وَهَجِ السِّرَاجِ جمع وترتيب بوستات د.سالم سراج

‫َو َهج الس َراج جمع وترتيب بوستات‬ ‫ثائرفيسبوكـ ـى‬
‫د‪.‬سالم سراج‬ ‫جروب فيلداوى‬

‫ سالم سراج‬.‫وهج السراج جمع وترتيب بوستات د‬
Canine Parvovirus (CPV) by Salem Serag
the most common infectious disorder of dogs worldwide
*Definition
highly contagious viral disease affects the GI tract and lymphoid tissues with high morbidity and
mortality
*ETIOLOGY/PATHOPHYSIOLOGY
- Infection occurs by fecal - oral transmission
- Incubation period ranges from 3 to 8 days (*others say – 14days )
- results in destruction of intestinal crypt epithelium – lymphocyte depletion
*Forms (2 forms)
-Intestinal form : most common – affects the GIT system
-Cardiovascular : less common – affects the heart
*Dogs in risk
1- Age predisposed : young, unvaccinated (or not fully-vaccinated) puppies between 6
weeks - 6 months of age are the most prone to parvovirus
2- Breed predisposition : some breeds are more predisposed ex. (dobermann- Rottweiler -
German shepherd – Labrador –Golden Retrievers - American pit bull terrier ) are more
susceptible than other breeds
*Disinfection
parvo is an extremely long-lasting, difficult to kill organism. It is resistant to heat, cold, and most
disinfectants
the only known effective disinfection is household bleach (‫)الكلور‬
*Signs and symptoms

1-Bloody hemorrhagic diarrhea ) ‫(اشهر االعراض‬
2-Vomiting
3-Dehydration
4-Fever
5-Depression/lethargy
6-Painful abdomen: on palpation.
7-severe weight loss
8-lowered WBC's count
9-Dehydration: characterized by prolonged SFT ( skin fold test ) - prolonged CRT (capillary
refilling time ) -sunken eyes
may progress to clinical signs of shock (poor pulse quality tachycardia, tachypnea, , cool
extremities.)
‫) جروب فيلداوى ثائرفيسبوكى‬1(

*Diagnosis
Confirmatory diagnosis
1- Fast Fecal ELISA antigen test ‫(الطريقة الوحيدة المستخدمة والموجودة في مصر اللي تقدر تاكد وجود‬
) ‫ جنية‬100 -40 ‫الفيروس سعره تجاري بين‬
disposable single used device ( Kit – Swap – Diluent – pipette )
Fecal sample taken by a swap then diluted in the diluent (mix well ) then by the pipette put 3
drops of the mix and put it on the kit 30 second the result will be +ve or –ve
2- Fecal PCR : is not routinely commercially available. )‫(مش موجود في مصر‬

Some tests but not specific tests or confirmatory tests
1- Serology : Detection of IgM antibodies) ‫( اختبارات مش مؤكدة لوجود الفيروس‬
2- Immunochemistry, latex agglutination, viral isolation, and electron microscopy
DIFFERENTIAL DIAGNOSIS
ruling out ‫ المفروض حضرتك تبدا‬Elisa test ‫(امراض تسبب اعراض مشابهه يعني لو العيادة مفيهاش‬
‫لالمراض دي او بمعنى اصح في مصر هتعالج االعراض ) االمراض من باب العلم بالشئ‬
Other diseases cause similar signs and symptoms
■ Bacterial — Campylobacter , Salmonella , Clostridium
■ Viral — coronavirus, CDV
■ Severe parasitic or protozoal infestation — Giardia , Coccidia , Cryptosporidium ,
roundworms,hookworms, whipworms
■ Foreign body or intussusception
■ Dietary indiscretion
■ Toxin ingestion
■ Metabolic diseases — hepatic, renal, hypoadrenocorticism
■ Pancreatitis
■ Central nervous system disease
Treatment
‫قبل ما اتكلم عن العالج عايز اقول نقطتين‬
‫البارفو اشهر مرض موجود في مصر ومفيش عيادة تخلو من انها يجيلها حاالت بارفو بالذات في الشتاء‬
‫لالسف ممكن سمعة عيادة تكون ممتازة او سيئة بناء على المرض دة الن نسبة الوفاة فيه عالية (عيادة دكتور فالن حلوة ده‬
) ‫عالجلي البارفو او العكس‬
‫النقطة االولى هي‬
‫ على المرض‬owner ‫ انك تعرف ال‬... ‫ ازاي‬safe side ‫ بمعنى اصح ان حضرتك تكون في ال‬Patient education
‫ واجتهادك انت كطبيب وكمان تكلفة المرض‬supportive treatment ‫ونسبة الوفاة فيه وانه مفيش عالج للمرض ولكن‬
‫النقطة الثانية‬
‫( والحالة دي من اكتر الحاالت مكلفة ومرهقة بالنسبة للعيادة( محاليل وكانيوالت‬costly ) ‫بخصوص التكلفة للعالج بتكون‬
: ‫ومنظفات وغيره ) غير مجهودك انت ك دكتور غير االدوية المهم‬
‫ الن في االخر هتيجي على دماغك انت‬owner ‫متقللش من قدرك وان انت تتغاضى عن حسابات معينة عشان التكلفة على ال‬
owner satisfaction ‫طيب انت خليك ذكي في النقطة دي بحيث انك تكسب حقك ( ال زيادة وال اقل ) وفي نفس الوقت ال‬
‫تعمل ايه بقى اغلب االدوية والمحاليل هي ادوية بشرية انت هتكتب روشتتك فيها كل االدوية اللي انت هتستخدمها والمحاليل‬
‫اللي هتستخدمها من الصيدلية هو يجيبهالك ( طبعا متكتبش مثال بالستر وال كانيوال ) الحاجات دي مش مكلفة وكمان لو كتبتها‬
‫) وفي االخر حضرتك بتحاسبه على مجهودك وصلى هللا وبارك عالج البارفو عايز حد مصحصح‬:D ‫هيقول عليك (معفن‬
‫وعنده ضمير‬
Treatment of CPV
There is no specific treatment for CPV but Supportive treatment
The goals of treatment are :-

1-correction of dehydration or shock
2-restoration of fluid and electrolyte balance
3-prevention or treatment of secondary bacterial infection,
4-aggressive supportive care while the GI tract is recovering
Treatment plan :
A- Intravenous fluid administration is the mainstay of therapy of CPV infections
B- Antibiotics for preventing the secondary bacterial infection
C- Anti – Emetics : If vomiting or nausea persists
D- Pain Medications: for relief of the abdominal pain
E- Ulcer medications
F- Corticosteroids !!!!???? (Contraindicated or can be used ??)
‫بسم هللا الرحمن الرحيم نبدا نركز وهشرح بالعربي عشان الكالم يوصل‬
Treatment plan
1- Intravenous fluid administration
-Solutions used are ‫المحاليل المستخدمة‬
(buffered crystalloid solution as lactated ringer or Normosol - R followed by fluids with glucose
as 5% dextrose ) some uses Panamin-G (as protein source )
-calculation of the fluid requirements ‫حساب جرعة المحاليل‬
Fluid requirements = maintenance requirements + dehydration deficits + ongoing losses
maintenance requirements = 60ml/kg
60 x 10 = 600 ml = ‫ اليومية‬maintenance requirements ‫ كيلو يبقى ال‬10 ‫يعني مثال لو كلب‬
Dehydration deficit = Dehydration % X body weight
‫ دي احسبها ازاي‬% Dehydration ‫طيب ال‬

Dehydration Physical findings
%
Mild (5%) Minimal loss of skin turgor, semidry mucous membranes,
normal eye
Moderate Moderate loss of skin turgor, dry mucous membranes, weak
( 8%) rapid pulses, enophthalmos
Severe loss of skin turgor -severe enophthalmos –tachycardia -
(10-12%) extremely dry mucous membranes - weak/thready pulses,
8 x 10 = 80 ml = Dehydration deficit ‫ كيلو يبقى‬10 ‫ ووزنها‬moderate ‫يعني لو حالة‬

Ongoing losses = body waste ( vomiting – diarrhea )
caliper ‫ ب حاجة زي االسفنجة كدة ويحطوه في‬vomitus ‫ مثال بياخدو ال‬vomiting ‫في اوربا والدول المتقدمة لو حصل‬
ongoing losses ‫بيحسبلهم كام مللي‬
‫ ودمتم‬fluid ‫ زود حبة‬... ‫ = الحيوان رجع او ربنا سهلهاله حبة‬Ongoing losses  ‫نرجع بقى الرض مصر‬
Fluid requirements ‫ دول يطلعولك االجمالي اليومي ل‬3 ‫تجمع بقى ال‬
‫ ال‬... ‫ محاليل هياخدهم ازاي يعني مرة واحدة مثال الصبح و خالص‬1000 ml ‫طيب نفترض طلع المفروض ياخد‬
shock ‫الحيوان المفروض يفضل ياخد الجرعة على مدار اليوم اال في حالة‬
15 : 30 minutes ‫ في خالل‬fast rate ‫ الجرعة ب‬3/1 ‫بياخد‬
300 ‫ مل في نص ساعة ازاي احسب بقى عدد النقط اللي تنزل من المحلول عشان ياخد ال‬300 ‫ لتر هاديله‬1 ‫مثال الجرعة‬
‫مللي في نص ساعة هتتحسب كالتالي‬
Requirement per minute (ml/hr) = total Requirement) ) 300 ‫ ÷ )اللي هي‬30
Requirement per second (ml/s)= Requirement per minute(ml/min) ÷ 60
Drops per second = Requirement per second (ml/s)x Giving Set Factor
3drpos / sec ‫(مكتوب على جهاز المحاليل ) بيطلع عندي كام نقطة في الثانية مثال‬
‫ نقط في الثانية‬3 ‫اظبط جهاز المحاليل لحد ما ينزل‬
shock ‫الجرعة المفروض تتاخد عل مدار اليوم وحسبتها كالتالي لو مفيش‬
Requirement per hour (ml/hr) = Requirement per day (ml/24hr) ÷ 24
Requirement per minute (ml/min) = Requirement per hour (ml/hr) ÷ 60
Requirement per second (ml/s)= Requirement per minute(ml/min) ÷ 60
Drops per second = Requirement per second (ml/s)x Giving Set Factor
‫ ساعة اللي‬12 ‫ ساعة او بمعنى اصح‬24 ‫يعني ببساطة المفروض الجرعة المحسوبة لو لتر مثال الحيوان ياخدها على مدار‬
‫العيادة هتكون فاتحة فيهم‬
treatment plan ‫ندخل بقى على باقي ال‬
2- Antibiotics for preventing the secondary bacterial infection
wide spectrum antibiotics ‫باختصار شديد‬
Ceftriaxone+metronidazole infusion (flagyl) ‫مثال انا بحب استخدم‬
Ceftriaxone dose 50-80mg/kg (full dose every 23 hrs )
Metronidazole dose 10-60mg/kg ( devided into 3 times every 8hrs )
3- Anti -emetics : If vomiting or nausea persists

primperan ‫ اللي هو‬metoclopramide ‫من اشهرها ال‬antiemetic ‫باختصار شديد أي‬
Metoclopramide dose 0.2-0.4mg/kg
phenothiazine drug (chloropromazine ) ‫االفضل منه‬
Chloropromazine dose 0.25-0.5mg/kg
4- Pain Medications: for relief of the abdominal pain

Opioid medications as ) ‫(مورفين ف مش هتستخدم‬
buprenorphine (0.01 – 0.02 mg/kg IV, IM, SQ every 6 – 8 hours), hydromorphone
(0.1 mg/kg SQ, IM, IV every 6 – 8 hours), fentanyl (3 –
Precautions/Interactions.
5-Ulcer medications
in order to reduce the pain of these acids burning on the ulcerated intestine
omeprazole ) ‫اشهرها وافضلها ( واغالها‬
zantac ‫ زي‬H2- blockers ‫يجي بعده المفضل لدى الجماهير عشان السعر‬
Omeprazole dose 0.5-1 mg/kg
Zantac 0.5- 2 mg /kg
Corticosteroids !!!!???? (Contraindicated or can be used ??)
‫ في حاالت‬contraindicated ‫ بالتالي هي‬immunosuppression ‫ انها بتعمل‬corticosteroids ‫من المعروف عن ال‬
‫ هيزيد طبعا لكل قاعدة شواذ‬bacterial & viral count ‫ عشان ال‬bacterial & viral infections ‫ال‬
sepsis (septic shock ) ‫( بالذات ال‬shock) ‫ بتستخدم هنا في حالة واحدة وهي‬corticosteroids ‫ال‬
‫طيب لية بتستخدم وازاي بتستخدم‬
‫ نتيجة‬virus or bacteria ‫ قبل ما يموت من ال‬septic shock ‫ليه عشان الحيوان هيموت من ال‬
(life saving) ‫ تحت مسمى‬textbooks ‫ وعشان كدة مكتوبة ف ال‬end organ damage
‫طيب ازاي بتتاخد‬
Single lifesaving dose of dexamethasone as early as sepsis is found to reduce the mortality
among septic shock patients
Dose of dexamethasone in septic shock 2-4mg /kg single dose

Canine and Feline Anesthesia Guidelines by Salem Serag
PRE-ANESTHETIC ROUTINE
1) PHYSICAL EXAMINATION
a) A pre-anesthetic physical examination should be performed
b) categorization of the patient should be made based upon the following guidelines:
1. Excellent - animal with no organic disease or in whom the disease is localized and is
causing no systemic disturbance.
 example - healthy 3 year old neuter.
2. Good - animal with mild systemic disturbance which may or may not be associated with the
planned procedure.
 example - mildly anemic patient - obese patient - geriatric patient.
3. Fair - animal with moderate systemic disturbance which may or may not be associated with
the planned procedure and which usually interferes with normal activity but is not
incapacitating.
 example - mitral valve insufficiency - moderate anemia.
4. Poor - animal with extreme systemic disturbances which are incapacitating and are a
constant threat to life and seriously interferes with the animal’s normal function.
 examples - uncompensated mitral valve insufficiency - severe pneumothorax.
5. Critical - animal presenting in a moribund condition - and is not expected to survive 24
hours with or without surgery. This implies that medical treatment cannot improve the
animal’s condition and that surgery is required immediately.
 Example – acute severe intra-abdominal hemorrhage.
2) PRE-ANESTHETIC MEDICATIONS & FLUIDS
a) The selection of these medications should be based on the individual needs of the patient.
Species - size - age - attitude - and health status should be factored into this decision.
The timing of the administration of the pre-anesthetic meditation is also an important
consideration.
 In general - the pre-anesthetic medications should be administered:
 30 to 45 minutes prior to the induction of anesthesia if given subcutaneously.
 15 to 20 minutes prior to the induction of anesthesia if given intramuscularly
 It would be ideal to wait until the pre-anesthetic medications have taken effect before
placing the patient’s IV catheter.
b) Pre-anesthetic fluids may be indicated for optimal patient support.
c) The timing and the length of the fluid administration should be for general peri-operative fluid
support:
 5 ml/lb/hr (10 ml/kg/hr) is the suggested starting point.
 10 ml/lb/hr (20 ml/kg/hr) is the upper limit for general fluid support.
 The individual needs of the patient may dramatically alter this fluid rate.
5 ml/lb (10 ml/kg) bolus can be useful when Bp drops and needs to be addressed more
quickly. This may be repeated once.

