Small Animal Internal Medicine for Veterinary Technicians and Nurses

Linda Merrill, LVT, VTS (Small Animal Internal Medicine, Clinical Practice) is the executive director and founding chair of the Academy of Internal Medicine for Veterinary Technicians and organizing committee member of the Academy of Veterinary Technicians in Clinical Practice. She is also a former president of NAVTA and has nearly 30 years of practice experience in small animal, cardiology, oncology, and internal medicine.

• Contributors xiiiPreface xvChapter 1 Physical Examination 1Charting 1Goals of the consultation appointment 2Conclusion 9Chapter 2 Endocrinology 11Section 1 Pituitary Gland 11Growth hormone disorders 11Diabetes insipidus 13Section 2 Thyroid Glands 14Canine hypothyroidism 14Feline hyperthyroidism 16Canine thyroid tumors 20Section 3 Parathyroid Glands 22Hypoparathyroidism 22Hyperparathyroidism 23Section 4 Adrenal Glands 25Hypoadrenocorticism: Addison’s disease 25Hyperadrenocorticism: Cushing’s disease 26Pheochromocytoma 29Section 5 Pancreas 31Feline diabetes mellitus 31Canine diabetes mellitus 37Canine diabetic ketoacidosis 40Insulinomas 41Glucagonoma 45Section 6 Miscellaneous Hormones, Glands, and Disease 47Calcitriol 47Erythropoietin 48Gastrin 50Gastrinoma 51The kinins 52Melatonin 53Natriuretic peptides 55Renin 57Somatostatin 59Other rare neuroendocrine tumors 60Bibliography 62Chapter 3 Musculoskeletal 69Section 1 Anatomy and Physiology 69The skeletal system 69The muscular system 71Section 2 Selected Diagnostics in Musculoskeletal Disease 72Arthrocentesis 72Muscle biopsy 73Section 3 Diseases of the Musculoskeletal System 73Inflammatory joint disease 73Noninflammatory joint disease 76Neuromuscular diseases 77Inflammatory myopathies 78Hepatozoonosis 79Neoplasia 80Section 4 General Musculoskeletal Examination 81Section 5 Musculoskeletal Therapy 82Veterinary rehabilitation therapy 82Palliative radiation therapy 88Section 6 Musculoskeletal Nutrition 89Nutrients 90Antioxidants 91Energy and growth 91Osteoarthritis 92Body condition scoring 92Body condition score uses 92Muscle condition scoring 93Bibliography 96Chapter 4 The Neurological Examination 99Clinical signs and the relevant anatomy 99Seizures 102Encephalopathies 103Cerebral neoplasia 105Inflammatory/infectious etiologies: encephalitis 105Meningitis 107Cranial nerve syndromes 107Spinal diseases 109Neuromuscular diseases 113Diagnostic testing 114Pharmacology 119Nursing considerations 121Neurological glossary 122Suggested readings 124Chapter 5 Thrombotic Disorders in Small Animal Medicine 127Physiology 127Thrombotic disorders 129Diagnosis 130Therapy 132Client education 134Suggested readings 134Chapter 6 Respiratory 137Section 1 Upper Airway Disease 137Anatomy and physiology 137Diseases of the upper airway 137Nutritional considerations 140Anesthetic and analgesic considerations 140Section 2 Mediastinal Disease 141Anatomy and physiology 141Mediastinitis 141Pneumomediastinum 141Mediastinal masses 141Section 3 Lower Airway Disease 142Anatomy and physiology 142Clinical signs 142Diagnostic testing 142Specific airway diseases and treatment 143Anesthetic and analgesic considerations 146Section 4 Pulmonary Parenchymal Disease 146Anatomy and physiology 146Clinical signs 146Diagnostic testing 147Treatment 148Diseases 148Nutritional considerations 151Anesthetic and analgesic considerations 151Section 5 Pleural Disease 152Anatomy and physiology 152Clinical signs 152Diagnostic testing 152Treatment 154Nutritional considerations 156Anesthetic and analgesic considerations 156Section 6 Anesthesic and Analgesic Considerations in Respiratory Disease 156Premedication 156Induction 157Maintenance anesthesia 157Monitoring 157Recovery 157Section 7 Feeding Considerations for Respiratory Disease 157Bibliography 158Chapter 7 Hematology 161Section 1 Anatomy and Physiology 161The circulatory system 161The lymphatic system 162The spleen 162The coagulation system 163Section 2 Red Blood Cell Disorders 163Anemia 163Polycythemia 167Transfusion medicine 167Immune-mediated hemolytic anemia 171Section 3 Leukocyte Disorders 174Methods for determining the leukogram 174Disorders of neutrophils 175Disorders of eosinophils 180Disorders of basophils 180Disorders of monocytes 180Disorders of lymphocytes 181Section 4 Platelet, Coagulation, and Inherited Disorders 182Diseases of coagulation 182Disorders of platelets 184Breed-related