Bronhoskopija i bronhoalveolarna lavaža u pasa i mačaka

Diseases of the respiratory tract are widespread in small animal practice. Bronchoscopy and bronchoalveolar lavage are valuable diagnostic techniques that allow visualisation of the lumen and mucosa of a large part of the airway, and enable sampling. The decision on the sampling method depends on the patient’s assessment and imaging. Bronchoalveolar lavage is a safe and simple procedure indicated for diffuse diseases of the bronchi, pulmonary interstitium or alveoli. It is performed by infusion of 0.9% saline solution into the selected regional bronchus through the working channel of a bronchoscope or as a “blind technique” and removed as quickly as possible. The samples obtained by bronchoalveolar lavage are suitable for cytology, bacteriology and fungal cultures or other diagnostic tests such as PCR or specific antigen tests. Bronchoscopy requires appropriate and expensive equipment, in addition to specialised training and experience of the physician performing the procedure. This review article provides an overview of the technique, equipment, most common indications, complications and interpretation of the results of bronchoscopy and bronchoalveolar lavage in dogs and cats.Bolesti dišnih prohoda vrlo su česte u pasa i mačaka. Bronhoskopija i bronhoalveolarna lavaža korisne su dijagnostičke metode koje omogućuju vizualizaciju lumena i sluznice velikog dijela dišnog prohoda te uzimanje uzorka. Odluka o metodi uzorkovanja ovisi o procjeni stanja pacijenta i provedenoj slikovnoj dijagnostici. Bronhoalveolarna lavaža je siguran i jednostavan postupak indiciran u dijagnostici difuznih bolesti bronha, plućnog intersticija ili alveola; izvodi se aplikacijom 0,9 % fiziološke otopine u odabrani regionalni bronh kroz radni kanal bronhoskopa ili kao „slijepa tehnika“, potom se tekućina što je moguće brže uzorkuje. Uzorci dobiveni bronhoalveolarnom lavažom prikladni su za citološku pretragu, bakteriološku i mikološku pretragu ili druge dijagnostičke testove kao što su PCR ili specifični antigenski testovi. Bronhoskopija zahtijeva odgovarajuću opremu te specijaliziranu obuku i iskustvo veterinara koji izvodi zahvat. U ovom preglednom članku iznesen je prikaz osnovne tehnike, opreme, najčešćih indikacija, komplikacija i tumačenja rezultata bronhoskopije i bronhoalveolarne lavaže u pasa i mačaka

Acute pancreatitis in dogs: diagnostic and therapeutic challenges

U ovom je radu obrađena akutna upala gušterače (akutni pankreatitis) kod pasa. Posebna je pažnja usmjerena na dijagnostiku i liječenje. Simptomi mogu varirati od blagih, samoograničavajućih do životno ugrožavajućih. Također, simptomi variraju od suptilnih, nespecifičnih do teških, koji uključuju nekontrolirano povraćanje i/ili proljev, bolan abdomen te brojne sistemske i/ili metaboličke komplikacije. Postavljanje konačne dijagnoze akutnog pankreatitisa težak je i izazovan zadatak jer simptomi bolesti, klinički nalaz i laboratorijske abnormalnosti nisu specifični. U dijagnostici se primjenjuju i sofisticiranije metode kao što su ultrazvučna pretraga i specifične laboratorijske pretrage poput PLI-ja (imunoreaktivnost pankreasne lipaze), no ni jedna pretraga sama za sebe nije dovoljna za postavljanje dijagnoze. Zbog toga se dijagnoza akutne upale gušterače temelji na kombinaciji nekoliko čimbenika: prisutnosti tipičnih kliničkih simptoma, eliminaciji mogućih diferencijalnih dijagnoza, povišenog PLI-ja te tipičnim ultrazvučnim promjenama. Izbor i način liječenja ovise o težini bolesti, a uključuju tekućinsku terapiju, analgeziju, specijalnu prehranu i antiemetike. Prognoza je povoljnija kod blagog i umjerenog oblika, dok je kod teškog pankreatitisa nepovoljna, pogotovo dođe li do lokalnih ili sistemskih komplikacija.This thesis addresses acute inflammation of the pancreas in dogs (acute pancreatitis). Particular attention has been given to diagnosis and treatment. Symptoms can range from mild and self limited to life threatening. Furthermore, they may be vague, nonspecific gastrointestinal symptoms but also severe, including uncontrolled vomiting and/or diarrhea, abdominal pain and a combination of systemic and/or metabolic complications. Making a definitive diagnosis is a difficult and challenging task because the symptoms of the disease, clinical findings and laboratory abnormalities are not specific. More sophisticated diagnostic methods include abdominal ultrasound and specific laboratory tests like PLI (pancreatic lipase immunoreactivity), but still no test alone is sufficient to make the final diagnosis. For this reason, the diagnosis of acute pancreatitis is based on a combination of several factors: presence of typical clinical symptoms, elimination of possible differential diagnosis, elevated PLI and typical ultrasound changes. Choice and type of treatment depend on the underlying pancreatic disease and includes fluid therapy, analgesia, special nutrition and antiemetics. The prognosis is favorable for mild/moderate acute pancreatitis, while it is unfavorable for severe pancreatitis, particularly if local or systemic complications occur