3) PRE-ANESTHETIC TESTING
a) Pre-anesthetic testing for detection of underlying disorders that may influence the management of
the patient or influence the prognosis associated with any given disorder
b) There is considerable debate as to the extent and timing of such testing.
c) Blood samples should be drawn prior to premeds if it is not excessively stressful to the patient as
premeds may influence the results of certain tests
1. Example – Acepromazine can decrease patient PCV up to 30%
d) If blood collection is not possible without premeds - or is too stressful -
then administer premeds - wait 15 to 20 minutes - then collect samples

SPECIFIC PRE-ANESTHETIC PROTOCOLS
1) Acepromazine (only)
General information
 A phenothiazine tranquilizer
 Acepromazine has no direct analgesic properties
 Acepromazine can be used alone - as a premedicant
 it is more effective to use Acepromazine in combination with an opioid narcotic agent.
 The addition of an opioid reduces the acepromazine dose - and therefore - also reduces
the likelihood of hypotension or sustained - excessive sedation that can occur.
Patient selection
Recommended use
 Use of acepromazine as a sole agent is not recommended
2) Acepromazine & Butorphanol
General information
 Combination of a phenothiazine tranquilizer and an opioid
 Butorphanol adds a short acting analgesic effect
 The synergistic effect of these two agents allows for a substantial reduction in the
acepromazine need - reducing the likelihood of hypotension or sustained - excessive
sedation that can occur
Patient selection
 Recommended use
 Healthy animals in the Good to Excellent category
 Larger - calmer - older patients require much lower acepromazine doses
 Smaller - stressed - younger patients may require higher acepromazine doses
 Cautionary information
 Avoid if:
(a) History of seizures
(b) Geriatric
It is generally recommended to avoid acepromazine in geriatric patients.
Substantially lower doses are adequate in patients 7 years of age or older
(c) Debilitated
(d) Liver dysfunction
(e) Anemic
(f) Hypotensive
(g) Hypovolemic
(h) Known patient sensitivity exists
 Butorphanol has an antagonistic effect when used with mu agonist opioids such as
morphine - hydromorphone - fentanyl - or oxymorphone
Dosage
 Dog
 Acepromazine 0.005 to 0.060 mg/kg (0.0025 to 0.03 mg/lb)

2.0 to 3.0 mg are frequently recommended maximum total dosages regardless of weight
 Butorphanol 0.1 to 0.4 mg/kg (0.05 to 0.2 mg/lb)
(a) 0.1 mg/lb is usually adequate for most patients
(b) Higher dosages do not result in better analgesia and excitation can occur.
 Cat
0.1 mg/lb is usually adequate for most patients
 Route of administration
 IV/IM/SC use
(a) IV has a more rapid and profound effect
Use the lower end of the dose range for both agents when administering this
combination IV
(b) IM has a moderately rapid - moderately profound effect but is painful
(c) SC is less painful though the effect is slower and less profound
General Cost Category
Moderate - acepromazine is inexpensive but butorphanol is of moderate expensive especially for
larger dogs
3) Acepromazine & an Opioid (Hydromorphone - Oxymorphone - Morphine -
Fentanyl)
General information
 Combination of phenothiazine tranquilizer and a reversible opioid agonist
 Compared to acepromazine & butorphanol - this combination provides has greater sedation in
dogs and a stronger analgesic influence of longer duration in both dogs and cats
 Less sedative synergism exists between acepromazine and hydromorphone in dogs when
compared to the sedative synergism that exists between acepromazine and morphine in dogs
 Medetomidine may produce more consistent sedation and relaxation than acepromazine when
combined with the mu opioids in cats
Patient selection
 Recommended use
 Generally for healthy animals in the Good to Excellent category
 Larger - calmer - older patients may require much lower acepromazine doses
 Smaller - stressed - younger patients may require higher acepromazine doses
 Cautionary Information
 All mu agonists can cause bradycardia and respiratory depression
 Morphine and hydromorphone commonly cause vomition regardless of route
Oxymorphone is less likely to cause vomition regardless of route
 Histamine release: morphine can cause a histamine release which may cause a transient
hypotensive effect
This is more likely with IV use and is unlikely when morphine is given IM or SC
 Avoid acepromazine if:
(a) History of seizures

Some anesthesiologists feel that seizures are of minimal concern at usual clinical
acepromazine doses
(b) Geriatric
It is generally recommended that acepromazine be avoided in geriatric patients.
When used in older patients - substantially lower doses may be adequate
(c) Debilitated
(d) Liver dysfunction
(e) Anemic
(f) Hypotensive
(g) Hypovolemic
(h) Known patient sensitivity exists
Dosage
 Dog
2.0 to 3.0 mg are frequently recommended maximum total dosages regardless of weight
 One of the following opioids:
(a) Hydromorphone 0.10 to 0.20 mg/kg (0.05 to 0.10 mg/lb)
(b) Oxymorphone 0.05 to 0.10 mg/kg (0.025 to 0.05 mg/lb)
(c) Morphine 0.50 to 1.0 mg/kg (0.25 to 0.50 mg/lb)
(d) Fentanyl 0.005 to 0.010 mg/kg (0.0025 to 0.005 mg/lb)
 Cat
Most common dose is 0.06 to 0.10 mg/kg (0.03 to 0.05 mg/lb) for cats
The lower end of the opioid dose range is usually adequate for cats
 Routes of administration
 IV/IM/SC use
 IV has a very rapid and profound effect
Use the lower end of the dose range for both agents when administering this
combination IV
 IM has a moderately rapid - moderately profound effect but is painful
 SC somewhat less painful and somewhat slower - less profound effect
Low
4) Buprenorphine (only)
General information
 Mixed agonist/antagonist opioid of moderately long duration depending on dose
 Dose has significant influence on duration of effect but no influence on degree of analgesia
 There is a significantly delayed time of onset
 30 minutes when given IV
 45 to 60 minutes when given IM
 SC use is not recommended
Patient selection
 Recommended use
 Aging or debilitated patients where an analgesic effect is desired but sedation is not
 Routine surgeries and procedures that are not associated with severe pain
 Extremely high affinity makes this opioid difficult to reverse
Dosage
 Dogs 0.010 to 0.040 mg/kg (0.005 – 0.020 mg/lb)
 Cats 0.010 to 0.040 mg/kg (0.005 – 0.020 mg/lb)
 The dose influences the duration of effect but not the degree of analgesia
 0.010 mg/kg 4 to 6 hour duration
 0.020 mg/kg 6 to 8 hour duration
 0.030 to 0.040 mg/kg 10 to 12 hour duration
 IV or IM
 SC use is not recommended
Moderate to high depending on dose
5) Butorphanol (only)
General Description
 Mixed agonist/antagonist opioid with short duration and very mild sedative effects
Patient selection
 Recommended use
 In patients where:
(a) Acepromazine use is a concern
(b) Some analgesia and mild sedation is desired
(c) A mu agonist is not necessary or is of a concern
 The duration of analgesic effect is very short
(a) 45 to 60 minutes in the dog
(b) 60 to 90 minutes in the cat
 Will antagonize mu agonists if given concurrently
Dosage
 Dog 0.10 to 0.40 mg/kg (0.05 to 0.2 mg/lb)
 Cat 0.10 to 0.40 mg/kg (0.05 to 0.2 mg/lb)
 Increased dosages are NOT associated with an increase in analgesia
 Doses exceeding 0.4 mg/kg (0.2 mg/lb) can cause undesirable excitatory effects

 IV – IM – or SC
Moderate
6) Hydromorphone (only)
General information
Mu opioid agonist of moderate duration
Patient selection
 Recommended use
 Higher risk patients
 See ace/opioid combinations above
 Histamine release is not expected with hydromorphone
 Cat usually experience excitatory effects when given mu agonists alone
Dosage
 Dogs 0.10 to 0.20 mg/kg (0.05 to 0.10 mg/lb)
 Cats not recommended as a sole agent
 IV - IM - or SC
Low
7) Medetomidine ( Same family of xylazine )
General Description
 Alpha-2 agonist
 Medetomidine can be used alone - however it is often combined with an opioid for a
synergistic effect.
 Addition of an opioid allows a reduction of the Medetomidine dose and reduces the
negative cardiovascular effects that alpha-2 agonists can cause
 reduces induction agent need
 Potent sedative and analgesic
 Effects can be completely reversed using atipamazole ‫ ( في فرق في االستخدام مع ال‬yohimbine
Patient selection
 Recommended use
 Normal - young - healthy patients in the excellent category
 Use of medetomidine in older or more debilitated patients requires significant reductions
in dosage and more vigilant attention the patient’s cardiovascular status
 Stressed patients may not respond as well
(a) Isolate in quiet - dark room if possible to facilitate effect
(b) Additional medetomidine may be given after 20 minutes if further sedation is
required
 Can cause bradycardia

 Anticholinergic use is controversial
Dosage
Doses above 0.020 mg/kg (0.010 mg/lb) should be used with careful attention to patient
selection
 Cats 0.002 to 0.040 mg/kg (0.001 to 0.020 mg/lb)
selection
 IV/IM use
(a) IV has a much more rapid and profound effect
Use lower doses - approximately 50% of the dose you would consider giving IM
(b) The epaxial muscles are the preferred site of injection for more predictable drug
absorption
Needles of appropriate length to penetrate through subcutaneous fat and into muscle
must be selected. Larger dogs will commonly require a 1½” needle
High – especially if reversal agent - atipamazole - is used
8) Medetomidine & Butorphanol
General Description
 An alpha-2 agonist and opioid agent
 The synergistc effect of these two agents allows for a substantial reduction in the
medetomidine dosage - thereby reducing the likelihood of the more dramatic negative
cardiovascular effects that alpha-2 agonists can cause
 Substantially reduces induction agent need
 Potent sedative and analgesic effects
 Effects can be substantially reversed using atipamazole
 The more complete the sedation reversal - the more complete the reversal of the analgesic
effects
 Partially reversing the medetomidine may allow you to retain some of the analgesic
benefit of the drug
 Provides good relaxation and analgesia when used in young - healthy cats
Patient selection
 Recommended use:
required

 Anticholinergic use is controversial
Dosage
 Dogs
 Medetomidine 0.002 to 0.040 mg/kg (0.001 to 0.020 mg/lb)
selection
 Cats
 Same as the dogs
 IV/IM use
absorption
9) Medetomidine & an Opioid (Hydromorphone - Oxymorphone - Morphine - or
Fentanyl)
General Description
 An alpha-2 agonist and a mu opioid agonist
 The synergistc effect of these two agents allows for a substantial reduction in the
medetomidine dosage thereby reducing the likelihood of the more dramatic negative
cardiovascular effects that alpha-2 agonists can cause
 reduces induction agent need
 Potent sedative and analgesic effects
 Effects can be completely reversed using atipamazole and naloxone
Patient selection
 Recommended use:
required
 Bradycardia may be more profound than with medetomidine alone
 While the use of anticholinergic is still controversial - the addition of the opioid often
justifies the use of anticholinergics.
Dosage
 Dogs
 Medetomidine 0.002 to 0.040 mg/kg (0.001 to 0.020 mg/lb)
selection
 Cats
Same as the dogs
Use the lower end of the opioid dose range above
 IV/IM use
absorption
10) Midazolam (only) ‫بيستخدم في الفيلد‬
General Description
 Benzodiazepine (as is diazepam)
 Unlike diazepam - midazolam is quickly and predictably absorbed when given by the IM
route.
 Of little use as a sole agent due to minimal sedation in normal healthy adult patients
 Generally combined with an opioid or ketamine
Patient selection
 Recommended use
 Can reduce induction agent need in dogs
 When used alone may cause nervousness and excitement in cats
Dosage
 Cats not recommended
 Used alone - can cause nervousness and excitement in cats
 IV or IM use
General Cost Category Moderate

11) Midazolam & Butorphanol
General information
A benzodiazepine and an opioid agent
Patient selection
 Recommended use
 Higher risk patients:
(a) Cardiac disease
(b) Debilitation
 Generally not suitable if heavy sedation is desired
Dosage
 Dogs
 Midazolam 0.10 to 0.20 mg/kg (0.05 to 0.10 mg/lb)
 Cats
 Same as the dogs
 IV or IM use
General Cost Category : Moderate
12) Midazolam & an Opioid (Hydromorphone - Oxymorphone - Morphine - or
Fentanyl)
General Description
A benzodiazepine and an mu opioid agonist
Patient selection
 Recommended use
 Higher risk patients:
(a) Cardiac disease
(b) Debilitation
 Generally not suitable if heavy sedation is desired
 Can cause bradycardia and respiratory depression due to the opioid
 Use mu agonists with caution if vomition is considered a significant risk
Dosage
 Dogs
 Midazolam 0.10 to 0.20 mg/kg (0.05 to 0.10 mg/lb)
 One of the following opioids

 Cats
Same as the dogs Use the lower end of the opioid dose range above
 IV or IM use
13) Morphine (only)
General Description
A pure mu opioid agonist
Patient selection
 Recommended use
 Suitable for healthy animals
Most commonly used in combination with acepromazine - an alpha-2 agonist - or a
benzodiazepine sedative/tranquilizer
 When greater sedation than can be achieved with hydromorphone or oxymorphone is
desired
 Histamine release: morphine can cause a histamine release which may cause a transient
hypotensive effect
This is more likely with IV use and is unlikely when morphine is given IM or SC
 Often causes vomiting and defecation when given IM or SC
 Higher dosages can cause bradycardia and respiratory depression
 Should be used with caution in the cat if no sedative/tranquilizer is used
Dosage
 Cat not recommended except as a low dose CRI
 Should be combined with acepromazine to avoid hypersensitivity
 IV/IM/SC use
IV injections should be given slowly to minimize the potential for a histamine mediated
hypotensive effect
General Cost Category: Low
14) Oxymorphone (only)
General Description
A pure Mu opioid agonist
Patient selection
 Recommended use
 Similar to the other the other mu agonists
 Higher risk patient when the risk of vomiting needs to be minimized
 Hypotensive patients
 Similar to the other the other mu agonists
Histamine release is not expected with oxymorphone
 Noise hypersensitivity may be a problem
Dosage
 Cats 0.025 to 0.10 mg/kg (0.0125 to 0.05 mg/lb)
 IV/IM/SC use
15) Xylazine ‫االكثر استخداما في مصر‬
General Description
i) reduces induction agent need
ii) Potent sedative and analgesic also have muscle relaxation effect
iii) Effects can be completely reversed using atipamazole ‫ ( في فرق في االستخدام مع ال‬yohimbine
Patient selection
Recommended use
Normal - young - healthy patients in the excellent category
Cautionary information
Use of xylazine can make cardiovascular and respiratory depression
Side effects
Vomiting – hypoglycemia ( caution ‫ ساعات‬6 ‫) في السن الصغير ياكل قبل العملية ب‬
Diuresis - GIT motility depression – platlet aggregation
Indications
Diagnostic procedures – catheterization – radiographing minor ortho procedures as splints
and casting - minor surgeries as neoplasms removal and suturing of wounds
Doses
For sedation or premedication. Onset 5– 15 min; duration up to 60 min (dose- dependent). Dose
(dogs and cats) 1– 3 mg/kg IM.
● In combination with any opioid to improve the reliability of sedation/premedication.

Use lower doses of xylazine with
e.g. pethidine (3.5 – 5 mg/kg, but up to 10 mg/kg if necessary in cats)
morphine (0.1 – 0.2 mg/kg, but up to 0.5 mg/kg if necessary in dogs)
methadone (0.25 mg/kg)
buprenorphine (0.01– 0.02 mg/kg)
butorphanol (0.1– 0.5 mg/kg).
● In combination with (an opioid and) ketamine for anaesthesia.

Dose:
dogs, xylazine 1 mg/kg (lower doses in larger animals) followed 10 min later by ketamine c.10+ mg/kg
IM;
cats xylazine1 mg/kg administered alongside ketamine c.10+ mg/kg IM.
Antagonism
One of the advantages of the use of 2 agonists is the potential for their specific
antagonism (reversal) idazoxan, yohimbine ( antisedan ‫) اسم التجاري في مصر‬
Atipamezole

Cesarean Section = Hysterotomy by Salem Serag
**This operation is performed on an emergency basis.
Indications (When to perform C – Section?) If:-

1- The puppies are not deliverable
(Large puppy size (puppy skull is larger than the mother's pelvic canal) – small pelvic size -pelvic
shape - pup in a bad position)
2- Uterine Inertia (absence of uterine contractions )
Black- red or green discharge means the placenta has detached or there is fetal discharge (both can
indicate UI).
3- Prolonged labor or signs of dystocia
 Strong abdominal contractions for greater than 30 minutes with no production of a fetus
 Weak straining for greater than two hours
 More than four hours between puppies
 Retained pup at the vulva
 Lochia (green/black discharge from vulva) present for 3 hours with no delivery of pup
 Copious clear discharge
 Bloody discharge
4- Prolonged gestation greater than 68 days

5- Past history of needing a C-section
6- Fetal putrefaction
C- Section is More common (predisposed ) in

- toy dogs ( Small breeds like chi-Wawa
- brachycephalic breed ( flat wide skull like bulldog – Boxer
Preoperative Tests
CBC – Chemistry profile
**C-section should never be performed BEFORE the dam is overdue date it is best to wait till labor starts
or the temperature drops below 37 C and stays down
Anesthesia protocols
Pre medications.
Pre-anesthetic Medications
(1) Acepromazine
(a) Avoid if hypotensive
(b) Stay at the low end of the dose range

(2) Mu agonist
Hydromorphone, oxymorphone, morphine, fentanyl
Doses
Dose (mg/kg) Routes
Acepromazine 0.060 IM, SC, IV
Oxymorphone 0.090 IM, SC, IV
Xylazine 0.33 IM, SC
diazepam 0.25 IV
Induction
Propofol is now the best anesthetic for a C-section
induction dose for propofol is 6 to 8 mg/kg IV in dogs that have not been premedicated;
premedication may reduce this induction dose by ( 2 to 5 mg/kg IV) over 30 to 90
seconds followed by lidocaine 1 mg/lb IV if needed ( to deepen anesthetic )
Preanesthetic Propofol Induction Dose Propofol Rate of Administration

mg/kg Sec./ mg/kg/min mL/kg/min
None 5.5 40 - 60 5.5 - 8.3 0.55 - 0.83
Acepromazine 3.7 30 - 50 4.4 - 7.4 0.44 - 0.74
Acepromazine / 2.6 30 - 50 3.1 - 5.2 0.31 - 0.52
Oxymorphone
Maintenance
 ‫ اللي معندوش ينزل على تحت‬inhalation anesthesia ‫الجزء ده للي عندة جهاز‬
Best maintenance by inhalation anesthsea BY Isoflurane/Sevofluran)
1) SEVOFLURAN
General Description
1) Its extremely low solubility provided for the quickest inductions - level adjustments - and
recoveries of the currently used inhalant anesthetics
2) MAC
 Dog – 2.1 to 2.4%
 Cats – 2.6%
Patient selection
3) Recommended use
 This anesthetic agent is suitable for use with most veterinary patients
 With the exception of patients experiencing extreme respiratory compromise
sevoflurane is rarely of any advantage over isoflurane any other inhalant agent
Dosage
4) Routine use
 Completing induction following injectable agent
(i) Initiate flow rates of 1.0 to 1.5 liter per minute at 5 % - 7.0 %

