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scott@vtx-cpd.com

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  • scott@vtx-cpd.com
    Keymaster
    13:25 29/07/20

    Hello.

    This is an excellent question about the gastroprotectants. It is one of my favourite topics. We definitely massively overuse these drugs. If there is no obvious signs of gastroduodenal ulceration, there is really very little indication. I might pick this up in the liver Q&A tomorrow is that is OK, I can expand a bit more there. We also have a full webinar on the topic (shameless plug):

    Gastroprotectants: Taking the acid out of the suppression

    There is also a brilliant consensus from ACVIM, which is open access:

    https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.15337

    The antibiotic question is also a great one! I am definitely more likely to start antibiotics in cats, as there seems to be more of a role of bacteria in their liver disease. I probably am ore inclined to start antibiotics in sicker patients. So yes, I would consider antibiotics if there was a neutrophilia and pyrexia. The degree of neutrophilia is not that helpful in decision making. If ultrasound was performed and there was evidence of gallbladder inflammation, I would also be more inclined to start antibiotics.

    I hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    20:32 27/07/20

    Such great discussion!

    Has this really all come down to a question of basic maths?!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    19:58 27/07/20

    Hey Mike.

    Hope you are safe and well. These are really great questions. As with everything in medicine, there is never a black and white, but I will do my best.

    Regarding the ‘everything else’… I think the following table summarises well the other main causes of increases in liver enzymes:

    Non-Hepatic-Causes

    These would be the main things that I would want to rule out if you were at the stage of just having initial blood work.

    If things had progressed to a stage where you had taken biopsies… the following is the most useful regarding decision making:

    Liver-Biopsy-Decision

    Based on this I would do the following:

    1. If there was significant inflammatory change, copper came back as a non significant quantification and culture was negative then I would treat as immune mediated.

    2. If copped was in a significant range… I would treat copper first.

    3. If there was a positive culture… I would treat that first.

    4. If the inflammation was not that significant… I would be looking again for the possible causes in the table above.

    Hope that helps. Thanks again. This is a really great question.

    Really appreciated your interaction and support.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    18:44 25/07/20

    Thank you!

    So glad you enjoyed it!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    20:31 24/07/20

    Olga,

    Thank you for your question and a massive hello to you in Estonia. We are really excited for you to be joining us from there.

    What sort of information are you getting back from the laboratory? I suppose we always have to remember the limitations of FNA’s generally. In cats the FNA would be most useful for lymphoma, hepatic lipidosis and vacuolar change.

    There is not a specialist lab for liver aspirates. The first thing I would do is call the pathologist and talk through the cytology results. It may be that the results are not helpful as the FNAs do not represent the disease process.

    I would start my calling the lab and quizzing them about the results!

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    21:21 22/07/20

    No problem.

    I really would consider in this case. Particularly with it being a Greyhound.

    I would start 24 hours before the surgery and continue 24 hours after. It can make them feel quite sick so I would make sure to give maropitant too.

    I think vitamin K would be a good shout too. Lets do all we can to help! Vitamin K (0.5-1.5mg/kg SC q12h for 3 doses). I would start this the day before.

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    20:42 22/07/20

    Thanks so much for this.

    Really interesting. I a really interested regarding the boswellia extract (boswellic acids) and bark extract (proanthocyanidins). Does it say why these are included or what the benefits are.

    I love looking at the labels and deconstructing the ingredients!

    Is that sad?! I think I need to get out more!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    20:09 22/07/20

    And one more…

    There is never such a thing as a silly question!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    15:03 21/07/20

    Sara…

    Were they saying that the alpha 2’s had a renoprotective effect? Could you ask them a bit more about it/do they have a reference. Not something I have heard before and really interesting!

    Thanks for that.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    06:57 21/07/20

    Really interesting!!!

    Is this generally, or in cases of urethral obstruction. I have not heard this but have just fired off an email to an anaesthesia specialist to find out more! I will let you know.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    06:54 21/07/20

    Keppra is a good shout!

    I often escalate like Zoe says. Diazepam/midazolam first choice with phenobarbitone next and then Keppra, then propofol?! It often feels like we are giving all at once!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    10:52 20/07/20

    Hey.

    It does seem like it was a last resort in these cases. What would you use in really refractory cases in practice?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    10:48 20/07/20

    Thanks.

    Is the diazepam and methadone alone enough to unblock some?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    10:46 20/07/20

    You may need the whole bottle by the end!

    Let me know how you get on.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    10:34 20/07/20

    HAHA!

    Agreed!

    Scott 🙂

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