Diagnosis of Liver Diseases in Dogs

Funkcija jetre izrazito je raznolika, naime ona sudjeluje u brojnim metaboličkim i biokemijskim procesima, skladištenju vitamina, proizvodnji gotovo svih faktora za zgrušavanje krvi te u stvaranju žuči koja pomaže u probavi i otklanjanju otpadnih tvari iz krvi detoksikacijom određenih toksina i lijekova. Klinički znakovi bolesti hepatobilijarnog sustava veoma su raznoliki i uglavnom nespecifični, poput anoreksije, depresije, povraćanja i proljeva, zbog čega je nužan pravilan odabir kombinacije dijagnostičkih metoda u daljnjem tijeku dijagnosticiranja. Rutinskom biokemijskom pretragom seruma može se uočiti povećana aktivnost jetrenih enzima, poput alanin-aminotransferaze (ALT) i aspartat-aminotransferaze (AST) te alkalne fosfataze (AP) i gama-glutamiltransferaze (GGT) koji su nešto specifičniji za bolesti bilijarnog sustava, hipoalbuminemija, hiperbilirubinemija, smanjena koncentracija ureje i glukoze. Uvid u funkcionalnu sposobnost jetre, izlučivanje žuči i enterohepatičnu cirkulaciju može nam omogućiti mjerenje koncentracije žučnih kiselina u serumu prije i nakon obroka. U slikovnoj dijagnostici rendgenska pretraga abdomena upotpunjuje kliničku pretragu te omogućuje subjektivnu procjenu veličine i položaja jetre. Ultrazvučna pretraga omogućuje detaljni uvid u vaskularne i žučne strukture te procjenu vezanu uz promjenu u ehogenosti i ehostrukturi parenhima. Sve se češće u dijagnostici bolesti jetre radi i pretraga kompjutoriziranom tomografijom (CT-om), a temelj je objektivne dijagnostike biopsija.The liver’s function is extremely diverse; it produces bile that helps in digestion and removing waste products from the blood, detoxicates some of the toxins and drugs, and is included in numerous metabolic and biochemical processes. The liver also stores vitamins and produces almost every coagulation factor that promotes blood clot formation. Clinical signs of hepatobiliary diseases are highly diverse and usually nonspecific, such as anorexia, depression, vomiting, and diarrhea. Therefore, choosing a specific diagnostic method is necessary for further diagnostic processes. With routine biochemistry panel screening, increased activity of liver enzymes can be found, such as Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) or Alkaline phosphatase (AP) and Gamma-glutamyl transpeptidase (GGT), which are somewhat more specific for biliary diseases, hypoalbuminemia, hyperbilirubinemia, and decreased concentrations of urea and glucose. By measuring serum bile acid concentration before and after a meal, we can get an insight into the liver’s function, bile excretion, and enterohepatic circulation. Radiographic evaluation of the abdomen, as part of diagnostic imaging, is used to complement the physical examination and can help in the subjective evaluation of the size and position of the liver. Ultrasonography allows a more detailed understanding of vascular and biliary liver structures. It also allows an assessment regarding parenchymal echogenicity and echostructure. Computed tomography (CT) examination is becoming more common in diagnosing liver diseases, but the basis of objective diagnostics is a biopsy