1. Reduce percentage as indicated by patients response
 Maintenance
Once stable - reduce oxygen flow to 500 ml or 1 liter per minute
1. The reservoir bag must remain full
2. If not - the flow rate must be increased and the machine must be examined
for leaks at the earliest possible convenience
3. A 0.002 mg/kg fentanyl bolus IV at initiation of surgery may help to
stabilize a patient that is on the light side
4. Effective analgesic & sedative premedicants will significantly reduce the
level of inhalant agent necessary for maintenance of a surgical plane of
anesthesia
2) ISOFLURANE
a) General Description
i) A volatile liquid of low solubility that is minimally metabolized by the liver
b) Dosage
i) Routine use
1) Completing induction following injectable agent
 Initiate flow rates of 1 to 1.5 liter per minute at 3.5 % - 5.0 %
(i) Reduce vaporizer setting as indicated by patients response
2) Maintenance
 Once stable - reduce oxygen flow to 500 ml or 1 liter per minute
(i) The reservoir bag must remain full
) inhalation anesthesia ‫ايوه هنا ( اللي معندوش‬
Propofol can be used as a sole maintenance agent Propofol do not have a cumulative effect via :-
Constant Rate Infusion ( CRI ) OR repeat boluses
PROPOFOL
c) General Description
i) A phenol in a hyperlipid emulsion
d) Patient selection
i) Recommended use
1) Canine cases when:
 Tracheal intubation is not possible
 An anesthetic machine cannot be used
 Isoflurane/Sevoflurane is not well tolerated
2) Appropriate for sighthounds ( Dog breed with very low fat % )
ii) Cautionary Notes
Once opened - contents should be used within 6 - 8 hours
1) Feline patients do not clear phenols well
 boluses or ongoing CRI doses should be adjusted downward over time
 Recovery will be more prolonged than with dogs
e) Dosage
maintenance

1) Dogs
 Boluses of ¼ to 1/3 of the original induction dose as needed
 CRI at 0.2 to 0.4 mg/kg/minute
(i) If too light - give 0.5 to 1.0 mg/kg) IV then increase CRI rate by 25%
(ii) If too deep - stop propofol until suitable anesthetic level is reached - then
reinitiate CRI at 25% lower rate
Cats -Boluses of ¼ to 1/3 of the original induction dose as needed
-CRI at 0.2 mg/kg/minute
(iii) If too light - give 0.5 mg/kg IV then increase CRI rate by 25%
(iv) If too deep - stop propofol until suitable anesthetic level is reached - then
reinitiate CRI at 25% lower rate
(v) Feline patients do not clear phenols well
Preanesthetic zPropofol Maintenance Rate of Administration
Dose seconds mg/kg/min mL/kg/min
mg/kg
None 2.2 10 - 30 4.4 - 13.2 0.44 - 1.32
Acepromazine 1.6 10 - 30 3.2 - 9.6 0.32 - 0.96
Acepromazine / 1.8 10 - 30 3.6 - 10.8 0.36 - 1.08
Oxymorphone
Preparation of the Dam to the surgery

 IVcatheter placement in cephalic vein
(how to !? click here
 Shaving the dam prior to induction
 Maternal oxygenation for 10 to 15 minutes before anesthesia induction (if possible )
Many dams in distress are dehydrated SO :
- IV Fluids ( 5-20 ml/kg) of isotonic solution
- Followed by surgical rate of fluid administration (10 ml/kg/hr )IV injection
* of a short-acting corticosteroid such as methylprednisolone (Solicortive )2 to 8 hours before
surgery stimulates progesterone decrease prevents shock development and stimulates surfactant
production in neonates
Opreation steps
1- Administering the anesthetic !!!
 Before making the incision injecting small boluses of 2% lidocaine along the ventral midline
from cranial to the umbilicus to cranial to the pubis
 lidocaine local anesthetic can be used after the surgery, but before complete closure of the
abdominal incision (after the linea alba has been apposed

2- Opening the abdomen ( Skin – s/c – Linea alba – peritoneum )
 ventral midline incision from around the umbilicus to the cranial part of the pelvis
 Incise the linea alba take care not to incise the underlying organs
 Continue the incision with blunt-tip scissors
3- Exteriorizing the uterus
 Manipulate the uterus gently and apply 0.5 -2ml of lidocaine to the ovarian suspensory ligaments
(reduces postoperative pain)
 Locate andexteriorize tips of uterine horns
4- Opening the uterus

 Identify the individual fetuses and their placentas
 Incise the uterine horns at the level of the great curvature between 2 placentas (blue
arrows) where the vasculature is minimal
 extend the incision using blunt scissors (B) to prevent injury to the puppies.

5- Delivering the puppies

 grasp theclosest one either by the head or by the hindlegs
 Open the fetal envelope with fingers (A & B) or scissors
 Exteriorize the puppy it is still connected to the uterus and oxygenated by the placenta through
the umbilical cord.
 Wipe the nasal area. Using 2 mosquito clamps close the umbilical cord distal to the abdominal
wall and then cut between the 2 clamps (D).
6-Removing the placentas

 Once all fetuses have been delivered, the placentas are classically extracted.
 To separate a placenta, grasp the mosquito forceps still in place on the maternal side of the
umbilical cord and gently pull the placenta to separate it from the uterus

7-Closing uterus and abdomen
 Close the uterine incisions using a continuous inverted pattern (A) (Cushing or Lambert),
with a 3-0 or 4-0 absorbable material (PDS, Vicryl; Ethicon ) on a taper-point needle
 The suture should pass through the myometrium and submucosa, but should not be
visible in the lumen of the uterus ( 2 Layers )
 inject oxytocin, 1 to 5 IU IV per dog.
 Check uterine contractility and incision sites for possible leakage If the uterine sutures
are leaking a second tight continuous inverted pattern suture can be placed on top of the
previous one If a Cushing pattern has been used first, the second suture should be a
Lambert pattern and vice versa
 Wash the uterus with physiologic saline
 the skin incision should be closed using an intradermal continuous pattern with 3-0 or 4-0
absorbable material other kind of skin suture (staples, interrupted stitches) can be
susceptible to sucking by puppies which can be a source of postoperative complications
(dehiscence or infection).
.

Casteration By Salem Serag
Casteration = Neutering =Gonadectomy (Male) = bilateral orchiectomy

Definition
Removal of both testes and the associated epididymis
Indications
- Breeding control
- Behavioural problems Control : - aggression - straying to track down bitches mark their
territory with a very pungent spray and urination
- Medical Reasons : it prevents testicular tumours - prostate disease - perineal hernias
and anal adenomas Cryptorchidism (is when one or both testicles fail to descend into
the scrotum) cryptorchoid testicles that remain in the abdomen are more prone to
cancer or torsion (twisting and cutting off blood supply).
If the testes did not descend by 6 months of age  it should be castrated
- The Owner will
Best age for castration : This is not based in science but most of the vets suggest between 6
and 9 months of age but also in early neutering with current anesthetic agents dogs can safely
undergo gonadectomy when as young as 6 to 8 weeks of age
Advantages
Behavioral advantages : Decreased Aggression Roaming Fighting spraying and urinating
Medical advantages: No Testicular Tumors -Fewer Hernias - Fewer Perianal Tumors- Fewer
Perianal Tumors
Disadvantages
Weight gain (obesity )
Behavioral changes less energetic
Anesthetic risks There are risks of complications with any surgery.
Wound complications by excessive licking of the wound and can result in soreness
Hair coat changes

When the owner asks about Vet (your) opinion :-
Clarify the advantages and dis for the owner and leave dog castration decision to the owner
choice unless it is for a medical cause like cryptorchidism
Preoperative testing
blood tests as CBC and Chemistry profile for evaluating the general health condition
Anesthesia protocol
Premedication: Xylazine
Doses : For sedation or premedication. Onset 5– 15 min; duration up to 60 min (dose-
dependent). Dose (dogs and cats) 1– 3 mg/kg IM.
Induction & Maintenance
Propofol
Induction Doses
6-8mg/kg IV for un-premedicated over 30-90 sec.
2-5mg/kg IV for Premedicated over 30-90 sec.
Maintenance Doses
maintenance
1) Dogs
 CRI at 0.2 to 0.4 mg/kg/minute
2) Cats
 CRI at 0.2 mg/kg/minute
Also Xylazine + ketamine combination can be used

Other Protocols
For Dogs
For Cats
Operation Steps
At first casteration is performed by two techniques (Open and closed) the difference will be
discussed in the steps below
1- Skin incision
Make a skin incision in front of the scrotum by scalpel blade

Others may suggest incsising over the scrotum to prevent penis and urethra injury
2- Exteriorize one of the testicles
In closed method :
just Clamp the spermatic cord by artery forceps ligate the spermatic cord and blood vessels
together by monofilament absorbable suture material as PDS size 3-0
Then cut above the ligation ( toward the testis )
This method is not preferable and bleeding is a common complication of it
In open castration method :
Make cut through the tunics if the testis till the tunica vaginalis and the testicular tissue
appears
-Separate the vascular part (blood supply ) form the Avascular part (vas deferens ) of the
spermatic cord
Others may separate into 3 parts ( vas deferens – cremastric ms. – pumpiniform plexus )
Ligate each of the parts separately by monofilament absorbable suture material as PDS size 3-0
Over ligate them both (together) with another tie ( optional but helpful )
Then cut above the ligation ( toward the testis )and remove the testis

3- Repeat these steps with the other testis

4- Subcutaneous Closure
Once both testes are removed and it is confirmed suture the s/c with inverted cruciate suture
using 2-0 monofilament absorbable suture material as PDS
inverted cruciate suture pattern video ( click here ) https://goo.gl/UtqtpW
5- skin closure
The skin layer is closed with a buried subcuticular or horizontal intradermal pattern, using 2-0
or 3-0 monofilament absorbable suture material
Tissue glue may be used if available
Full Operation Video ( click here )  https://goo.gl/VpNjzr

Canine Distemper by Salem Serag
Canine Distemper (CDV) = Hard Pad Disease

Canine distemper (Paramyxoviridae - Morbillivirus ) is a contagious and serious viral illness It
affect a wide range of organs skin-brain-eyes-intestinal and respiratory tracts
Dogs at risk
Dogs of any age can be affected but the most are puppies less than 6 months of age.
(unvaccinated puppies)
Transmission through
- the air through coughing by infected
- the body secretions such as urine
Pathogenesis
At first the virus attacks tonsils & lymph nodes and replicates then the respiratory &
urogenital &gastrointestinal & nervous systems.
Symptoms
initial stages :
 Fever
 Eye discharges and redness
 loss of appetite.
 Lethargy
GIT and respiratory
 Nasal discharge ( watery )
 Coughing
 diarrhea
 vomiting
Other systems involved
Skin : enlargement or thickening of the footpads ( hard-pad-disease ) - dermatitis
CNS : seizures, paralysis, and attacks of hysteria. Meningitis myoclonus (involuntary

muscle twitching).
Dental involvement : Enamel hypoplasia
Conjunctivitis, rhinitis, and facial dermatitis CDV Pad Hardness
Enamel Hypoplasia Nasal Discharge and Ocular discharge
Diagnosis
1- Clinical signs of systemic illness consistent with distemper can lead to a presumptive
diagnosis in puppies 3 to 6 months of age.
2- blood smear examination Reveals : intracellular distemper inclusion bodies ( highly
diagnostic )
Intra cellular within the cytoplasm of a neutrophil (at the 2 o ’ clock position)

3- Fast Fecal ELISA antigen
As the Canine parvo in post 1
Treatment
there is no cure for canine distemper mainly symptomatic and supportive therapy
One of the most long-term treatment diseases It takes much time for recovery
Treatment Goals
 to limit bacterial invasion
 support fluid balance
 control nervous system problems
*** Dogs with advanced CNS signs( signs are severe or continue to worsen) have a poor
prognosis for recovery recommendation for euthanasia may be justified
WITH ALL CONTROVERSAL OPENIONS RESPECT
Drugs I use in treating CDV

1- ORS (Oral Rehydration Therapy) & Normal Saline – Ringer L Solutions in case of
dehydration ( Dose calculations as in post 1 )
2- Antibiotics like Gentamycin Amoxicillin Erythromycin Cefatoxime
Give with their prophylactic doses to prevent secondary infections as pneumonia unless
systemic infection involved
as in amoxicillin dose range from 10-25mg/kg we use the dose of 10mg/kg
3- Anti emetic drugs like prempran to stop vomiting Metoclopramide dose 0.2-0.4mg/kg
4- Cough suppressors in case of cough as Dextromethorphan ( Brochocalm) 0.5-2mg/kg
5- Anti diarrhoeal drugs as Flagyl Metronidazole dose 10-60mg/kg
6- Anti inflammatory drugs like Dexamethasone in case of sever progressive forms of
neurologic signs
7- Vitamin B, vitamin C, protein hydrolysate are to be given to restore vitality
8- Deworning and ectoparasite drugs in case if the dog suffers from ectoparasite or
endoparasite
as ( Dorontal plus – Univerm – Praferan ) & ( Frontline – Revolution – Bars )
9- Anticonvulsants as Chlorazepate=Tranexene ‫موجود ومش غالي‬

Feline Panleukopenia by Salem Serag
Feline Panleukopenia=feline distemper=feline Parvo=feline infectious enteritis

Feline Panleukopenia ( FPV )
it is a highly contagious and life-threatening disease feline parvovirus is related to the canine
parvovirus ( Parvoviridae ) the feline parvovirus is not communicable to dogs or vice versa
Transmission through
Cats are infected Oro-nasally by exposure to infected animals (feces-secretions-contaminated
fomites)
Symptoms
 Most infections of the kittens ( young cats ) are subclinical and so Acute ill with no
warnings is what you get
Common signs and symptoms are

 fever
 Anemia
 Vomiting
 Depression
 Weight loss
 Dehydration
 Abdominal pain
 Rough hair coat
 cerebellar hypoplasia
 Complete loss of interest in food
 Chin resting on floor for long periods
 Feet tucked under body for long periods
 Some cats may hide themselves for a day or 2
 Hanging head over water bowl or food dish but does not drink or eat
 Diarrhea/bloody diarrhea: uncommon and usually occurs in the later stages of infection
 Neurological symptoms in those cats in which virus attacks brain (lack of coordination)
 Fading kitten syndrome
 Acute gastrointestinal toxicity (salmonellosis)
 Intussusception
 Septicemia
Diagnosis
A presumptive diagnosis is usually based on clinical signs in un vaccinated cats and the
presence of leukopenia (nadir 50–3,000 WBC/μL)
1-Fecal Elisa Antigen test
Fecal ELISA test kit made for parvovirus in dogs can be used for cats for pankeukopenia. This
test detects parvovirus in stool and is considered by some veterinarians to be accurate
2- Complete Blood Count

■ Severely affected kittens may have total WBC's between 50 and 3000 cells/ μ L.
■ Less severely affected cats may have counts between 3000 and 7000 cells/ μ L.
■ Cats that recover from acute FPV infection will manifest rebound leukocytosis with
white blood cell counts exceeding 30,000 cells/ μ L.
■ Anemia and thrombocytopenia are less common; variable laboratory findings.
3- Histopathology
 remains the confirmatory diagnostic test of choice for FPL.

Treatment
Goals of Treatment
-Affected cats will require immediate live saving treatment
-The major goal is to restore body fluid levels and electrolyte balance.
Treatment & medications
1-The treatment for panleukopenia is basically supportive fluids are given to correct the
dehydration but notice here the electrolyte imbalance should be corrected as hypokalemia
also hypoglycemia ( Dose calculation See post 1 )
2-Medications would be given to counter the other symptoms :
 prophylactic antibiotics for secondary infection control as Ceftriaxone+metronidazole
- Ceftriaxone dose 25-50mg/kg
- Metronidazole dose 10-60mg/kg
 Anti-Emetics to stop vomiting it provide some relief for earlier enteral feeding as
prempran
-Metoclopramide dose 0.2-0.4mg/kg
 B vitamins should be added to the infusion with 5% glucose if hypoglycemia is
suspected or proved
 Anti-diarrheal drugs ( Metronidazole has antidiarrheal effect )
 Antipyretics if persistent fever

Most Common Zoonotic Diseases by Salem Serag
Most Common Zoonotic Diseases are :

 Viral diseases : Rabies
 Fungal disease : Ringworm
 Skin parasites : Sarcoptic mange
 Bacterial Diseases : Salmonella - Bartonella
 Protozoans : Giardia lambilia – Cryptospordium – Toxoplasma
 Worms : Hock worms – Round worms – Tape worms – Heart worm
# Rabies Virus
it is an enveloped neurotropic (CNS )virus (Lyssavirus genus - Rhabdoviridae )
Transmission :
- Main transmission through: the bite and virus-containing saliva of an infected animal
- Rare as contamination of mucous membranes ( eyes- nose- mouth) -aerosol
transmission- corneal and organ transplantations.
Incubation period
3 to 8 weeks in dogs, 2 to 6 weeks in cats, and 3 to 6 weeks in people
Phases & Symptoms
After the virus reaches the brain the animal will show one, two, or all of the three different
phases.
Prodromal phase
- lasts for 2-3 days in dogs
- Apprehension-nervousness- anxiety and a fever may be noted.
- animals may become shy or irritable – docile
- lasts for only 1-2 days In cats
- usually develop more fever spikes and erratic behavior than dogs.
Furious phase
- in cats this phase is more common
- in dogs usually lasts for 1 to 7 days

- Signs are ( restless and irritable and are hyperresponsive to auditory and visual stimuli
begin to roam and become more irritable and vicious and start to bite and attack
- Animals become disoriented and then have seizures and die.
Paralytic (dumb) phase
The paralytic phase usually develops within 2 to 4 days after the
first signs are noted .Signs are:
- salivation as a result of their inability to swallow
- Deep labored breathing and a dropped jaw
- Animals may make a choking sound
- The animal become weaker and eventually go
into respiratory failure and die.
List of signs and symptoms in Animals
Pica
Fever
Seizures
Paralysis
Hydrophobia
Jaw is dropped
Inability to swallow
Excessive excitability
Change in tone of bark
Muscular lack of coordination
Unusual shyness or aggression
Paralysis in the mandible and larynx
Constant irritability/changes in attitude and behavior
Excessive salivation (hypersalivation), or frothy saliva