disorders 188Bibliography 189Chapter 8 Gastrointestinal 193Section 1 Clinical Signs and Examination of the GI Patient 193Patient history 193Physical examination 194Clinical signs of gastrointestinal disorders 194Conclusion 197Section 2 Selected Diagnostics in Gastrointestinal Disease 197Laboratory evaluation 198Microscopic fecal evaluation 198Bacteriologic examination 199Virologic examination 199Occult blood 199Alpha1-protease inhibitor 200Imaging 200Special tests 201Conclusion 201Section 3 Gastrointestinal Disease 201Oral disease 201Esophageal disorders 204Gastric disease 207Alimentary tract parasites 213Diseases of the small intestine 216Diseases of the large intestine 235Section 4 Pharmacology 238Antacids 238Antiemetics 239Anti-inflammatory and immunosuppressive drugs 240Antibiotics 241Gastromucosal protectants 241Digestive enzymes 241Laxatives 241Section 5 Feeding Tubes 242Feeding tubes 242Esophagostomy tube placement 243Gastrostomy tube placement 244Jejunostomy tube placement 247Conclusion 247Feeding tube management and complications 247Section 6 Food Intolerance and Food Allergy 251Clinical signs 251Causes 251Diagnostics 251Treatment 251Elimination diets 252Proteins 252Carbohydrates 252Prebiotics and probiotics 253Section 7 Anesthesia and Analgesia Considerations in Gastrointestinal Disease 255Premedication 255Induction 255Maintenance anesthesia 256Monitoring 256Recovery 256Bibliography 256Chapter 9 Liver 263Section 1 Hepatic Disease 263Acute hepatitis 263Chronic hepatitis 265Copper-associated chronic hepatitis 266Hepatic lipidosis 268Toxic hepatopathy 270Hepatocutaneous syndrome 272Congenital vascular anomaly 274Liver neoplasia 275Section 2 Posthepatic Disease 276Feline cholangitis complex 276Biliary cysts 278Extrahepatic biliary obstruction 279Gallbladder mucocoeles 280Section 3 Nutrition in Liver Disease 282Protein 283Fats 283Carbohydrates 283Fiber 283Vitamins and minerals 284Feeding plan 284Section 4 Anesthesia and Analgesia Considerations in Hepatic Disease 284Premedication 284Induction 284Maintenance anesthesia 285Monitoring 285Recovery 286Bibliography 286Chapter 10 Urinary and Renal Diseases 289Section 1 Urinary Anatomy and Physiology 289Section 2 Clinical Signs 291Section 3 Urinary Diseases 292Chronic kidney disease 292Acute renal failure 293Urinary tract infections 294Pyelonephritis 295Urolithiasis 295Prostatic diseases 298Lower urinary tract disease in cats 299Ectopic ureters 299Urethral sphincter mechanism incompetence 300Protein-losing nephropathy 301Urinary neoplasia 301Section 4 Urinary Diagnostics and Therapeutic Implications 302Urinalysis 302Complete blood count and serum biochemistry profile 306Proteinuria 309Blood pressure 311Urine culture 313Section 5 Urinary Tract Biopsy Techniques 315Aspiration biopsy 315Biopsy 316Sample handling 319Postbiopsy nursing care 319Section 6 Urinary Imaging 319Radiology 319Ultrasound 321Cystoscopy and vaginoscopy 323Computed tomography 323Section 7 Renal and Urinary Disease Pharmacology 324Fluid therapy and correction of electrolyte imbalances 327Section 8 Anesthetic and Analgesic Considerations 335Anesthesia 335Pain management 336Section 9 Nutritional Considerations 336Chronic kidney disease 336Urolithiasis 338Feline idiopathic cystitis 341Bibliography 341Chapter 11 Infectious Diseases 349Section 1 Infectious Bacterial Diseases 349Bartonella 349Lyme borreliosis 350Canine brucellosis 352Ehrlichiosis 353Helicobacter-associated disease 355Leptospirosis 357Methicillin-resistant Staphylococcus aureus 360Mycobacterial disease 361Mycoplasmal diseases 363Plague 365Section 2 Fungal Diseases 366Histoplasmosis 366Aspergillosis 368Coccidioidomycosis 368Cryptococcosis 369Blastomycosis 370Section 3 Protozoal Diseases 374Amebiasis 374Babesiosis 374Giardia 375Trichomoniasis 375Leishmaniasis 376Toxoplasmosis 376Neosporosis 377Cytauxzoonosis 378Hepatozoonosis 379Section 4 Infectious Viral Diseases 381Canine and feline herpesvirus 381Influenza 383Papillomas 384Section 5 Infectious Disease Testing 385Disease prevention and control in the small animal hospital 395Bibliography 400Chapter 12 Vaccine, Vaccination, and Immunology 403Section 1 The Immune Response and Cancer Immunotherapy 403Innate and adaptive immune response 403Humoral and cell-mediated immunity 404Immunomodulation 404Cancer vaccines 404Cytokine immunotherapy 405Summary 405Section 2 Laboratory Diagnostics in