Most common esophageal diseases in dogs

Jednjak je cjevasti organ koji povezuje ždrijelo sa želucem, a glavna mu je funkcija prijenos hrane iz usne šupljine do želuca. Bolesti jednjaka u pasa imaju manju pojavnost u odnosu na ostale bolesti probavnog sustava. Mogu se pojaviti kao samostalne bolesti i sekundarno, zbog drugih bolesti. Najučestalije su upala jednjaka (ezofagitis), gastroezofagusni refluks, opstrukcija stranim tijelom, strikture jednjaka, megaezofagus, hijatusna kila, gastroezofagusna intususcepcija i anomalije vaskularnog prstena koje uzrokuju parcijalnu opstrukciju jednjaka. Klinički znakovi kojima se te bolesti očituju jesu regurgitacija, bolno i otežano gutanje, pojačano slinjenje, povraćanje, gušenje i kašalj uzrokovan aspiracijom sadržaja. U dijagnostici svih bolesti jednjaka danas se primarno radi endoskopska pretraga. Uz nju se rade i rendgenska, ultrazvučna i videofluoroskopska pretraga. Uspješnost liječenja ovisi o etiopatogenezi bolesti, pravodobnom postavljanju dijagnoze, pravilnoj i prilagođenoj medikamentnoj terapiji.The esophagus is a tubular organ that connects the throat (pharynx) with the stomach. Its main function being food transfer from the mouth to the stomach. Canine esophageal diseases are less common in relation to other digestive diseases. They occur as secondary illnesses or as an independent disease. The most common esophageal diseases are esophagitis, gastro-esophageal reflux, foreign body obstruction, esophageal strictures, megaesophagus, hiatal hernias, gastro- esophageal intussusception and vascular ring anomalies. Clinical signs that manifest these disorders include regurgitation, painful and difficult swallowing, increased snuff, vomiting, choking, coughing, consequent aspiration of the contents. The golden standard for diagnosing all diseases is endoscopic examination. Along with it, radiography, ultrasonography and videofluoroscopic scanning are used. The success of the treatment depends on the pathogenesis of disease, timely diagnosis, proper and customized medical therapies

Most common esophageal diseases in dogs

Jednjak je cjevasti organ koji povezuje ždrijelo sa želucem, a glavna mu je funkcija prijenos hrane iz usne šupljine do želuca. Bolesti jednjaka u pasa imaju manju pojavnost u odnosu na ostale bolesti probavnog sustava. Mogu se pojaviti kao samostalne bolesti i sekundarno, zbog drugih bolesti. Najučestalije su upala jednjaka (ezofagitis), gastroezofagusni refluks, opstrukcija stranim tijelom, strikture jednjaka, megaezofagus, hijatusna kila, gastroezofagusna intususcepcija i anomalije vaskularnog prstena koje uzrokuju parcijalnu opstrukciju jednjaka. Klinički znakovi kojima se te bolesti očituju jesu regurgitacija, bolno i otežano gutanje, pojačano slinjenje, povraćanje, gušenje i kašalj uzrokovan aspiracijom sadržaja. U dijagnostici svih bolesti jednjaka danas se primarno radi endoskopska pretraga. Uz nju se rade i rendgenska, ultrazvučna i videofluoroskopska pretraga. Uspješnost liječenja ovisi o etiopatogenezi bolesti, pravodobnom postavljanju dijagnoze, pravilnoj i prilagođenoj medikamentnoj terapiji.The esophagus is a tubular organ that connects the throat (pharynx) with the stomach. Its main function being food transfer from the mouth to the stomach. Canine esophageal diseases are less common in relation to other digestive diseases. They occur as secondary illnesses or as an independent disease. The most common esophageal diseases are esophagitis, gastro-esophageal reflux, foreign body obstruction, esophageal strictures, megaesophagus, hiatal hernias, gastro- esophageal intussusception and vascular ring anomalies. Clinical signs that manifest these disorders include regurgitation, painful and difficult swallowing, increased snuff, vomiting, choking, coughing, consequent aspiration of the contents. The golden standard for diagnosing all diseases is endoscopic examination. Along with it, radiography, ultrasonography and videofluoroscopic scanning are used. The success of the treatment depends on the pathogenesis of disease, timely diagnosis, proper and customized medical therapies

Razine kemokina KC i IL-8 u serumu pasa prirodno zaraženih vrstom Babesia canis canis.