List of signs and symptoms in humans
Fever
Headache
Nausea
Vomiting
Agitation
Anxiety
Confusion
Hyperactivity
Difficulty swallowing
Excessive salivation
Fear of water (hydrophobia) because of the difficulty in swallowing
Hallucinations
Insomnia
Partial paralysis
Tratment
Once the signs developed … there is no treatment and death is almost certain
*** If a Human patient had bitten by suspected rabid animal suggest immediate seek for hospital
to take the rabies vaccine as programed below
three regimens are available
Before the rabies vaccine the patient should take ( hyper immune serum ) which is Hyper
immune globulin which contains antibody to rabies antigen as Rabies Post-exposure
Prophylaxis.
Intramuscular regimens (2) :
 The five-dose regimen is administered on days 0-3- 7- 14 and 28 into the deltoid muscle
( Egyptian hospitals regimen )
 The four-dose regimen is administered as two doses on day 0 (one dose in the right and
one in the left arm (deltoid muscles), and then one dose on each of days 7 and 21 into the
deltoid muscle

Intradermal regimen (1) :
 The two-site i.d. method: one i.d. injection at two sites on days 0, 3, 7 and 28.
Notes
*** If dog is suspected to be rabid it should be isolated for 10-14 day in cage if survived then it
was not rabid and vice versa
*** As said before once the signs developed no treatment is available thus leads us as a
veterinarians to advice about the puppies vaccination against rabies for the seek of the human
and animal life saving
*** Puppies at 12 weeks age should receive rabies vaccine and should have booster doses
annually
# Ringworm = Dermatophytosis
*** it will be discussed in details in the dermatology posts but here is a brief informations about
it
Ringworm : is a common fungal infection of the skin and is not due to a worm ( miss nominee )
its medical term for ringworm is tinea
Transmission
by contact with fungal carrier animal or even human Children are more susceptible to get
infected
Diagnosis
In animals
- Wood’s lamp
- Trichogram
- Fungal culture
- Biopsy
In humans
simply by looking at it.. If the diagnosis isn't clear-cut dermatologist
may need skin scrapings
Signs in Animals
 Scales
 Reddened skin (erythema)
 Darkened skin (hyperpigmentation)
 Itchiness (pruritus)
 Hair loss (alopecia patchy or circular)
 Rounded, knotty (nodular) lesions known as granulomatous lesion
 Paronychia inflammation of the claw folds
Signs in Humans
 Flat scaly area on the skin
 Erythema
 Itchiness .
 Formation of a roughly circular ring The interior of the ring may be clear or scaly or
marked with a scattering of red bumps
Treatment
Treatment in details will be discussed in the dermatology posts
Treatment in Animal
- Antimycotic agents : such as griseofulvin or ketoconazole
- Topical antifungal ointments
- Topical shampoos : decrease contamination of environment

Treatment in human
- For a mild case of ringworm you can apply an over-the-counter antifungal lotion or
cream as :
 clotrimazole and terbinafine (Lamisil .
- Modrate to sever cases
 Need systemic antifungal treatment as Diflucan weekly capsule
#Sarcoptic Mange = Scabies
Sarcoptic mange is a highly contagious skin disease found in dogs caused
by the Sarcoptes scabiei mite. These mites will burrow through the skin
causing intense itching and irritation
Transmission
Mange can spread to humans, both through direct contact and infested
surfaces
Symptoms
In Animal
 Intense scratching : sever itching especially on the elbows, ears, armpits, hocks, chest, and
ventral abdomen
 Skin rash
 Pastules with Crust formation in the affected area
 Hair loss (alopecia)
 seborrhea

In Human
excessive itching and a uniform red bumpy rash especially on the arms or midriff (trunk) lesions
are seen on the forearms-lower chest- abdomen
Small papules that look like insect bites can be seen
Diagnosis
In Animal
- Superficial skin scrapings
- Sarcoptes treatment trails
In Humans
- By visual examination and skin scraping
Treatment
Treatment in details will be discussed in the dermatology posts
In Animals
 Antiparasitic agents scabicide :
- Dipping : e dipped in a scabicidal shampoo as invermectin, selamectin, lime- sulfur and
doramectin - Amitraz
- Spot on & injection &Oral anti-parasitic medications also
In Human
- Permethrin 5% is the best cure for severe sarcoptic mange
- Malathion is another popular remedy for this disease It needs to stay on the body for
about 24 hours to stay effective
- Lindane is an ointment that is recommended for patients who have not been cured by the
use of Permethrin 5%.
- Crotamiton is an ointment that does not cure the disease, but provides some much-
needed relief from the itching sensation.
- Neem oil is also said to be very effective in treating this disease, but there are no
scientific backings to the effectiveness of this antidote.
***the doctor may prescribe an oral anti-parisitic as ivermectin

Spaying by Salem Serag
Spaying Refers to any operation that removes the ability of a female to Give
Birth
It can be achived by
- Ovariectomy = Removing the ovaries only
- Ovariohysterectomy = Removing both the ovaries and the uterus
Both surgeries achieve the goal of spaying but ovariectomy is less invasive and less time-
consuming than ovariohysterectomy
smaller incision less bleeding ( I prefer )
so this post will be around OVERICETOMY
Advantages and Indications of SPAYING

 Prevention of the heat
 Preventing the unwanted pregnancy
 It eliminates the possibility of false pregnancy following the heat cycle
 Uterine infection ( pyometra ) is prevented
 The prevention of breast cancer
 The prevention of uterine and ovarian cancer
 for several medical conditions as :
- Treatment of intractable false or phantom pregnancy, also called pseudocyesis
- Females with ovarian cysts have irregular or abnormal cycles
- To correct certain behavioral abnormalities
- Treatment of uterine infection (pyometra) or cancer
- Dystocia (difficult birthing) or post caesarean-section surgery
Age of Spaying
At first place it depends on the owner wish But it is better to spay before the first estrus cycle
between (4-6 months)
Anesthesia Protocols
1. Premedication: Xylazine

Doses
2. Place IV catheter and administer fluids at 10 mL/kg/hour

Propofol
Induction Doses
*** Maintenance by injectable anesthesia by propofol BUT with time consideration
Propofol maintenance (20 min) ‫يعني خليك سريع (في المعقول ) عشان الحيوان ميقعدش يفوق منك في العمليه‬
Maintenance Doses
maintenance
2) Dogs
- Boluses of ¼ to 1/3 of the original induction dose as needed
(2) Cats
-Boluses of ¼ to 1/3 of the original induction dose as needed
Post-operative:
• 0.2 mg/kg Meloxicam SQ once (loading)
• 0.1 mg/kg Meloxicam PO q24hrs for 3 days
Other protocols
Preoperative:
■ Sedation: Xylazine OR Acepromazine and/or benzodiazepines or
■ Induction of anesthesia:
 ketamine (3–5 mg/kg) + diazepam/midazolam (0.25 mg/kg)
 Intramuscular: xylazine + ketamine (5.0–7.5 mg/kg)
Maintenance
ketamine (1/3 or ½ of initial dose)
.Postoperative analgesia: NSAID

For Dogs
For Cats
Before the surgical steps you have to know some anatomical considerations as: ‫مهم‬
1- The arterial supply of the ovary
The ovaries are supplied by two arteries
 Ovarian artery

 Uterine artery
2- The anatomical considerations about the ovary and these arteries
*** in the surgery before the removal of the ovary you will have to cut off the blood
supply of the ovary to prevent any bleeding
3- Ligament support of the ovaries
 The Suspensory ligament ( ovarian blood supply runs on it )
 The round ligament
 The broad Ligament Connect between uterus and the ovary )
***in order to pull off the ovaries outside the body ( good exposure )you will need to cut
the suspensory ligament and also in cutting the blood supply of the ovary which runs over
the suspensory ligament
4- Site of the incision
incision is located beginning just caudal to the umbilicus and extended caudally. incision lengths
of 2 cm – 4 cm

Operation steps
1- Preparation of the incision site
 Clip the hair around the incision site
 Sterilize the site of the incision
2- Skin opening
 Make a skin incision just caudal to the umbilicus by scalpel blade
 By dissector start to dissect the CT blew the skin

 Cut into the linea alba and the peritoneum
 Explore the abdominal cavity
3-Exteriorizing the Ovary
 By Snook hock (pic below) drag the uterine horns and outside the abdominal cavity
Visual
 Identify the ( Ovary – Suspensory ligament ) visually

 In dogs suspensory ligament is too short you may need to tear by fingertip the ligament in
order to exteriorize the ovaries
 Once the ovary is exteriorized
4- Cut of the blood supply
In order to ligate the blood supply you will need to make a hole in the broad ligament as in the
pic
 The ovarian artery runs along the suspensory ligament so by PDS suture material ligate the
ovarian artery as in the pic

 The uterine artery runs along the uterine horn so ligate them both as in the pic
Now the blood supply is cut off the ovaries
5- Removal of the Ovarian pedicle

 Place two forceps across the ovarian pedicle between the ovary and the ligatures and two
forceps across the ligament and uterine horn as in the pic
 Cut between each pair of forceps( Blue arrows ) and remove the excised portion

 check for adequate hemostasis
 make sure that non of the ovarian tissue is not removed ( ORS !!!??)
6- Repeat these steps with the other ovary
7- Close the incision
- Peritoneum & linea ablba ( PDS or vicryl Size 0-3 ) simple continuous pattern
- S/C ( by vicryl size 0-3 ) simple continuous pattern
- Skin Closure ( Nylon Size 0-2 to 0-3 )
**** ( ORS ) Ovarian Ruminant Syndrome :
occurs if any ovarian tissue is left after surgery to remove both ovaries
the owner will notice estrus symptoms after spaying
 that means that you had left some of the ovarian tissue or some time ( One ovary forgotten)
 a second surgical operation will be done to correct this (not by you of course ) and also your
reputation will be in risk and for that I shall warn about the ORS
Video of the operation https://www.youtube.com/watch?v=UtAnWytsI0k

Most Common Toxicities by Salem Serag
Most Common Toxicities are

 Acetaminophen Toxicity
 Chocolate Toxicity
 Ivermectin Toxicity
 Organ phosphorus Toxicity
 Rodenticide Toxicity
 Amitraz Toxicity
# Acetaminophen Toxicity = Paracetamol

Description
Acetaminophen (paracetamol) is a common over - the - counter pain medication
Systems Affected
■ Hepatic : liver necrosis
■ Cardiovascular: facial and paw edema
■ Hemic:
-causes oxidative damage to red blood cells and converts hemoglobin to metHb
Incidence/Prevalence
■ Most common drug toxicity in cats
■ Less common in dogs
History
■ Administration of acetaminophen either
 Accidentally : Cat ingested some pills while playing
 Owner unawareness : My cat was in pain so I gave her panadol 
*** if this history is available it will shorten the diagnostic phase and start of the therapy
Physical Examination Findings
■ Anorexia – salivation – vomiting - abdominal pain
■ Hypothermia

■ Depression -weakness - coma in severe cases
■ cyanotic mucous membranes
■ Tachypnea
■ Respiratory difficulty
■ Dark urine
■ Edema of the face and
Other drugs/toxicities causing methemoglobinemia:
■ Nitrites ■ Phenacetin ■ Nitrobenzene ■ Phenol and cresol compounds ■ Sulfites ■
Naphthalene ■ Resorcinol in cats ■ Pyridium ■ Local anesthetics ■Garlic or onions
DIAGNOSTICS
CBC (Complete Blood Count ) & Biochemistry & Urinalysis Findings
■ Heinz bodies
■ anemia ( lysis of RBC's )
■ High total and direct bilirubin
■ High in BUN and creatinine
■ High ALT- ALP
- Liver values may increase 24 to 36 hours post - ingestion
■ Serum may be icteric
■ Dark colored urine with hemoglobinuria or methemoglobinuria
Other Laboratory Tests
ABG's (Arterial blood gas )
Methemoglobinemia with normal or high PaO 2 ( oxygen saturation )
Estimate metHb
Place a drop of blood on white filter paper it looks brown if metHb is > 15 %.
Normal < 1 percent
20 to 40 percent metHb causes respiratory difficulty
40 to 55 percent metHb causes neurologic depression
70 percent metHb is acutely life - threatening
Toxic Dose of Acetaminophen
Dogs
■ 100 mg/kg  hepatotoxicity
■ 200 mg/kg  methemoglobinemia may be seen
Cats
■ 10 mg/kg  toxic signs
Cats generally show severe signs of methemoglobinemia rather than hepatotoxicosis
Treatment
*** the know antidote for acetaminophen toxicity is (N – acetylcysteine )
Treatment plan
1- Induction of emesis
 Xylazine: 0.44 to 1.1 mg/kg IM
 Hydrogen peroxide: 1 to 2 ml/kg PO (max dose of 30 ml)
2- Activated charcoal : 2 to 5 g/kg every 3 to 4 hours
( acetaminophen undergoes enterohepatic recirculation)
3- N - acetylcysteine (Mucomyst)
 140 mg/kg PO or IV ( loading dose )
 70 mg/kg PO or IV every 6 hours for seven times
 240 mg/kg PO or IV as a loading dose in severe cases
*** Activated charcoal inactivates N - acetylcysteine if it is given PO. Wait at least 30
to 60 minutes between them
4- Vitamin C (ascorbic acid) : 30 mg/kg PO or SQ every 6 hours
Questionable efficacy !
5- Cimetidine ( anti-ulcer medication ): 5 to 10mg/kg every 6 to 8 hours IV, IM
Used here to Reduces metabolism of acetaminophen in the liver
6- Supportive therapy
 Intravenous fluids ( See Post 1 for doses and calculations )
7- Feed cats kitten food due to increased sulfhydryl group substrates

8- Chronic treatment until liver enzymes are within normal limits
9- Artificial tears (Tear guard ED ) Kerato-conjunctivitis may occur
Client Education
 Clients should know that treatment may be prolonged and expensive.
 Affected animals may have residual liver damage
Fascial Edema in Dog Vomitus contain acetaminophen Pills
Fascial Edema in cat Gum Cyanosis
Salivation Red Urine

#chocolate toxicity
Description
Ingestion of chocolate (methylxanthine alkaloids) in suffi cient quantity to cause
gastrointestinal, neurologic, and cardiac abnormalities
***Methylxanthine alkaloids ( theobromine and caffeine from the cocoa bean )
Systems Affected
■ Gastrointestinal : vomiting and diarrhea
■ Urologic : polyuria - polydipsia
■ Nervous : hyperactivity - CNS stimulation -seizures
■ Musculoskeletal : tremors - hyperreflexia
■ Cardiovascular :tachycardia increased myocardial contractility
History
 Recent chocolate ingestion reported
 Gastrointestinal signs; vomiting and diarrhea (2 – 4 hours)
 Polyuria/polydipsia
 Hyperactivity and anxiety
 Neurologic signs :tremors – seizures
Physical Examination Findings
■ Tachycardia
■ Tachypnea
■ Hyperthermia
■ Tachy-arrhythmias
■ Hyperreflexia
■ Muscle tremors
■ Ataxia
■ Seizures
■ Coma/death

■ Other toxins: mycotoxins- strychnine- nicotine- pesticides - organophosphates
■ Drugs: amphetamines - digitalis
■ Seizure disorder
■ Electrolyte/metabolic abnormality : hypomagnesemia and hypocalcemia
Diagnosis
■ CBC and serum biochemistry: hypokalemia
■ Urine specific gravity: low
■ Stomach content analysis: presence of chocolate and methylxanthine
■ Plasma, serum, and urine: theobromine levels
Treatment
Treatment goals
1- eliminate the methylxanthine toxin by decontamination and support of clinical signs.
2- Induce emesis if alert
3- Activated charcoal
4- Intravenous fluid diuresis: intravenous crystalloid fluids (high rates)
5- Urinary catheter theobromine is reabsorbed in the bladder
 Emetics :
-Hydrogen peroxide: 1 to 5 ml/kg PO
-Xylazine ( Dogs: 0.5 to 1 mg/kg IM o Cats 0.44 mg/kg IM )
 Toxin Binding
-Activated charcoal: 2 to 8 g/kg PO every 6 to 8 hours
 Seizures
-Diazepam: ( Dogs 0.5 to 2 mg/kg IV Cats 0.5 to 1 mg/kg IV )
- propofol 3 to 6 mg/kg IV 8 to 12 mg/kg per hour
 Tachycardia
-Lidocaine: 1 to 2 mg/kg IV bolus over 30 seconds
 Muscle Tremors

- Methocarbamol (Robaxin ): 44 mg/kg IV give slowly until relaxation and continue to effect
Precautions
- Do not induce vomiting if the animal having seizures
- Avoid corticosteroids and erythromycin  reduce methylxanthine excretion
***Pregnant animals at risk of abortion
#Ivermectin Toxicity = Ivomec

