scott@vtx-cpd.com

Replying to Felipe M. 07/10/2024 - 12:28

Hello Felipe!

What a joy to have you here.

We are very lucky to get to work with you!

Thank you for all of your hard work.

Scott 🙂

Replying to Rachel H. 06/10/2024 - 14:40

Hello!

Thank you for your excellent question! During a bile acid stimulation test, it’s crucial to offer a meal that stimulates gallbladder contraction effectively. While plain chicken can provide some stimulation, it may not be sufficient for all dogs. A meal with higher fat content generally triggers a stronger contraction, which is necessary for accurate post-prandial bile acid measurement.

You could try mixing a small amount of fat-rich food (e.g., canned food or cooked egg yolk) with the chicken to increase the fat content without making the meal too large. If dogs remain reluctant, adding a small amount of a favorite treat can encourage them to eat.

As far as I’m aware, there aren’t any specific studies in dogs that examine the impact of different food types on gallbladder contraction during BAST, so recommendations are based on clinical experience. Sometimes, you really only understand what’s happening once you have the test results!

I hope this helps clarify things! How are you finding the course so far?

Best,

Scott 🙂

Replying to Hilary J. 18/10/2024 - 14:55

Hello Hilary!

We are so lucky to have you as part of our course,

Thank you so much for your contribution.

Scott 🙂

Replying to Megan S. 16/10/2024 - 17:04

Hi Megan,

Thank you for your kind words! I’m glad you’re finding the course helpful and interesting.

To answer your question, differentiating between adrenal-dependent hyperadrenocorticism (ADH) and pituitary-dependent hyperadrenocorticism (PDH) can be important, but it’s not always essential, especially if the treatment plan may not change. Here’s a breakdown:

Clinical Importance of Differentiation:

PDH is more common (about 80-85% of cases), and medical therapy like trilostane or mitotane can effectively manage both PDH and ADH.
ADH can be more aggressive, particularly if there is a functional adrenal tumor. In these cases, surgery (adrenalectomy) may be curative. Differentiating ADH from PDH helps identify whether surgery should be considered as a more definitive option.
When to Differentiate:

If imaging or clinical signs suggest an adrenal mass, it may be worth investigating further, as adrenal tumors could require more specific management. I suppose that it is good to know if there is an adrenal mass as it may be something that needs careful monitoring with ultrasound and could even be an indication for surgical removal.
The other indication would be if there is a growing pituitary mass, which could require intervention. In cases of macroadenomas, there may be indications for radiation therapy or even surgical removal of the pituitary. This can be more of a concern if neurological signs develop or the tumor is compressing nearby structures. What are your thoughts on this?
Investigating:

Differentiation tests (such as endogenous ACTH or imaging) can sometimes give unclear results, which is frustrating.
In straightforward cases where medical therapy is working well, it may not always be necessary to push for a definitive diagnosis, especially if there’s no suspicion of an adrenal or pituitary mass.
In summary, while it’s not always necessary to differentiate between ADH and PDH when clinical signs are well controlled with medical therapy, there are situations—like with adrenal masses or growing pituitary tumors—where knowing which form is present becomes more important. Monitoring with imaging and considering interventions such as surgery or radiation might be key in such cases.

Let me know if you have any further questions!

Best regards,

Scott 🙂