Canine babesiosis, caused by Babesia canis canis, is one of the commonest canine diseases in Croatia. It is known that systemic inflammatory response syndrome (SIRS), which is a hallmark of babesiosis, is regulated by the host production of several pro-inflammatory and anti-inflammatory cytokines that have been implicated as playing a critical role in the pathogenesis of the disease. In the course of larger research, serum concentrations of CXC chemokines keratinocyte chemoattractant (KC) and interleukin-8 (IL-8) were determined. The aim of the present study was to determine serum chemokine concentrations and to compare values between healthy and dogs with babesiosis. An additional aim was to determine if KC and IL-8 serum concentrations are an important contributing factor in the development of complicated babesiosis, and whether they affect the outcome of the disease. The results suggest that a higher serum concentration of KC-like is connected with the severity of anemia, leukocytosis and development of a complicated form of babesiosis. The IL-8 concentration positively correlates with granulocyte-lymphocyte ratio. In addition concentration of both chemokines was higher in dogs with complicated babesiosis. Therefore, the concentration of the observed chemokines could be considered as an important factor in the pathogenesis of canine babesiosis.Babezioza pasa uzrokovana vrstom Babesia canis canis jedna je od najčešćih bolesti pasa u Hrvatskoj. Poznato je da je sustavni upalni odgovor (SIRS), koji se smatra osnovom patofiziološkog procesa tijekom babezioze, reguliran međudjelovanjem niza proupalnih i protuupalnih citokina. Cilj ovog istraživanja bio je odrediti koncentraciju CXC kemokina: kemoatraktanta za keratinocite (KC) i interleukina 8 (IL-8) u serumu pasa oboljelih od babezioze te usporediti koncentraciju s koncentracijom ovih citokina u serumu zdravih pasa. Također se željelo ustanoviti je li je aktivnost KC i IL-8 povezana s razvojem kompliciranog oblika babezioze i ishodom bolesti. Koncentracija kemokina u serumu određivana je Luminex xMap tehnologijom komercijalnim multiplex kompletom specifičnim za pse. Dobiveni rezultati pokazali su da je aktivnost KC povezana s razvojem anemije i leukocitoze, dok koncentracija IL-8 pozitivno korelira s omjerom granulocita i limfocita. Viša koncentracija obaju kemokina povezana je s razvojem kompliciranog oblika bolesti. Stoga se koncentracija KC i IL-8 u serumu može smatrati važnim čimbenikom u patogenezi babezioze pasa

Razine kemokina KC i IL-8 u serumu pasa prirodno zaraženih vrstom Babesia canis canis.