Description
- Anti parasitic drug that are effective against both
external and internal parasites
- Act as GABA agonists at the neuromuscular
junction in the peripheral nervous system of
nematode and arthropod parasites
Systems Affected
The toxic effect is on the neurologic system other organ systems are affected indirectly
Breed at risk
Seven collie - sighthound breeds – collie - Shetland sheepdog - old English sheepdog,
McNab – cattledog - Australian shepherd and English shepherd silken windhound and longhaired
whippet – White german shephered - German Shepherd
Signs and symptoms
Toxicity is to the CNS with other systems affected secondarily.
■ Ataxia
■ Tremors
■ Seizures
■ Coma
■ Hypersalivation
■ lethargy
■ Mydriasis
■ Vomiting.
■anorexia
■Blindnes
■ Respiratory arrest
Toxic doses
Toxicity in kittens at doses of 300 to 400 microg/kg
In Dogs ( wide variety ) according to breed ( 100 to 500 microg/kg - 2000 microg/kg)
Differential Diagnosis
Differentiation from other causes of acute neurologic signs is based on the history
of exposure to the drug in ( susceptible canine breed or severe overdose in other animals )
Diagnosis ( based mainly on history on having this drug )
- History : of having ivermectin specially in the susceptible breeds
- Laboratory Findings
Ivermectin can be detected in serum -gastrointestinal contents -Liver- -fat but levels in tissues
do not correlate with toxicity because it is the concentration of the drug in the brain that
determines toxicity
Treatment
The goals of therapy are decontamination and support
Intravenous fluid therapy with keeping electrolytes in balance
Turn the dog over frequently if comatose
Physical therapy
Ocular lubricants
Heat support if body temperature is low
Fans if body temperature is high
If the dog can't stand up urinary catheters may be needed
Medication for seizures ( Propofol )
*** If Ivermectin ingested orally
- If ingestion occurred <1–4 hours Emesis should be induced with by hydrogen peroxide –
xylazine as discussed earlier
- Activated charcoal should be administered

Continuation of the most common toxicities
# Organ phosphorus Compounds Toxicity

Description
anticholinesterase chemicals used most commonly as household and industrial insecticides they
cause toxicity by inhibiting the action of acetylcholinesterase neuronal synapses and the
neuromuscular junction
*** OPC toxicity in dogs and cats is by ingestion - dermal contact – inhalation
Commonly used insecticides

Diazinon – acephate -anilophos –dimethoate
Systems Affected
 Nervous Muscle tremors and twitching -paralysis -obtundation(less conscious )-
seizures - coma
 Cardiovascular Bradycardia -tachyarrhythmias.
 Gastrointestinal  ptyalism – vomiting –diarrhea - abdominal pain
 Ophthalmic  Miosis ( Helpful in diagnosis ) Lacrimation

 Respiratory  bronchoconstriction - bronchorrhea
Risk Factors/Causes
Household insecticides -garden insecticides- chemicals used to topically treat flea
or tick infestation on dogs and cats
History
- History of recently use of insecticides near the animal so ( ingestion - dermal contact –
inhalation can happen )
- Animal presented with complaints of acute muscle tremors- ataxia-hypersalivation -
gastrointestinal disturbance
Signs & symptoms
Physical examination reveals generalized muscle tremors; seizures- coma
Clinical signs of parasympathetic are common and include DUMBELS:
■ D: diarrhea
■ U: urination
■ M: miosis
■ B: bradycardia/bronchospasm
■ E: emesis
■ L: lacrimation
■ S: salivation
*** Bronchospasm and bronchial secretions can cause life threatening hypoxemia.
*** Not all signs are present in all patients.
Diagnosis
- Diagnosis mainly ade by Signs and historical data in combination with examination
findings
- Definitive diagnosis requires toxicological examination of blood and urine
Treatment
Antidote : Atropine is the most useful antidote
Goals of treatment
 Supportive therapy and Seizures treatment

 Oxygen supplement if  respiratory distress or tachypnea.
 Intravenous fluid therapy if  hypovolemia or dehydration due to vomiting-
diarrhea
 Antiemetics and gastric protectants
 Recumbent patients should be turned every 4 to 6 hr ( SORES )
 Induce vomiting if toxin ingested 1 to 2 hrs before But Don’t induce vomiting if 
neurologic abnormalities or that have already vomited
 Activated charcoal is useful
 Patients with topical exposure should be bathed with mild soap then dried completely
to prevent hypothermia
 Antidotes are available for the muscarinic (parasympathetic) and nicotinic (skeletal
muscle) signs of OPC toxicity
Treatment
- Supportive intravenous Fluids (Dose calculation see post 1 )
- Seizures should be treated with diazepam 0.5 to 1 mg/kg IV
- Activated charcoal can be administered at 1 to 4 g/kg repeated every 6 hours for the first
day
- Atropine treat the muscarinic signs of bradycardia- bronchospasm-bronchial secretions
 initial atropine dose of 0.1 to 2 mg/kg 1/4 of the dose IV the remainder (3/4) S/C
 Depending on the severity atropine may need to be repeated every 20 to 30 minutes at
smaller doses of 0.1 to 0.25
*** Adequate treatment leads to clinical signs of atropinization : mydriasis dry
mouth and mild sinus tachycardia
- Pralidoxime ( antidote for the nicotinic signs of OPC ) 10 to 20 mg/kg Slow IV every 12
hrs
- Antiemetics if needed (primpran ) Metoclopramide dose 0.2-0.4mg/kg
- Gastric protectants Omeprazole dose 0.5-1 mg/kg
# RodenticideToxicity (Anticoagulant type )

Description
Ingestion of anticoagulant rodenticide compounds results in a depletion of vitamin

K and functional vitamin K - dependent coagulation factors and causes an acquired
Coagulopathy
Normal coagulation factor synthesis
Effect of anticoagulant Rodenticide
Systems Affected
 Cardiovascular — hemopericardium, subepicardial hemorrhage
 Gastrointestinal — sublingual or gastric hemorrhage, hemoabdomen
 Hemic/Lymphatic/Immune — active coagulation factor defi ciency, anemia,
hypoproteinemia
 Musculoskeletal — hemarthrosis, lameness
 Nervous — intracranial hemorrhage, seizures, paresis, paralysis
 Respiratory — hemothorax, parenchymal hemorrhage
 Skin/Exocrine — SQ hemorrhage
Risk Factors/Causes
The presence of vit. K antagonist rodenticides in the surrounding environment

Historical Findings
■ Ingestion of anticoagulant rodenticides
■ Ingestion of an animal that consumed anticoagulant rodenticide (relay toxicosis)
■ Vomit or feces with green or turquoise - colored granules in it (Characteristic)
■ Respiratory difficulty or hemorrhage
Signs and symptoms
■ Clinically asymptomatic if ingestion < 48 hours previously.

■ hypoproteinemia may develop prior to the anemia
■ Deep tissue hemorrhage
 Hemoptysis
 Hemothorax
 Hemoabdomen
 Hemarthrosis
 Intracranial
 Pericardial
 Sublingual
 Subcutaneous
most frequently develop between 2 and 6 days following consumption
Diagnosis
Diagnosis is made by history- clinical presentation - coagulation profile tests
*** Coagulation profile tests (coag) is a blood test includes :

INR- APTT - Platelets - fibrinogen
***INR Device is available as fast strip test
Treatment
Treatment depends on timing of ingestion and the urgency of the clinical
presentation
 Emesis induced if ingestion within previous 2 hours
 Activated charcoal is ideal if ingestion occurred within
previous 2 hrs
 Vitamin K 1 :
2.5 to 5 mg/kg per day PO for up to 6 weeks
*** oral administration is generally more rapidly effective ( < 12 hours) than S/C (12 –24hours)
and safer than intravenous dosing (risk of anaphylaxis).
 Vitamin K 1 therapy alone is usually sufficient to reverse the anticoagulant effect
inpatients without hemorrhage.
 Cautious intravenous fluid administration to reverse shock while minimizing the
unnecessary or excessive increases in blood pressure (doses should be well
calculated)
 Oxygen therapy if hypoxemia is present
Surgical Considerations
 Thoracocentesis may be indicated if the development of a hemothorax which
compromises respiration
 Preferably avoid unnecessary procedures until coagulation ability has normalized (
back to the normal level )
# Amitraz Toxicity
Description
Amitraz is pesticide applied topically to control ticks- mites -
and lice
Flea and tick collars contain enough amitraz to cause clinical
signs of intoxication
in a 12 kg dog
Amitraz affects peripheral á 1 - and á 2 - adrenergic receptors

Systems Affected
 Nervous System  depression and ataxia
 Cardiovascular  bradycardia and hypotension
 Gastrointestinal  vomiting, diarrhea, and abdominal pain
***Toxicity in dogs is more commonly reported than in cats
***Amitraz should never be used in cats.
Historical Findings
Signs of sudden collapse- depression-vomiting and diarrhea
Signs and symptoms
■ Neurological signs as
 depression
 ataxia and weakness
■ Cardiovascular sings as
 Collapse
 Bradycardia
 Recumbency
 Hypotension
■ Gastrointestinal signs as
 Vomiting
 Diarrhea
 abdominal pain

Diagnosis
Through history of use of amitraz products and signs
Complete Blood Count/Biochemistry
■ Hyperglycemia is common.
■ Liver enzymes may be elevated.
Imaging
■ Abdominal radiology may reveal a collar buckle ( amitraz collar ) in the gastrointestinal tract
Treatment
Treatment of amitraz poisoning is best accomplished by administration of antidotes (yohimbine
or atipamezole).
[antisedan(yohimbine) : which used as xylazine reversal ]
Ingestion of Collar
■ Emetic as 3% hydrogen peroxide (2.2 m/kg PO maximum 45 ml after feeding )
Xylazine not recommended to induce vomiting
■ x-ray retrieval of collar if large segments within the stomach usually numerous
small pieces are located
■ Surgical removal of collar from gastrointestinal tract
■ Activated charcoal (2 g/kg PO) containing sorbitol

Intestinal Resection and Anastomosis by Salem Serag
Intestinal Resection and Anastomosis

Descriptions
is a surgical procedure in which a section of intestinal tract is removed and the remaining parts
are connected
-The resection refers to the removal of the abnormal tissue and the
-The anastomosis is the procedure where the two parts are reconnected
Indications
 foreign body such as ingested toys or other obstruction
 Perforation of the intestine
 Intussusception in which one piece of intestine becomes incorporated in an adjacent
segment
 Torsion or twisting of the intestines
 Neoplasia (cancer)
 Dehiscence
 Necrosis
 Sever infection
The goal of resection and anastomosis

is to remove an irreversibly injured or abnormal segment of intestine that contain contamination
and rejoin the ends in a manner that will optimize healing and restoration
Surgical techniques
 hand-sutured repair ( discussed in this post )
 Staples Technique
 Anastomotic device
Anesthesia protocol
One injectable anesthesia protocol
1. Premedication:
Xylazine
Doses

2. Place IV catheter and administer fluids at 10 mL/kg/hour
Propofol
Induction Doses
*** Maintenance by injectable anesthesia by propofol BUT with time consideration
Propofol maintenance (20 min)
Maintenance Doses
maintenance
3) Dogs
- Boluses of ¼ to 1/3 of the original induction dose as needed
(2) Cats
-Boluses of ¼ to 1/3 of the original induction dose as needed
Post-operative:
• 0.2 mg/kg Meloxicam SQ once (loading)
• 0.1 mg/kg Meloxicam PO q24hrs for 3 days
For other protocols see anesthesia posts ( upcoming )
Anatomical considerations
5- The arterial supply of the Intestine
 Branches of the mesenteric artery (Red arrows)
 The terminal arcade vessel (Blue arrow )

*** in the surgery before the removal of the affected part of the intestine you will have to cut off
the blood supply of this part to prevent any bleeding
6- The Omentum
It has a role in strengthen the intestinal anastomosis ( in the steps below )

Operation Steps
1- Prepare the patient

 Place patient in dorsal recumbency
 Clip the hair in the incision area
 Sterilize the site of the incison
2- skin opening
 Incision is made in the mid-way between to the pubis
 By dissector cut the linea alba & peritoneum and explore the abdominal cavity
3-Exteriorizing the intestine
 Identify and exteriorize the affected segment of bowel
 Remember that the bowel should be kept moist and warm at all times ( use warm saline ) to
prevent its dryness

4- Cutoff the blood supply
 Ligate the arcadial vessels that supply the affected segment of the intestine ( a )
 ligate and the terminal arcade vessels on either side of the segment (b)
 Transect the mesentery ( c ) Blue line it will be removed with the segment
5-Segment removal :
 Manually milk the contents from the segment

 occlude the lumen noncrushing Doyen tissue forceps (a)
***This is done to prevent leakage of intestinal contents into the surgical site. Place intestinal
forceps (b) just adjacent to the other forceps leaving 2 cm of healthy tissue between the 2 clamps
 also place two forceps on the other side of the segment as in the pic below

 using surgical blade sharply incise the intestine between each two forceps (Green line) as in
pic above
 Note that the intestinal mucosa evert after transection (B) (pic below )
 Sharply trim the everted mucosa with scissors to facilitate apposition (c).
Fix the 2 incision ends with a stay suture (placing a one simple interrupted suture at the
mesenteric border ( blue arrow )and another one at the antimesenteric border (red arrow )
 Suture the bowel ends together using a single-layer appositional suture pattern
 modified Gambee suture pattern can be used to minimize the mucosal
eversion

 suture by PDS size 0/3 to 0/4
*** Before releasing the luminal occlusion the integrity of the suture line can be tested by
injecting sterile saline
If leakage is present place an additional simple interrupted suture to close the gap.
Remember to Irrigate and the abdomen with copious amounts of warm sterile saline
 Intestinal anastomoses can be strengthened by omentalization or serosal patch graft
techniques which reduce the leakage and improve vascularity
*** take a part of the omentum and wrap it around the anastomosis site

6- Close the incision
- Peritoneum & linea ablba ( PDS or vicryl Size 0-3 ) simple continuous pattern
- S/C ( by vicryl size 0-3 ) simple continuous pattern
- Skin Closure ( Nylon Size 0-2 to 0-3 )

Anal gland diseases and anal sacculectomy operation
( closed technique ) by Salem Serag
Anal Glands Diseases " Anal Glands = Anal Sacs "

What are the anal glands
 Two anal sacs near the anus they help in identification and territory marking
 They produce produce very strong and pungent scent for marking the territory a dark
smelly oily liquid ( Pheromones = chemical messenger )
 They help the body eliminate toxins and substances that are not needed
 That liquid is usually squeezed out when they poops
*** This is the reason dogs smell other dogs' bottoms when they meet and greet
Their position
glands found on either side of your dog's anal opening just below the surface of the skin
they sit about 4 o'clock and 8 o'clock
Common anal sacs problems

1. Impaction
The most common problem happens when the duct of the anal sac gets clogged
2. Infection
When bacteria invade the anal sacs it can become so painful and itchy that animal may show
signs of fear or anger.
It’s important to treat an infection right away or it may turn into an abscess.
3. Abscess
An abscess is a swollen, tender mass of pus. the most painful of the three and needs to be cut and
drained before it ruptures

4. Tumor formation
Anal gland adenocarcinoma is a common in dogs
Symptoms
 Scooting : dragging their bottoms along the ground)
 Tail chasing : try to catch its tail
 A lot of licking or biting : Excessive licking or biting near the tail
 Pain : animal may strain when poops animal may also find it painful to sit
 Swelling: Sacs may be swollen- impacted( hard masses in this area )
 A bad smell : bad odor of the animal bottom
 Constipation or pain when pooping or sitting
 Red skin around the anus
 bleeding or drainage of pus from around the anus
factors that cause anal gland problems :

 Diet –artificially flavored and preserved food
 Body toxins in general
 Obesity due to overfeeding or lack of exercise
 Liver imbalance which is also related to general toxicity
 Lumbo-sacral spine and muscle injury that leads to decreased energy flow to the anal
glands and lack of tone ( after trauma )
Anal gland impaction Anal gland adenocarcinoma Anal gland abscess

Scooting position
Licking around anal area Tail chasing
Red skin around the anus hemorrhagic drainage
Treatments
Non-surgical treatment
1- Anal Sac Expression
It is done by applying pressure with the finger start below the gland and then pushing upwards
If the contents are hard or dry try to soften them up by flushing with warm saline solution
You may also use a tranquilizer or sedative to keep him calm while expressing
2- Antibiotics
If your cat has an infection, your vet will express his anal sacs and then give him an antibiotic to
treat the bacteria.
3- Pain medications

4- Diet additives : extra fiber which bulks up the poop facilitate the emptiness of the sacs
5- Repeated expression of the gland : this may be needed to be done every two week or
month
How to express the anal sacs
 You may need to sedate the animal at first  give xylazine
 Put on gloves and lubricate your index finger with vaseline or a water-based lubricant
 insert your index finger into the rectum 2 cm forward
 Feel with your index finger and thumb for a firm pea sized object at 4 or 8 o’clock
positions
 When you have found the gland place a tissue paper between the dog anus and your hand
and gently milk the glands contents( squeeze towards you )
 Wipe the anal area & clean and repeat on the other side also you may flush with saline
SURGERY TO REMOVE ANAL GLANDS OR NOT?