Immunology 405Serology 405Biopsy techniques 407Section 3 Immunosuppressive Medications 409Corticosteroids 409Immunosuppresives 411Less commonly used immunosuppressives 412Novel immunosuppressive medications 412Immunomodulating medications 413Conclusion 413Section 4 Vaccines and Vaccination 413Vaccination strategies 413Canine vaccines 416Feline vaccines 422Vaccinations and adverse reactions 427Bibliography 429Chapter 13 Pain and Its Management 433Veterinary technician as pain management team leader 433What is pain? 434Pathophysiology of pain 434Types of pain 435Causes of pain 436General approach to pain control 436General rules of thumb in managing pain 436Questions to consider 437How to be an analgesic advocate for your patient 437Clinical signs and means of detection 438Pain scoring systems 439Analgesics 439Nursing care as analgesic 446Clinical examples 447Conclusion 448Bibliography 448Chapter 14 Nursing 449Section 1 Occupational Health and Safety 449Making the work place safe 449Health and safety committees 449Hazards in the workplace 450Chemotherapy safety 452Conclusion 453Section 2 Pharmacological Implications in Internal Medicine 453Drug calculations, compatibilities, dosing, and administration 453Constant rate infusion 453Drug compatibilities 454Drug dosage adjustments in patients with heart, renal, and hepatic insufficiency or failure 454Oxygen therapy 460Drug calculations 461Client education 462Section 3 Nutritional Support 463Nutritional support 463Energy balance: weight loss versus weight gain 468Refeeding syndrome 471Section 4 Diagnostic Procedures 474Cystocentesis 474Abdominocentesis 475Thoracocentesis 478Urinary catheters 480Bone marrow collection 484Section 5 Endoscopy 487Flexible endoscope 487Videoendoscope 489Instrumentation 489Rigid endoscopes 490Reprocessing 492Patient and equipment preparation 495Section 6 Selected Nursing Considerations of Internal Medicine Patients 495Thermoregulation 495Fever or hyperthermia? 495Hypothermia 498The sepsis syndrome 499Bibliography 504Appendix Accredited State Veterinary Diagnostic Laboratories 509Abbreviations 515Index 521

“I would recommend this book for nurses and technicians studying towards a Diploma in Advanced Nursing or a Veterinary Nursing degree but also to those qualified nurses working in practice as a great reference book. I enjoyed the secret login for the website and the multiple choice questions (MCQs) are a great study aid.”  (The Veterinary Journal, 1 October 2013)“This textbook is an excellent addition to the library of any veterinary hospital, especially a speciality practice or academic institution.”   (Journal of The American Veterinary Medical Association, 15 March 2013)"Overall, this is an extremely useful textbook for nurses of any experience and ability. It is something that can be kept handy during the working day, both for in-depth study of unfamiliar diagnoses or as a general reference for more common disorders of a body system.”  (Australian Veterinary Journal, 6 June 2013)“No veterinary reference holding should be without this detailed guide!.”  (Midwest Book Review, 1 March 2013)“It is superb value for money and should be a welcome addition to any personal or practice library.”  (Veterinary Practice News, 1 March 2013)"Linda Merrill's SMALL ANIMAL INTERNAL MEDICINE FOR VETERINARY TECHNICIANS AND NURSES (9780813821641, $79.99) deserves ongoing recommendation as a basic reference - the first written - for the veterinary technician. Chapters cover everything from diagnostic testing to evaluating clinical signs, and includes reviews of nursing requirements for a wide range of conditions. All are top picks for any vet's practice."  (Midwest Book Reviews, 1 December 2012)“This is a high quality book. I work with CVTs in a university setting and would definitely recommend it to any technician seeking to better understand internal medicine.”  (Doody’s, 30 November 2012)“This is really a great tool for revising before exams but also for in house training.”  (Vet Nurses Today, 1November  2012)                    “Small Animal Internal Medicine for Veterinary Technicians and Nurses provides veterinary technicians with the information they need and is essential reading for veterinary technician students, practicing technicians, and those studying for the AIMVT speciality exam.”  (Small Animal Internal Medicine, Clinical Practice, 1 September 2012)