a case that you could then taper quickly.
Thoughts?
Scott 🙂
Replying to austeja Zykute 13/07/2021 - 06:19
Hello.
Lovely to hear from you. I hope you are enjoying the course. You are welcome to ask any questions at any time! I welcome that at any stage!
I have added some new links that should work.
Looking forward to hearing from you.
Scott 🙂
Hey.
Sorry the links did not work. Not sure why! Have posed again below. I will also email round to avoid any confusion:
https://drive.google.com/file/d/1luJw-Ts646S96zNz61q8Vg-fw8T81LJE/view?usp=sharing
https://drive.google.com/file/d/1eagajbyPpOpLIIImt_x9llnQ-DBxd4W3/view?usp=sharing
https://drive.google.com/file/d/17OIrqhk6MQkFvf_jn7SaZ9ARqA_F_kVZ/view?usp=sharingHope to see you there.
Scott 🙂
Replying to Lucy Morley 07/07/2021 - 12:50
Hey Lucy.
Lovely to hear from you. I am so glad you are enjoying the course. I know how mad things are out there at the moment, I hope you are managing to get out on the tennis course. I am certainly enjoying watching it!!!
I am really glad you are enjoying the course.
Let me know if you have any questions at any time.
Scott 🙂
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