Surgery indicated in two cases
- Recurrent uncontrollable infection
- Anal Sac Neoplasms
***it may also be requested by the owner ( tired of frequent expression )
*** healthy anal glands should not be neither expressed nor removed
Anal sacculectomy procedure
Description
Surgical removal of both the anal glands due to failure of the non-surgical treatment

Pre-surgical Considerations
- Anal sacculectomy should not be performed if the anal sac has ruptured or edema and
inflammation are present
- localized therapy is preferred until the wound has healed and inflammation resolved
Pre-surgical preparation
 Perineal area should be clipped and draped
 patient should be placed in perineal position
 A moistened (not wet) piece of gauze can be inserted into the rectum and a purse-string
suture used to minimize fecal contamination
Techniques
Anal sacculectomy can be perfomed by two techniques
- Close technique
- Open technique
Operation steps
Closed method
1- insert piece of gauze into the anal sac through the sac opening to mark it during dissection
2- Paraffin oil can be used to distend the anal sac by infusing it into the anal sac
Paraffin oil will solidify at body temperature making the anal sac easily markable
3-asmall oblique incision (2–3 cm) from just below the tip of the anal sac opening down word in
oblique manner as in the picture

4- separate SC tissue using dissector & Separate fibers of the external anal sphincter
5-Use the gauze inserted into the anal sac as a guide while dissecting the s/c and fibers to expose
the anal sac
6-Keep the wound moist and clear by use of warm saline
7-Use the Tissue hock to expose the anal sac ( The external surface of the anal sac is a smooth
grayish–brown structure with some of the muscle fibers from the sphincter muscle adhering to
the surface )
8-Continue dissection around the edges of the anal sacs to be dissected free from underlying
tissue
9-By forceps grasp and elevate the apex to permit dissection around the (deep) aspect of the sac

10- Continue dissecting until the duct is the only remaining attachment
At this point:
11- either excise the duct of the anal sac in total with a small piece of rectal mucosa or ligate the
duct using a monofilament absorbable suture as close to its exit point
***closed method is more preferable than the open one in which the anal sac is opened and
increase the risk of more hemorrhage and risk of contamination and can lead to anal fistula so I
will not discuss it
12-close the incision

 s/c with absorbable monofilament suture material as PDS
 skin with non-absorbable monofilament suture material as Nylon to be removed 10 days
later
*** Don't forget to Repeat these steps for the other anal sac
*** don’t forget to remove the gauze pre-surgically inserted in the anus and to untie the purse-
string suture

Vomiting in cats and its related diseases by Salem Serag
Vomiting
At first as u know vomiting is a symptom of a disease not a disease itself so this post will be
about diagnosing and treating vomiting according to its related disease
Description
it is forceful expulsion of stomach contents through the mouth
The difference between vomiting and regurgitation?
In regurgitation the food comes from the mouth or esophagus
Vomiting involves the contraction of stomach muscles regurgitation does not
series of questions to determine how severe the vomiting is. It
 When the vomiting started?
 How many times cat has vomited?
 What the vomit looks like?
 Is there is blood in the vomit?
 If the cat has a swollen abdomen?
 If the cat have eaten something (toxic or poisonous)?
 The onset of the symptoms (acute or chronic)?
 If the cat vaccinated (or not)?
 If the cat also has other symptoms (Fever –dehydration - urinary problem –weakness –
diarrhea - weight loss)?
 Timing of vomiting in relation to meals or drinking.
some data you need to determine
 the cat temperature ( feverish or not )
 the cat's gums color ( pale or yellow )
 Degree of nausea (licking or smacking of lips-drooling-swallowing-gulping)
 Medical History (vaccinations – deworming - contact with other cats- diet )
 Laboratory and diagnostic tests :
fecal flotation - CBC and chemistry panel (x-rays) if a tumor- foreign body is suspected
- ultrasound

How is vomiting treated?
 Treatment should be according to the causative disease
Some notes before I discuss the diseases and its treatment
*** It is recommended to withhold food for at least 24 hours and give small amounts of water
frequently
***it may be necessary to modify the diet permanently if the causative is the diet
***If intestinal worms are present deworming be done
***If dehydration is present it is usually necessary to give the animal intravenous fluids with the
correct doses as discussed before (post 1)
***Antibiotics are given if the vomiting is caused by bacteria also given if the stomach or
intestine has been damaged (blood in the stool or vomit indicate an injured intestine or stomach)
and there is a chance for secondary bacterial infection
it is important to have an accurate diagnosis before use of these drugs and ask yourself :
***It is important to determine the cause so the appropriate treatment can be

given

This table below will have almost all what you need to treat a vomiting case
Cause Example Cats Most Symptoms Diagnosis Treatment

at Risk
Diet change Changing cat Those Usually no History and Withhold food
food brand switching other signs physical as needed then
from a of being ill exam-tests switch to bland
consistent (fecal diet and then
diet flotation) to slowly back to
rule out other normal diet
causes
Food Sensitivity to or Sudden Monitor Withhold food
intolerance or inability to onset of response to as needed then
sensitivity digest or absorb diarrhea- removing switch to diet
certain foods sometimes ingredient without the
such as milk or with gas from diet and offending
gluten then adding it ingredient
again (food
trial)
Bacterial Salmonella E. Young Mild to Fecal culture Antibiotics
infection coli -Clostridia cats or severe and intravenous
Campylobacter those who bloody sensitivity fluids and
are diarrhea supportive care
immuno- loss of in more serious
suppressed appetite conditions
depression
- fever
vomiting
Hookworms Kittens Diarrhea- Fecal Multiple
vomiting- flotation treatments with
weakness- exam appropriate
pale wormer-
gums- decontaminate
dehydration- environment
anemia-
swollen
abdomen-
black and

tarry
stools
Giardia Usually Mild to fecal flotation Metronidazole-
young cats severe soft exam or albendazole or
or those diarrhea microscopic febantel-bathing
who are with exam of and sanitation to
immuno- mucus and feces-difficult remove Giardia
suppressed a bad to diagnose - from coat and
odor- often need environment.
weight multiple Reinfection
loss- samples over commonly
abdominal several days occurs.
pain and
vomiting-
often
intermittent
Viral Panleukopenia Young cats Acute History- Intravenous

infections (feline who have diarrhea- physical fluids-
distemper) not loss of exam- white antibiotics to
received appetite- blood cell prevent
full series
fever- count secondary
of feline
depression bacterial
distemper
vaccinations - infection-
and those vomiting- withhold food
who are dehydration- and water
immuno- abdominal
suppressed pain
Feline corona Young Diarrhea History and None
virus (FCoV) cats- cats and physical
in catteries possible exam-tests
vomiting ELIZA test
Feline Young Diarrhea- History- Supportive care
Infectious cats- cats in fever- physical
Peritonitis (FIP) catteries- lethargy- exam-
may be loss of analysis of
genetic
appetite- abdominal
susceptibilit
weight fluid- CBC
y in some
breeds loss- and serum
vomiting chemistry

Idiopathic Granulomatous Chronic History- Modify diet-
inflammatory enteritis- vomiting physical wormers and
bowel disease eosinophilic diarrhea exam- antibiotics to
gastroenterocoli possibly intestinal treat or prevent
tis- or with blood biopsy-tests hidden
lymphocytic/ and/or (fecal infections-
plasmacytic mucus- flotation) to probiotics-anti-
enteritis (LPE) straining- rule out other inflammatory
mild causes drugs-
weight immunosuppres
loss- black sing drugs if no
and tarry response to
stools other treatment
Cancer Lymphoma- Middle- Chronic History- -Medications
adenocarcinoma age or diarrhea- physical not available in
older weight exam- Egypt
loss- poor intestinal (chemotherapy)
appetite-
biopsy - surgery
may see
depending upon
vomiting
and dark- the type tumor
tarry stools
Small Cats with Intermittent History- Antibiotics (at

intestinal other watery physical exam- least 4-6
bacterial intestinal diarrhea- intestinal weeks)-modify
overgrowth diseases poor biopsy-tests diet
growth or
(SIBO) also ( fecal
weight
called flotation) to
loss-
antibiotic increased
rule out other
resistant causes-
gas-
diarrhea ultrasound-
sometimes
blood tests
vomiting
(serum folate
and cobalamin-
bile acids)
Obstruction Foreign body- Diarrhea- History- Surgery

intussusception vomiting- physical
- pyloric loss of exam-x-rays-
stenosis appetite-as barium series-
progresses
ultrasound-
see
exploratory
depression
possible- surgery

abdominal
pain
Pancreatitis Adult cats- Fever- History- Restrict oral

Siamese loss of physical intake as needed-
appetite- exam administer fluids-
lethargy- chemistry provide pain
control and other
painful panel-other
supportive care-
abdomen- blood tests (
medications to
vomiting Feline control vomiting-
trypsin-like maintain on low
immunoreactiv fat diet if
ity) necessary
Liver or Hepatitis- Vomiting- History- Medications and

Biliary biliary yellow physical fluids to control
Disease obstruction discolorati exam- effects of
on of chemistry vomiting and
gums and panel-other liver disease-
whites of blood tests-x- possible surgery
the eyes rays and/or depending on
ultrasound- cause
biopsy
Kidney Pyelonephritis- Older cats Vomiting- History- Diet changes-
Disease glomerulonephr increased physical medications and
itis thirst and exam- fluids to control
urination chemistry effects of
panel- vomiting and
urinalysis-x- kidney disease
rays and/or
ultrasound
Peritonitis Perforated Vomiting- History- Antibiotics-
intestine painful physical exam- fluids-
abdomen- chemistry medications to
sometimes panel-complete control
blood count-x-
fever vomiting-
rays and/or
possible surgery
ultrasound
depending upon
cause
Pyometra Unspayed Vomiting- History- -medical
(infection of females fever- physical exam- treatment
the uterus) complete blood -Surgical
count-x-rays
vaginal and/or removal of
discharge ultrasound uterus
Diabetes Overweig Vomiting- History- Insulin therapy (

mellitus ht cats increased physical not available in
thirst and exam- Egypt )-dietary
urination- chemistry management-
depression panel- supportive care
urinalysis
Hyperthyroidi Middle- Increased Blood test for Treatment of
sm age to appetite- T4 hormone hyperthyroidism
older cats weight with
loss- methimazole-
vomiting-
hyperactivit
y- stool - surgery
greasy
appearance
Toxins Strychnine- Outside Loss of History and Depends on

ethylene glycol- cats and appetite- physical exam- toxin
lead- zinc- those left depression- tests ( fecal
poisonous unattended vomiting- flotation) to
dehydration rule out other
plants or
- causes-testing
unsupervis
abdominal of blood- feces
ed pain or vomit
Medications Digoxin- Vomiting History- Medications to

erythromycin- physical control vomiting-
chemotherapy exam-drug change drug
levels therapy
Septicemia Vomiting- History- Antibiotics-

fever physical supportive care
exam-blood
culture
Hypo- Vomiting History- Medications to
adrenocorticism physical exam- control effects of
(Addison's chemistry hypoadrenocortici
disease) panel-complete sm( in derma post
blood count )

Gastritis Helicobacter Vomiting History- Medications to
infection-high physical control vomiting
blood urea exam- and protect
nitrogen endoscopy stomach-treat
underlying cause-
(BUN)-stomach
fluids- if
worm
necessary
Urinary tract Male cats Straining Physical Remove

obstruction but exam obstruction
producing while under
no or little anesthesia-
urine-
intravenous
vomiting-
fluids and
licking
genital area supportive care
Ulcers Vomiting- History- Anti emetics

blood in physical stomach
vomit- exam- protectants -treat
black- endoscopy or underlying
tarry barium series cause-fluids- if
stools necessary
Heartworm Lethargy- Blood testing- Supportive care
infection weight radiographs-
loss- echocardiogra
coughing- m
vomiting
Motion Drooling- History- Medications to
sickness vomiting physical control vomiting
while exam
riding in a
vehicle

Vomiting in Dogs and its related diseases by Salem Serag
Vomiting
At first as u know vomiting is a symptom of a disease not a disease itself so this post will be
about diagnosing and treating vomiting according to its related disease
Description
it is forceful expulsion of stomach contents through the mouth
The difference between vomiting and regurgitation?

In regurgitation the food comes from the mouth or esophagus
Vomiting involves the contraction of stomach muscles regurgitation does not
series of questions to determine how severe the vomiting is. It

 When the vomiting started?
 How many times the dog has vomited?
 What the vomit looks like?
 Is there is blood in the vomit?
 If the dog has a swollen abdomen?
 If the dog have eaten something (toxic or poisonous)?
 The onset of the symptoms (acute or chronic)?
 If the dog vaccinated (or not)?
 If the dog also has other symptoms (Fever –dehydration - urinary problem –weakness –
diarrhea - weight loss)?
 Timing of vomiting in relation to meals or drinking.
some data you need to determine
 the dog temperature ( feverish or not )
 the dog's gums color ( pale or yellow )
 Degree of nausea (licking or smacking of lips-drooling-swallowing-gulping)
 Medical History (vaccinations – deworming - contact with other dogs- diet )
 Laboratory and diagnostic tests :
fecal flotation - CBC and chemistry panel (x-rays) if a tumor- foreign body is suspected
- ultrasound

How is vomiting treated?
 Treatment should be according to the causative disease
Some notes before I discuss the diseases and its treatment
*** it is recommended to withhold food for at least 24 hours and give small amounts of water
frequently
***it may be necessary to modify the diet permanently if the causative is the diet
***If intestinal worms are present deworming be done
***If dehydration is present it is usually necessary to give the animal intravenous fluids with
the correct doses as discussed before (post 1)
***Antibiotics are given if the vomiting is caused by bacteria also given if the stomach or
intestine has been damaged (blood in the stool or vomit indicate an injured intestine or
stomach) and there is a chance for secondary bacterial infection
***It is important to determine the cause so the appropriate treatment can be given
This table below will have almost all what you need to treat a vomiting case
Cause Example Dogs Most at Symptoms Diagnosis Treatment

Risk
Gastric Deep chested- Vomiting- History; Surgery

dilatation and large breed retching- physical exam supportive
volvulus dogs bloated radiographs care this is an
(bloat) abdomen emergency
condition and
requires
immediate
treatment
Benign gastric Pyloric stenosis- Boxers- Intermittent History- Surgery to

outflow polyps Bulldogs- vomiting- physical exam- correct
obstruction Boston weight loss- radiographs outflow
Terriers- young dehydration obstruction
animals antacids
Diet change Changing dog Those Usually no History and Withhold food
food brand or switching from other signs physical exam as needed then
feeding a high fat a consistent diet of being ill tests (fecal switch to
meal flotation) to bland diet and
then slowly
rule out other
back to
causes normal diet

Food Sensitivity to or Gluten Sudden Monitor Withhold
intolerance or inability to digest hypersensitivity onset of response to food as
sensitivity or absorb certain : Irish setters diarrhea- removing needed then
foods such as and soft coated sometimes ingredient switch to
milk or gluten Wheaton with gas from diet and diet without
terriers then adding it the offending
again (food ingredient
trial)
Intestinal Hookworms Young dogs Diarrhea- Fecal flotation Multiple

parasites vomiting- exam treatments
weakness- with
pale gums- appropriate
dehydration wormer
- anemia- decontamina
swollen te
abdomen- environment
black and supportive
tarry stools care
Giardia Usually young Mild to ELISA - fecal Metronidazole

animals or severe soft flotation exam - albendazole
those who are diarrhea or microscopic or febantel
immunosuppres with exam of feces bathing and
sed mucus and difficult to sanitation to
a bad odor diagnose - remove
weight often need Giardia from
loss- multiple coat and
abdominal samples over environment.
pain and several days Reinfection
vomiting commonly
often occurs.
intermittent
Garbage Those left Diarrhea- History and Withhold

ingestion unattended or vomiting physical exam food as
unsupervised needed then
switch to
bland diet
and then
slowly back
to normal
diet
Bacterial Salmonella- E. Young Mild to Fecal culture Antibiotics
infection coli- Clostridia kenneled dogs severe and sensitivity intravenous
or those who bloody fluids and

are diarrhea microscopic supportive
immunosuppres with loss exam of feces care in more
sed of appetite- serious
depression conditions
- fever and
vomiting
Viral Parvovirus Young dogs Loss of History- Intravenous

infections who have not appetite- physical exam- fluids-
received full fever- fecal test for antibiotics to
series of parvo depression presence of prevent
vaccinations - vomiting- parvovirus- secondary
diarrhea- white blood bacterial
dehydration cell count (See infection-
- parvo post no withhold
abdominal 1) food and
pain water
Distemper Young dogs Loss of History and Intravenous
who have not appetite- physical exam fluids if
received full fever- tests ( - fecal dehydrated
series of depression flotation) to antibiotics to
distemper - cough- rule out other prevent
vaccinations vomiting- causes viral secondary
diarrhea testing on bacterial
later see blood- urine- infections.
neurologic or other body Prognosis is
al signs fluids (See poor
canine
distemper post)
Coronavirus More severe in Diarrhea- Virus isolation Intravenous

very young dogs- poor or electron fluids if
especially those appetite- microscopy of dehydrated
with other lethargy- biopsy antibiotics to
intestinal
sometimes prevent
diseases more of
a problem in
vomiting secondary
animal shelters bacterial
or where there infections
are large
numbers of
stressed dogs
Toxins Strychnine- Those left Loss of History and Depends on

ethylene glycol- unattended or appetite- physical exam toxin
lead- zinc unsupervised depression tests ( - fecal
- vomiting- flotation) to
dehydration rule out other

- causes testing
abdominal of blood- feces
pain or vomit for
presence of
toxin x-rays
Idiopathic Small breed Sudden History Intravenous