Canine babesiosis, caused by Babesia canis canis, is one of the commonest canine diseases in Croatia. It is known that systemic inflammatory response syndrome (SIRS), which is a hallmark of babesiosis, is regulated by the host production of several pro-inflammatory and anti-inflammatory cytokines that have been implicated as playing a critical role in the pathogenesis of the disease. In the course of larger research, serum concentrations of CXC chemokines keratinocyte chemoattractant (KC) and interleukin-8 (IL-8) were determined. The aim of the present study was to determine serum chemokine concentrations and to compare values between healthy and dogs with babesiosis. An additional aim was to determine if KC and IL-8 serum concentrations are an important contributing factor in the development of complicated babesiosis, and whether they affect the outcome of the disease. The results suggest that a higher serum concentration of KC-like is connected with the severity of anemia, leukocytosis and development of a complicated form of babesiosis. The IL-8 concentration positively correlates with granulocyte-lymphocyte ratio. In addition concentration of both chemokines was higher in dogs with complicated babesiosis. Therefore, the concentration of the observed chemokines could be considered as an important factor in the pathogenesis of canine babesiosis.Babezioza pasa uzrokovana vrstom Babesia canis canis jedna je od najčešćih bolesti pasa u Hrvatskoj. Poznato je da je sustavni upalni odgovor (SIRS), koji se smatra osnovom patofiziološkog procesa tijekom babezioze, reguliran međudjelovanjem niza proupalnih i protuupalnih citokina. Cilj ovog istraživanja bio je odrediti koncentraciju CXC kemokina: kemoatraktanta za keratinocite (KC) i interleukina 8 (IL-8) u serumu pasa oboljelih od babezioze te usporediti koncentraciju s koncentracijom ovih citokina u serumu zdravih pasa. Također se željelo ustanoviti je li je aktivnost KC i IL-8 povezana s razvojem kompliciranog oblika babezioze i ishodom bolesti. Koncentracija kemokina u serumu određivana je Luminex xMap tehnologijom komercijalnim multiplex kompletom specifičnim za pse. Dobiveni rezultati pokazali su da je aktivnost KC povezana s razvojem anemije i leukocitoze, dok koncentracija IL-8 pozitivno korelira s omjerom granulocita i limfocita. Viša koncentracija obaju kemokina povezana je s razvojem kompliciranog oblika bolesti. Stoga se koncentracija KC i IL-8 u serumu može smatrati važnim čimbenikom u patogenezi babezioze pasa

Klinički i laboratorijski nalazi te ishod liječenja pasa sa spontanim hiperadrenokorticizmom u Hrvatskoj.

Hyperadrenocorticism (HAC) is one of the most common endocrine disorders in dogs, and establishing a diagnosis requires extensive diagnostics. In this study, 54 dogs with spontaneous hyperadrenocorticism were included, and were divided in two groups: the treated group which consisted of 35 dogs (trilostane therapy 32, adrenalectomy 3) and the non-treated group, which consisted of 19 dogs. According to the Kaplan-Meyer survival curve, the mean survival time of the whole population was 29.6 months, where the untreated patients’ mean survival time was 12.7 months, and in patients with therapeutic intervention it was 34.7 months. In the multivariable Cox proportional hazards model, no single clinical or laboratory parameter was found to significantly influence the outcome. The significance of this research is in its contribution to understanding the natural course of spontaneous canine hyperadrenocorticism.Hiperadrenokorticizam jedna je od najčešćih endokrinoloških bolesti koja zahtijeva opsežnu dijagnostiku za postavljanje konačne dijagnoze. U ovo su istraživanje bila uključena 54 psa različitih pasmina koji su bili podijeljeni u dvije skupine: liječeni pacijenti (trilostan 32 i adrenalektomija 3) u kojoj se nalazilo 35 pasa i skupinu bez terapije, u kojoj se nalazilo 19 pasa. Prosječno vrijeme preživljavanja prema Kaplan-Meyer krivulji bilo je 29,6 mjeseci, pri čemu je pacijentima iz netretirane skupine aritmetička sredina bila 12,7 mjeseci, a u pacijenata u kojih se terapijski interveniralo 34,7 mjeseci. Multivarijantnom Cox regresijskom analizom nije ustanovljen niti jedan klinički ili laboratorijski pokazatelj koji bi značajno utjecao na ishod bolesti. Doprinos je ovog istraživanja u postizanju boljeg uvida u prirodni tijek bolesti pacijenata sa spontanim hiperadrenokorticizmom