Hemorrhagic dogs onset of physical exam fluids-
Gastroenteritis bloody complete blood antibiotics to
vomiting count tests ( - prevent
and fecal flotation) secondary
diarrhea- to rule out bacterial
depression other causes infection-
- withhold
abdominal food and
pain- black water as
and tarry needed
stools-
shock
Small German Intermitten History Antibiotics

intestinal shepherds- t watery physical exam (at least 4-6
bacterial dogs with other diarrhea- intestinal weeks)
overgrowth intestinal poor biopsy tests ( - modify diet
(SIBO) also diseases growth or fecal flotation)
called weight to rule out
antibiotic loss- other causes
resistant increased ultrasound
diarrhea gas- blood tests ( -
sometimes serum folate
vomiting and cobalamin-
bile acids)
Tumors Lymphoma- Middle-age or Chronic History Chemothera

adenocarcinoma older diarrhea- physical exam py or surgery
weight intestinal depending
loss- poor biopsy upon the
appetite type of
may see tumor
vomiting
and dark-
tarry stools
Idiopathic Granulomatous Middle-age Chronic History Modify diet-

inflammatory enteritis- LPE in German vomiting physical exam wormers and
bowel disease eosinophilic Shepherds and and intestinal antibiotics to
gastroenterocoliti Basenjis diarrhea biopsy tests ( - treat or
s- or possibly fecal flotation) prevent

lymphocytic/ with blood to rule out hidden
plasmacytic and/or other causes infections
enteritis (LPE) mucus probiotics
sometimes anti-
straining- inflammator
mild y drugs
weight immuno-
loss- suppressing
and/or drugs if no
black and response to
tarry stools other
treatment
Histoplasma Those living in Loss of biopsy Itraconazole-

enteritis or the central US appetite- ketoconazole
colitis along the mild fever-
Mississippi- depression
Ohio- and - severe
Missouri Rivers weight
loss-
vomiting-
blood in
stool-
straining
may also
have
respiratory
signs
Obstruction Foreign body- Diarrhea- History Surgery
intussusception- vomiting- physical exam
pyloric stenosis- loss of x-rays barium
splenic torsion appetite series
as ultrasound
progresses exploratory
see surgery
depression
and/or
possible
abdominal
pain
Pancreatitis Dogs eating a Vomiting- History Restrict oral
high-fat meal dehydratio physical exam; intake as
Schnauzers and n- painful chemistry needed
Yorkshire abdomen panel other administer
blood tests fluids

terriers middle- (e.g.- PLI or provide pain
aged dogs pancreatic control and
lipase other
immunoreactiv supportive
ity) care
medications
to control
vomiting
maintain on
low fat diet
Liver or Hepatitis- biliary Vomiting History medications

Biliary obstruction yellow physical exam and fluids to
Disease discolorati chemistry control
on of gums panel other effects of
and whites blood tests x- vomiting and
of the eyes rays and/or liver disease
ultrasound possible
biopsy surgery
depending
on cause
Kidney Pyelonephritis- Older dogs Vomiting- History Diet changes
Disease glomerulonephriti increased physical exam medications
s- urinary thirst and chemistry and fluids to
obstruction urination panel control
decreased urinalysis x- effects of
or no rays and/or vomiting and
urination if ultrasound kidney
obstructed disease
remove any
obstruction
Peritonitis Perforated Vomiting- History Antibiotics-

intestine painful physical exam fluids
abdomen chemistry medications
sometimes panel to control
fever complete blood vomiting
count x-rays possible
and/or surgery
ultrasound depending
upon cause
Pyometra Unspayed dogs Vomiting History Surgical

(infection of who have increased physical exam removal of
the uterus) recently had an thirst and complete blood uterus
estrus (heat) urination count x-rays

and/or medical
ultrasound treatment
Diabetes Older and Vomiting History (Not

mellitus female dogs increased physical exam available )
Schnauzers and thirst and chemistry Insulin
Poodles urination panel therapy
sometimes urinalysis dietary
depression management
supportive
care
medications Digoxin- Vomiting History medications

erythromycin- physical exam to control
-drug levels vomiting
change drug
therapy
Septicemia Vomiting- History Antibiotics
fever physical exam supportive
blood culture care
Hypo- Young to Vomiting History medications

adrenocorticis middle-age physical exam to control
m (Addison's female dogs chemistry effects of
disease) panel hypo-
complete blood adrenocortici
count sm
Gastritis Helicobacterinfec Vomiting History medications

tion high blood physical exam to control
urea nitrogen endoscopy !! vomiting and
(BUN) stomach protect
worm stomach
treat
underlying
cause fluids-
if necessary
Ulcers Vomiting History medications

blood in physical exam to control
vomit endoscopy !! vomiting and
black- or barium protect lining
tarry stools series of stomach
and
intestines
treat
underlying

cause fluids-
if necessary
Gastroesopha More common Drooling- History Feed small-

geal reflux in licking of physical exam low-fat
brachycephalic lips- endoscopy !! meals
breeds (eg- vomiting or barium medications
bulldogs and or series to help
pugs) regurgitati protect
on- bad esophagus-
breath reduce
stomach acid
and increase
movement of
food out of
stomach
Bilious May be more Vomiting History Feed a late

vomiting common in of bile on physical exam night meal
syndrome dogs with an empty endoscopy !!or medications
giardiasis or stomach barium series to help
V. Rare
inflammatory (usually protect the
bowel disease late at stomach and
night or increase
early movement of
morning) food out of
stomach
Motion Drooling- History medications

sickness vomiting physical exam to control
while vomiting
riding in a
vehicle

Splenectomy Surgery by Salem Serag
Total Splenectomy
Description
A splenectomy is the surgical removal of a dog's spleen to treat splenic neoplasia – rupture -
torsion
Partial splenectomy (splenorrhapy) removal of a portion of the spleen however total splenectomy
offers more control of hemorrhage.
Indications
Splenic tumors
Splenic rupture
Splenic torsion
Splenic Infection
certain unresponsive immune diseases
***Splenectomy is generally contraindicated in patients with immune-mediated hematologic
disorders
What You Will Need
• Standard general surgery pack
• Suture for ligation (generally 0 to 2-0 size depending on patient and pedicle size)
• 4 to 8 large Curved hemo-static forceps
• Self retained retractor
• Abdominal laparotomy sponges or surgical tampons
Some considerations:
1- Anatomic considerations
the blood supply of the spleen
1) Short gastric arteries
2) Dorsal splenic branch
3) Main splenic branch
4) Omental branch

2- Anesthesia considerations
Thiopental and ketamine and propofol can cause splenic engorgement ( propofol is the least )
So it is not recommended the use of thiopental – ketamine In splenectomy operation
Operation Steps
1. Abdominal incision
ventral midline celiotomy incision from the xiphoid to caudal to the umbilicus to enable
complete abdominal exploration
2. Insert the retractor to help expose the abdominal viscera
3. Exteriorize the spleen and the stomach fundus

to expose the short gastric vessels attached to the head of the spleen
***If the spleen is friable or ruptured do not grasp or pull it from the abdomen But simply push
the abdominal wall edges down (dorsally) and allow the spleen to "spill out" of the incision.
Cross-clamp with 3 forceps and incise the short gastric vessels to release the head of the spleen
as follows:

- Cut between clamp 2 and 3 (green line)

- Ligate before clamp 1 and before clamp 2
Clamp and ligate the Main splenic branch and the dorsal branch and omental branch
careful to preserve the left gastric epiploic artery un cut which located close to this main
splenicbranch
Cut between the clamp and ligation and remove the spleen with the associated clamps
*** make sure to secure and tighten the ligation to prevent any bleeding
Characteristics of Secure vessels Ligation
• Tight ligature

• Tight knots with 4 square throws
• Cuff of vessels extends past ligation site
• No tension is placed on pedicle during clamping or ligation
• Critical vessels are double-ligated
4- Skin closure
Suture the peritoneum - linea alba and the S/C with absorbable suture material as PDS – Vicryl
Size 2/0-4/0
Suture the skin with monofilament non absorbable material as Nylon

‫وهج السراج جمع وترتيب بوستات د‪ .‬سالم سراج‬
‫‪Medical Approaches Series Post no. (1) Diarrhea Medical‬‬
‫‪approach by Salem Serag‬‬
‫في البدايه هيكون في شرح بالعربي عشان المعلومه توصل اسهل ‪ ....‬في سطرين يعني كده ايه كلمه ‪approach‬‬
‫باختصار يعني ازاي حضرتك هتدخل تتعامل مع الحاله من منطلق العرض اللي بيشتكي منه ال ‪ owner‬و ازاي حضرتك‬
‫توصل منه ل انك تشخص الحاله وبناء عليه تعالج بطريقه صحيحه ك دكتور وتبعد عن شغل عالج االعراض اللي ملوش‬
‫عالقه بالطب‬
‫?‪Diarrhea‬‬
‫‪Diarrhea is the passing of loose or liquid stool … Diarrhea may be due to primary GIT‬‬
‫‪disease or non GIT disease as liver disease and uremia etc. ….‬‬
‫قبل ما نبدا ال ‪ steps‬الزم نعرف ال ‪common cause of diarrhea‬‬

‫ليله طويله واسباب كتير ودول اشهرها‬
‫‪‬‬ ‫)‪Dietary causes (food allergy –foreign body ingestion - Indiscretion‬‬
‫‪‬‬ ‫‪Parasite infestation‬‬
‫‪‬‬ ‫‪Toxin ingestion‬‬
‫‪‬‬ ‫)‪Infectious cause (viral -bacterial etc.‬‬
‫‪‬‬ ‫‪Allergic reactions‬‬
‫‪‬‬ ‫) ‪IBD ( inflammatory bowel disease‬‬
‫‪‬‬ ‫)‪Non GIT diseases (Liver diseases -Kidney diseases -Endocrine diseases‬‬
‫‪‬‬ ‫‪Cancers‬‬
‫‪‬‬ ‫‪Medications‬‬
‫‪‬‬ ‫‪Colitis‬‬
‫‪‬‬ ‫‪Motility disorder‬‬
‫االسباب كتير بالتالي الزم يكون في اسئله كتير عشان تعمل ‪narrowing the list of the possible causes‬‬
‫‪Step no. 1: Data collection‬‬

‫اول خطوه هي ان حضرتك بتجمع بيانات عشان البيانات دي هي اللي هتقرب حضرتك من التشخيص وتعمل ‪rule out‬‬
‫لباقي االمراض وده بيكون عن طريق كذا حاجه واالسئله اللي تسالها ومدلول االسئله دي ايه بالنسبه ليك‬
‫ممكن حضرتك تعمل ‪ sheet‬وتكتب فيه االسئله دي وتطبعه وتتابع بيها الحاله لما تجيلك اسهل‬
‫كل سؤال بتساله بيقربك من مجموعه امراض وبيبعد عنك مجموعه امراض عشان كده كل ما تسال بيكون افضل ليك‬
‫(‪ )104‬جروب فيلداوى ثائرفيسبوكى‬

History taking and related question to the case
a) Case History :
1- Vaccinated or not?
( if truly finished the vaccination program so u can rule out the idea of catching
infection of these viruses and bacteria )
‫لو الحيوان محصن ممكن تستبعد االمراض المحصنه من انها كون المسبب في االعراض الحاليه‬
‫لو ال وهو في السن المعرض لالصابه هبدا افكر في االمراض اللي تعمل العرض ده انها ممكن تكون سبب قوي‬
2- Deworming Program
( if the animal is routinely dewormed (internal and external parasites ) every 2-3
months this reduces the possibility of being infected with these parasite )
‫لو الحيوان منتظم على جدول للطفيليات بيقلل نسبه امكانيه حدوث االصابه بيها‬
3- The diet: it gives you an idea about
-how healthy he/she eats and how can this be reflected on the case your facing now
.. ‫الحاله العامه وهل االكل صحي او ال‬
- food allergy for certain types of food ‫بعض االطعمه تسبب حساسيه و اسهال‬
4- Any access to garbage or medications
-it will also focus on if he may ate something toxic or not
b) Questions to ask the owner
- When did it start (diarrhea)?
- The onset of the diarrhea?
‫ واللي كل حاجه منهم ليها طريقه تشخيصها زي ما‬intermittent ‫ وال‬chronic ‫ واال‬acute ‫هيفرقولي هنا بين هل ده‬
‫هنشوف تحت‬
• Acute : if it lasts for less than 7-14 days
• Chronic : if it persists for longer than 14 days.
• Intermittent: Comes and goes
Acute diarrhea either: (self-limiting) or (Life threatening)
‫الزم اعرف هنا افرق بينهم عشان كل حاجه وليها سكتها‬
Self-limiting: usually resolve within 5 days with supportive treatment (require minimal
diagnostics and therapy)
Life threatening: requires more investigations & intensive care

How to tell it is a life threatening condition?
If the patient with some of the followings
• Moderate to severe dehydration
• Abdominal pain
• Abdominal mass
• Depression
• Melena or hematochezia
• Frequent vomiting
• Signs of systemic illness, such as:
• Ascites • Hepatomegaly
• Lymphadenopathy • Oliguria/anuria
• Coughing • Icterus
• Ocular and nasal discharge • Fever
Suffered from episodes of diarrhea in the past?

‫ وبالتالي ترمي تركيزك في‬dietary intolerance ‫ ممكن تكون‬intermittent ‫لو بتتكرر كل فترة تركز في نقطه ال‬
‫النقطه دي شويه‬
Bright and alert or depressed and lethargic?

‫هنا بتاخد فكره عن‬how urgent the case ‫ هل الحاله خلصانه وبتودع ف يبقى في‬necessary urgent diagnosis
and treatment
How is the appetite???
a good sign of how simple ‫لو بياكل ومزأطت وعايش حياته وكل البراميترز كويسه بس في اسهال تقدر تعتبر ده‬
systemic illness ‫ ولو ال يبقى العكس واحتمال‬this case
How it looks like (diarrhea I mean):
 Consistency : Watery or just slightly loose
‫ عشان دي مصيبه الن مع ال‬dehydration and fluid loss ‫ يعني هبدا احط في دماغي ال‬watery watery ‫لو‬
‫ وبالوي كتير‬arrest ‫ او‬shock ‫ و ممكن يدخل في‬electrolyte disturbance ‫ ده هيبقى في‬fluid loss
‫ وعشان تجاوب على السؤال‬how severely dehydrated he is ‫السؤال التاني هناعند النقطه دي بقى تساله لنفسك‬
‫ ودي هتقراها بس تحت شويه هقولك عليها‬dehydration assessment ‫ده هتعمل حاجه اسمها‬
‫ معلش على الصوره بقى‬fecal scoring system ‫ بيقاس ب حاجه اسمها‬consistency ‫ال‬

‫?‪ There is a blood in the stool‬‬

‫الجميل في موضوع الدم ده انه بيعرفك ال ‪ severity‬ومكان االصابه هل هو ‪ small bowel‬وال ‪large bowel‬‬
‫ودي نقطه محوريه جدا الن قدام شويه في اول خطوات التشخيص مع حضرتك هتحتاج تعمل ‪localization of the‬‬
‫‪ origin of the diarrhea‬وكمان هل هو ‪life threatening‬وال ال واللي بناء عليهم هتعالج‬
‫‪Is there any other signs other than the diarrhea (vomiting in particular) or any‬‬
‫?‪other signs‬‬
‫هنا بقى حضرتك بتبدا تستوضح الصوره عن طبيعه المرض هل هو خاص ب ‪ system‬واحد وال بياثر على كذا ‪system‬‬
‫ف ابدا اقرب من مرض او مجموعه استبعد الباقي‬
‫طيب وليه السؤال عن الترجيع باالخص النه بيديني صوره عن ان المرض ده‬
‫‪Affecting the frontal and rear parts of the digestive tract … so this may be‬‬
‫‪something the pet has eating like toxins and affecting the whole GIT‬‬
‫كمان االعراض ممكن تدل على مرض معين مثال بارفو او غيره اعراض واضحه تقربني من التشخيص يبقى في الحاله دي‬
‫ناقصني اني اعمل ‪ confirmation‬بالتحاليل‬
‫?‪Received any medications (drugs) lately and any disease lately‬‬

‫سؤال بديهي يعني ‪ ...‬ممكن يكون االسهال ده بسبب دوا ال ‪ owner‬اداهوله من دماغه او حتى عالج موصوف له بس‬
‫بيعمل اسهال ك ‪side effect‬‬
‫تاني نقطه هل تعب او جاله اي مرض الفتره اللي فاتت ده سؤال مهم جدا في نقطه مهمه جدا وهي‬

‫ بتفضل تاثر‬chronic ‫ يعني ايه اللعبكه دي يعني في امراض‬chronicity in relation to previous diseases
‫ وغيره هيجو بعدين بردو في ال‬Cushing syndrome ‫ و‬liver diseases ‫ و ال‬PSS ‫على فترات طويله زي‬
scheme
large ‫ وال‬small bowel ‫ هقوله هنا وهقول مدلوله في النقطه بتاعه‬owner ‫في سؤال اخير بقى عشان تخلص من ال‬
‫ اي وصف من االتنين دول هو االقرب‬owner‫ السؤال لل‬.. ‫ عشان الصوره تكون اوضح‬bowel
Which of these two descriptions best fits the diarrhea ‫؟‬
a) Your pet is producing huge amounts of explosive diarrhea a couple of times a day at
most, or
b) your pet is straining to defecate and passing small amounts of mucus covered diarrhea 4
or more times during the day
 ‫ بره عشان تبدا تشتغل على رواقه‬owner ‫يعد ما تسال االسئله دي ممكن تطرد ال‬
‫ و‬Physical examination ‫الخطوه الجايه هي التشخيصيه اللي فيها ال‬
 ‫ وبعد ما تحدده تعالجه باذن هللا‬plan for specific tests to determine the cause of diarrhea
Step no 2 (Diagnostic approach)

a) Physical exam
‫ و‬general health condition ‫ ل ال‬assessment ‫الموضوع هنا ببساطه انك هتشوف كل الباراميترز وتحاول تعمل‬
assessment ‫ وكمان لو في جفاف تعمل له‬.. ‫اصال‬GIT ‫ وال مش‬large ‫وال‬small bowel ‫المرض هنا فين بالظبط‬
life threatening ‫ وال‬self-limiting ‫ و‬chronic ‫ وال‬acute ‫و‬
1- Check temperature … feverish or not
2- Check the gum … color & CRT (capillary refilling time ) … gives u indication about
circulation condition
3- Abdominal palpation(see if there is pain along with or not in case of ulcers or
foreign body - check the intestinal thickness – masses )
4- Rectal palpation ( thickness of rectum – lymphadeopathy – masses )
5- Check the respiration and the heart rate … also about general health assessment
and multi systemic diseases
6- Dehydration assessment ‫كنا قلنا هنتكلم عليها بعدين‬
‫ازاي اعمل الموضوع ده‬
SFT ( skin fold test ) ‫ في اختبار اسمه‬-1

skin will pop back to its normal ‫ ال‬normal ‫ وبعدين اسيبه في ال‬scruff ‫باجي امسك الجلد من عند ال‬
‫ ممكن ميرجعش ويفضل‬severe ‫ في الجفاف بقى بيفضل حبه وبعدين يرجع لمكانه ولو الحاله‬position immediately
fold ‫عامل‬

‫ عشان هنحتاجها في العالج بعدين ببساطه شوف الجدول‬Dehydration % ‫ طيب انا عايز احدد ال‬-2
Dehydration % Physical findings
Mild (5%) Minimal loss of skin turgor - semidry mucous membranes,

normal eye
Moderate ( 8%) Moderate loss of skin turgor ( elasticity ) dry mucous
membranes, weak rapid pulses, enophthalmos (sunken eye)
Severe (10-12%) loss of skin turgor -severe enophthalmos –tachycardia -
extremely dry mucous membranes - weak/thready pulses,
7- Localization of diarrhea
large bowel ‫ وال‬small bowel ‫طيب عايزين نحدد المشكله من‬
‫جدول نبص عليه وبعدين نرجع لسؤال من اللي كنا سالناهم‬

Symptoms of diarrhea due to a small intestine disease versus a large intestine disease
Symptom Small Intestine Diarrhea Large Intestine Diarrhea

Volume of stool Huge volume Small volume
Frequency Normal 2 times / day very increased 4 or more
Straining Uncommon Common
Blood present Melina ( black tarry ) Hematochezia ( red blood is seen )
Mucous present No Large amount common
Increased gas Possible Uncommon
‫السؤال بقى كان‬
Which of these two descriptions best fits the diarrhea?

a) your pet is producing huge amounts of explosive diarrhea a couple of times a day and
may be tinged black
b) your pet is straining to defecate and passing small amounts of mucus covered diarrhea 4
or more times and contain blood
‫ طيب انت قارفنا واصال هتفرق ايه النقطه دي‬....large ‫ يبقى‬B ‫ لو‬small bowel ‫ يبقى‬A ‫لو االجابه‬
. ‫ وفي العكس بالتالي اني احدد اي نوع هتقلل االحتماالت‬small bowel diarrhea ‫ في امراض بتعمل‬.. ‫اقولك‬
) ‫ طب زي ايه )خد فكره‬... ‫بس طبعا الكالم ده مش قاعده‬

Small bowel
Viruses ( CDV CPV CCV FPV FCV )
bacteria ( salmonella – clostridia –cambylobacter )
fungal infection ( Histoplasmosis )
Worms and Giardia
Gastric ulcer
Foreign bodies ( bones –sticks .. )
Food allergy
hyperthyroidism
Toxins
IBD inflammatory bowel disease in both
Tumors
protein-losing enteropathy
Large bowel
Whipworms
polyps
IBD
Colonic ulcers
Colonic tumors
Stress
Diseases outside the intestinal tract
liver failure – kidney failure – pancreatic diseases – Cushing disease - PSS
‫ دي باجابات االسئله دي‬2 ‫مهم جدا اني اكون طالع من النقطه‬
1- Acute or chronic
2- self-limiting or life threatening?
3- Small bowel or large bowel?
4- Assessment of the dehydration status
5-GIT or non GIT disease (systemic illness)?
6- Possible causes of the diarrhea
7-General health condition of the patient

Step 3: diagnostic tests
‫ خطوه دي عن التحاليل اللي بتقربني لتشخيص معين او حتى تاكده‬3
‫في ناس هم اعداء التحاليل ليه معرفش بس احب اقول ان الواحد من غير التحاليل دي تقريبا كده = دجال‬
a) Diagnostic lab
Fecal analysis - CBC – Chemistry panel – urinalysis
b) Diagnostic imaging
X-ray – Ultrasound - Endoscopy
c) Diagnostic histopathology
Biopsies
d) Specific tests
‫*** مع انها مش موضوعنا بس عشان الفايده في بعض الناس متعرفش التحاليل دي بتتعمل ليه او لو اتعملت حتى هتبص‬
‫على ايه ولو بصت مدلول الكالم ده ايه ف باختصار هتكلم كلمتين على التحاليل دي وكل تحليل بيقربني من تشخيص ايه فيما‬
‫يخص موضوع النهارده مش كل التحاليل‬
a) Lab investigations
1- Fecal analysis
 floatation  parasites and protozoans like giardia
 Culture  bacterial diseases & trophozoid (giardia )
2- CBC :-
 WBC’S leukopenia supply is depleted by infection
 leukocytosis  infectious or inflammatory diseases
Neutrophilic leukocytosis  acute bacterial infection
Eosinophilic leukocytosis  allergy – parasites – IBD
Basophilic leukocytosis  allergic reaction
Monocytosis  chronic infections – IBD
Lymphocytosis  viral infections
 RBC’s & Hb  when decreased  anemia – GIT bleeding( haemorrhagic
disease)
3- Chemistry panel
 Liver function : for liver related diseases as Porto-systemic shunt (PSS)
- In liver failure :liver enzymes (ALT – AST- GGT –ALP )  increase then
eventually decrease Serum albumin decrease and bilirubin increase

- Serum albumin decrease in  liver failure – PLE ( protein loosing enteropathy )
- Serum globin decrease in  PLE
 Kidney functions : for kidney failure
- Increased (creatinine – BUN – urea – total protein )
 Electrolyte panel : assess electrolytes – acidosis – shock – endocrine diseases (as
Addison’s disease )
 Thyroxine : total t4 & free t4 hypo & hyperthyroidism
 Serum TLI : ( trypsin like immune-reactivity )  pancreatic insufficiency
 CPL : in pancreatitis
 serum B12 (Dec) – folate (INC)  bacterial overgrowth in small intestine (SIBO)
4- Urinalysis :
In kidney failure  Specific gravity (decreased) - proteinuria
b) Diagnostic imaging
 X-ray:
Plane  any masses (tumor) – foreign bodies - anatomical abnormality
Contrast GIT motility analysis – GIT obstruction
 Ultrasound
Masses – ascetic fluids (liver diseases) poor differentiation of kidney (kidney failure)
c) Diagnostic histopathology ( Biopsy ) :
 Tumors (lymphoma or other neoplasia ) – IBD – Fungi
d) Specific tests
When specific disease is suspected (like parvo ELISA – Giardia etc...)
Step 4: Diagnostic algorithm

... ‫ نرتب بقى افكارنا في الخطوه دي‬.... ‫معلومات كتيره ودش كده والدنيا ملخبطه‬
‫ بتعتمد على مدي انت ملم للمواضيع ومذاكر بس طبعا هنا اهي مجمعهالك‬disease algorithm ‫اخر خطوه دي بيسموها‬
biochemistry ‫ زي بتاعه ال‬scheme ‫ وهي باختصار‬ ‫على الفرازه‬
‫ روح شمال وهكذا لحد ما توصل للتشخيص‬no ‫ روح يمين لو‬yes ‫ لو‬no ‫ و‬yes
‫ بس حماده حلو يعني‬ ‫نركز بقى عشان اللي فات ده حماده وده حماده تاني خالص‬

1- NPO for 24 hrs. Diarrhea

2- Diet:
* Fat restricted History + physical exam
* Bland diet (rice &
chicken) Finding suggests a specific disease
* Probiotic yoghurt
3- Correct dehydration Yes No
4- Empiric (deworming):
* Fenbendazole 50mg/kg Confirmatory tests +ve Determine the case onset
PO once daily / 5 days
* Metronidazole 10-20
mg/kg PO BID / 5 days Treat this disease accordingly Acute Chronic
5-Anti-diarrheal
medication
`1 Self-limiting Life Threatening
*Loperamide (Imodium)
Dogs: 0.08–0.2 mg/kg PO Treatment Trial
Q 6 –12 H
Cats: 0.04 mg/kg PO Q Treat with specific anthelmintic
12–24H +ve Fecal analysis
eg. : +ve Giardia - Treat with
6-Antibiotic (indicated
only if +ve bacterial specific anthelmintic for giardia
(fenbendazole +metronidazole) -ve
infection)
Empiric treatment with

Confirm the Yes Finding suggests a specific disease broad spectrum
disease with
anthelmintic then start lab
other
investigations (CBC -
investigation&
No chemistry panel -urine
signs then treat it
analysis –TLI)
eg: findings and
signs suggest Localize the diarrhea
parvo virus:
confirm with
ELISA then treat Small intestine Large intestine
Subsequent episodes of diarrhea First episode of diarrhea

Non specific findings Full lab investigations+Rectal exam+Diagnostic imaging Treatment trial (as acute self-limiting)
Biopsy Laboratory investigation Hemat- Fecal examination Diagnostic imaging

ology-chemistry-urine analysis
Direct smear -bacterial culture X-ray – ultrasound -contrast x-ray
Inflammatory Systemic disease Enteric infection (bacteria Other pelvic/abdominal

Bowel Disease Treat accordingly – fungi - parasites) diseases
Treat accordingly
Small intestine / large intestine NO response

Histiocytic ulcerative
colitis
TLI < 8 Further investigations PLI > 12
ttt: mg/L mg/L
Fluoroquinolones Coblamin – Folate – TLI - PLI
Lymphoplasmacytic- Pancreatitis ttt :

Exocrine Cobalami Folate <
eosinophilic
pancreatic n < 300 9.7 -Low fat diet
ttt: Diet- antibiotics- insufficiency
-pain medications
immunosuppressives Distal small intestine Proximal small
ttt: Enzyme -antiemetics
disease Cobalamin
supplimentation Intestinal disease
Deficiency
-steroids
Lymphoma or ttt: Cobalamin Folate acc to case
supplementation
other neoplasms Supplementation 150–250
mg/dose SC once a week if only below 4
for 6 weeks
ttt: Surgery -
Chemotherapy
In case of small intestine diarrhea at this point
you can start with a treatment trial as follow:
1- NPO (nothing per os) 24hrs.

Dietary trial – Antibiotic
2-Diet: rice and chicken -probiotic yoghurt
trial – Biopsy No
response 3-Empiric (deworming) if not given earlier
Dietary trial:read from post
4-Anti-diarrheal medication
no 12
5-Antibiotic trial
Antibiotic trial: tylosin 25
6-B12 + folic acid supplementation
mg/kg PO BID / 6 weeks
7-Pain medication if indicated
Biopsy : treat acc to disease
And if no response you can continue these
revealed investigations discussed in the algorithm beside

‫‪Dermatology by Salem Serag‬‬
‫بخصوص البوست شويه نقط مهمه ‪-:‬‬
‫‪ -1‬الموضوع عبارة عن ملف مضغوط فيه ‪folders 4‬‬
‫*االول فيه االمراض زي ما قلت مكتوبه بخط االيد من زمان ف لو مش واضح بالنسبه لكم هبقى اكتبهم‬
‫‪word‬‬
‫* االمراض مكتوبه باختصار ( ‪) Etiology - Signs - Diagnostic tests - treatment‬‬
‫* الثاني ‪ photo gallery‬فيه صور لبعض االمراض مش كلهم ( ‪ 18‬مرض )‬
‫* الثالث فيه جداول للكل االدويه الخاصه بال ‪ derma‬بجرعاتها باستخداماتها‬
‫* الرابع فيه ‪ 3‬ورقات كلمتين كده عن ال ‪diagnostic tests‬‬
‫‪ -2‬بالنسبة للتشخيص‬
‫اوال ‪ Derma=Tests‬ف ‪ % 90‬من الحاالت‬
‫االعراض بتاعت المرض بتقربك لل ‪ diagnosis‬عشان تعرف هتعمل اختبارات ايه اما موضوع اشخص‬
‫بالنظر او بالحب يعني مينفعش في الجلديه‬
‫بالنسبه ل ‪cytology – skins craping – fungal culture – wood's lamp‬‬
‫فدول سهل انك تعملهم في عيادتك ومش هيكلفوك حاجه تقريبا‬
‫ال ‪ biopsy‬هتاخد العينه انت وتبعتها لمعمل ‪ Histopathology‬افضل‬
‫بالنسبه ل ‪ intradermal skin tests‬و ‪ specific IG‬فدول مش متوفرين‬
‫الخالصه فيهم انهم بيكونو المراض ال ‪ allergy‬ف انت هتشخص ازاي‬
‫هتعمل ‪ rule out‬لالمراض التانيه عن طريق االختبارات اللي فوق و لو مفيش حاجه هتعالج على انها‬
‫‪ allergy‬بغض النظر عن نوع ال ‪ allergen‬اللي االختبار كان هيطلعه‬
‫لو في أي حاجه مش واضحه اكتبها لي وانا ان شاء هللا موجود‬







































‫‪Punch‬‬
‫‪biopsy‬‬
‫‪Wood’s lamp‬‬ ‫‪sterile-beveled-stacker-petri-dish‬‬

Photo Gallery
Atopy
atopic-kyla Atopic-dermatitis_medium Allergy testing
Callie_allergy_skin_testing atopy

Superficial Pyoderma
Bacteria Pyodemra
Contact hypersensitivity

‫‪Cushing disease‬‬

‫‪Dermatomyositis‬‬
‫‪Flea bite hypersensitivity‬‬

‫‪Folicular dysplasia‬‬

‫‪Food adverse reacion‬‬

‫‪Hypothyrodism‬‬
‫‪Malasezia‬‬

‫‪Mange‬‬


‫‪Mast cell tumor‬‬

‫‪Metabolic Epidermal Nec‬‬
‫‪Pemphigus Foli‬‬


‫‪Ringworm‬‬

‫‪Seborrhea‬‬
‫‪Sertoli cell tumor‬‬

‫‪Zinc dermatosis‬‬



























‫خالص تحياتى‪ /‬ثائرفيسبوكى‬
‫أسألكم الدعاء بالشفـاء‬

وَهَجِ السِّرَاجِ جمع وترتيب بوستات د.سالم سراج

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وَهَجِ السِّرَاجِ جمع وترتيب بوستات د.سالم سراج

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‫َو َهج الس َراج جمع وترتيب بوستات‬ ‫ثائرفيسبوكـ ـى‬

‫د‪.‬سالم سراج‬ ‫جروب فيلداوى‬

the most common infectious disorder of dogs worldwide

*Signs and symptoms

‫) جروب فيلداوى ثائرفيسبوكى‬1(

2- Fecal PCR : is not routinely commercially available. )‫(مش موجود في مصر‬

The goals of treatment are :-

‫ دي احسبها ازاي‬% Dehydration ‫طيب ال‬

‫) جروب فيلداوى ثائرفيسبوكى‬3(

8 x 10 = 80 ml = Dehydration deficit ‫ كيلو يبقى‬10 ‫ ووزنها‬moderate ‫يعني لو حالة‬

3- Anti -emetics : If vomiting or nausea persists

4- Pain Medications: for relief of the abdominal pain

‫) جروب فيلداوى ثائرفيسبوكى‬4(

‫) جروب فيلداوى ثائرفيسبوكى‬5(

‫) جروب فيلداوى ثائرفيسبوكى‬6(

‫) جروب فيلداوى ثائرفيسبوكى‬7(

‫) جروب فيلداوى ثائرفيسبوكى‬8(

‫) جروب فيلداوى ثائرفيسبوكى‬9(

‫) جروب فيلداوى ثائرفيسبوكى‬11(

‫) جروب فيلداوى ثائرفيسبوكى‬12(

‫) جروب فيلداوى ثائرفيسبوكى‬13(

‫) جروب فيلداوى ثائرفيسبوكى‬15(

‫) جروب فيلداوى ثائرفيسبوكى‬16(

● In combination with any opioid to improve the reliability of sedation/premedication.

● In combination with (an opioid and) ketamine for anaesthesia.

‫) جروب فيلداوى ثائرفيسبوكى‬18(

Indications (When to perform C – Section?) If:-

2- Uterine Inertia (absence of uterine contractions )

4- Prolonged gestation greater than 68 days

C- Section is More common (predisposed ) in

‫) جروب فيلداوى ثائرفيسبوكى‬19(

Preanesthetic Propofol Induction Dose Propofol Rate of Administration

‫) جروب فيلداوى ثائرفيسبوكى‬20(

‫) جروب فيلداوى ثائرفيسبوكى‬21(

Preparation of the Dam to the surgery

‫) جروب فيلداوى ثائرفيسبوكى‬22(

2- Opening the abdomen ( Skin – s/c – Linea alba – peritoneum )

3- Exteriorizing the uterus

4- Opening the uterus

‫) جروب فيلداوى ثائرفيسبوكى‬23(

5- Delivering the puppies

6-Removing the placentas

‫) جروب فيلداوى ثائرفيسبوكى‬24(

 inject oxytocin, 1 to 5 IU IV per dog.

 Wash the uterus with physiologic saline

‫) جروب فيلداوى ثائرفيسبوكى‬25(

Casteration = Neutering =Gonadectomy (Male) = bilateral orchiectomy

‫) جروب فيلداوى ثائرفيسبوكى‬26(

‫) جروب فيلداوى ثائرفيسبوكى‬27(

‫) جروب فيلداوى ثائرفيسبوكى‬28(

‫) جروب فيلداوى ثائرفيسبوكى‬29(

3- Repeat these steps with the other testis

‫) جروب فيلداوى ثائرفيسبوكى‬30(

Canine Distemper (CDV) = Hard Pad Disease

 Eye discharges and redness

‫) جروب فيلداوى ثائرفيسبوكى‬31(

Conjunctivitis, rhinitis, and facial dermatitis CDV Pad Hardness

Enamel Hypoplasia Nasal Discharge and Ocular discharge

‫) جروب فيلداوى ثائرفيسبوكى‬32(

Drugs I use in treating CDV