Clinical and laboratory findings in dogs with anticoagulant intoxication

Antikoagulantni se rodenticidi upotre- bljavaju u čitavom svijetu za kontrolu glo- davaca. Oni su jedan od najčešćih uzroka trovanja, a najviše je slučajeva trovanja reg- istrirano u pasa. Pregledom arhiva Klinike za unutarnje bolesti u razdoblju od 01. siječnja od 2009. do 01. siječnja 2011. godine identi- ficirana su 22 psa kojima je dijagnosticirano trovanje anikoagulantnim rodenticidima, a imali su potpunu anamnezu, podatke kliničke slike, laboratorijske i rendgenološke nalaze te poznat ishod bolesti. Najčešći osnovni simp- tom trovanja bilo je krvarenje, koje je bilo utvrđeno u 59% pasa. U 18% pasa utvrđena je dispneja, dok su konvulzije i inapetenca bili su prisutni u 9% slučajeva, a depresija u 5% pacijenata. U 59% pasa temperatura, bilo i disanje bili su povišeni, dok su u 9% njih bile povišene samo vrijednosti bila i disanja, uz fiziološke vrijednosti temperature. U 9% pasa su vrijednosti temperature, bila i disanja bile unutar fizioloških granica. Analizirajući rezultate hematoloških pretraga utvrdili smo da su srednja vrijednost broja eritrocita i srednja vrijednost hematokrita bile snižene, dok je srednja vrijednost broja trombocita bila unutar fizioloških granica. Rezultati bio- kemijskih pretraga su pokazali da je srednja vrijednost ureje bila iznad, a srednja vrijed- nost kreatinina unutar fizioloških granica. Srednja vrijednost ukupnih proteina te albu- mina bila je neznatno ispod donje fiziološke granice, dok je srednja vrijednost kreatinin fosfokinaze bila znatno iznad fizioloških granica. Izljev je imalo 76% pacijenata, od toga u 50% životinja je utvrđen likvidotoraks, u 18% likvidoperitoneum, dok je likvidoperi- kard utvrđen u 9% pasa. U svih je pasa anal- izom izljeva potvrđeno da se radi o krvarenju. Svi su pacijenti terapirani vitaminom K te 36% uključivala transfuziju pune krvi. Od 22 psa u 21 psa je došlo do potpunog oporavka, a 1 pas (5%) je eutanaziran iz financijskih razloga. Trovanja antikoagulantnim roden- ticidima predstavljaju dijagnostički izazov kliničarima jer često nedostaju anamnestički, klinički ili laboratorijski podatci kojima bi se jednoznačno moglo potvrditi da se radi o trovanju antikoagulantnim rodenticidima, ipak pravovremena uporaba etiološke i potporne terapije rezultira većinom povoljnom prog- nozom.Anticoagulant rodenticides are used extensively worldwide to control rodent populations. They are one of the most common causes of poisoning in various domestic animal species, with the highest number of poisonings reported in dogs. Case records of dogs presented with prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT) values and compatible history at the Clinic for internal medicine at the Faculty of Veterinary Medicine in Zagreb between 1 January 2009 and 1 January 2011 were reviewed. A total number of 22 dogs were found to have complete clinical and laboratory data as well as results of diagnostic imaging and outcome in which the diagnosis of poisoning with anticoagulant rodenticide poisoning was established. The most common presenting symptom was external bleeding, found in 59% of dogs, while 18% of dogs presented with respiratory distress, 9% with convulsions and inappetence, and 5% with depression. In 59% of dogs, temperature, heart rate and respiration rate were increased, while in 7% of dogs, heart rate and respiration rate were increased though temperature was within normal limits. In 9% of dogs, temperature, heart rate and respiration rate were within normal physiological limits. Mean total erythrocyte number and mean hematocrit values were lower than the minimum reference value, and mean platelet number was within normal limits. The biochemistry profile revealed increased mean urea values and normal creatinine values. Total protein values and albumin were decreased, which is compatible with bleeding. The mean creatinine kinase level was significantly above the upper reference value. Body cavity effusions were present in 76% of patients, in most cases (50%) pleural effusion was diagnosed, 18% had ascites, and pericardial effusion was present in 9% of dogs. In all patients, effusion analysis confirmed bleeding within the body cavities. All patients were treated with vitamin K1, and received supportive therapy according to clinical signs, which included whole blood transfusion in 36% of patients. Twenty-one patients recovered uneventfully, and one dog (5%) was euthanized due to financial reasons. Anticoagulant rodenticide intoxications are a constant challenge to practicing veterinarians due to inconsistent history, vague and/or variable clinical signs and laboratory findings. If no appropriate suspicion is established, clotting tests are not performed and a definitive diagnosis is missed. Still, cases of rodenticide intoxications with early diagnosis and adequate etiological and supportive therapy carry a favourable prognosis