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Equine Internal Medicine Q&A 04 (view source)
Revision as of 17:35, 31 May 2011
, 17:35, 31 May 2011Created page with "{{Template:Manson Mair}} centre|500px<br> <br /> '''A 23-year-old mixed breed horse is examined because of failure to shed its wi..."
{{Template:Manson Mair}}
[[Image:Equine Internal Medicine Q&A 04.jpg|centre|500px]]<br>
<br />
'''A 23-year-old mixed breed horse is examined because of failure to shed its winter coat, chronic coughing and, more recently, partial anorexia and loss of weight. A serum chemistry had the following abnormalities: hyperglycaemia (9.2mmol/l; 166mg/dl) and increased liver enzyme activity (AST, 560u/l; GGT, 167u/l). Clinical examination reveals widespread wheezes during thoracic auscultation. The temperature and heart rate are normal but the respiratory rate is elevated (20bpm) and there appears to be an increase in expiratory effort.'''
<br />
<FlashCard questions="3">
|q1=What diseases are most probable from the clinical examination of this patient?
|a1=
*Pituitary adenoma (hirsutism)
*Chronic obstructive pulmonary disease (COPD)
|l1=
|q2=What further diagnostic tests should be performed to help confirm your diagnosis?
|a2=The age of the horse, clinical signs and hyperglycaemia in combination are virtually diagnostic of pituitary adenoma. <br><br>
Further confirmatory tests might include:
*thyrotropin releasing factor (TRF) stimulation test,
*plasma insulin concentration,
*plasma ACTH concentration (the sample must be promptly frozen and remain frozen until the assay is performed for ACTH measurement). <br><br>
There are many other tests that could be performed but none appear to be as sensitive and specific as the TRF response or ACTH measurement or as easy as the plasma insulin (a single sample is all that is required). <br><br>
A tracheal wash or bronchoalveolar lavage would be indicated to help confirm the diagnosis of COPD.
|l2=
|q3=How might the elevation in liver enzymes be related to one of the physically apparent disorders?
|a3=
*An ultrasound examination of the liver would be indicated. In this case it did not look abnormal.
*A liver biopsy might also be indicated since the cause of the elevated liver enzyme activity is not proven.<br><br>
In this case the microscopic diagnosis was hepatic lipidosis. This is likely to be related to the pituitary adenoma and the resulting increase in lipolysis.
|l3=
</FlashCard>
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[[Category:Equine Internal Medicine Q&A]]
[[Image:Equine Internal Medicine Q&A 04.jpg|centre|500px]]<br>
<br />
'''A 23-year-old mixed breed horse is examined because of failure to shed its winter coat, chronic coughing and, more recently, partial anorexia and loss of weight. A serum chemistry had the following abnormalities: hyperglycaemia (9.2mmol/l; 166mg/dl) and increased liver enzyme activity (AST, 560u/l; GGT, 167u/l). Clinical examination reveals widespread wheezes during thoracic auscultation. The temperature and heart rate are normal but the respiratory rate is elevated (20bpm) and there appears to be an increase in expiratory effort.'''
<br />
<FlashCard questions="3">
|q1=What diseases are most probable from the clinical examination of this patient?
|a1=
*Pituitary adenoma (hirsutism)
*Chronic obstructive pulmonary disease (COPD)
|l1=
|q2=What further diagnostic tests should be performed to help confirm your diagnosis?
|a2=The age of the horse, clinical signs and hyperglycaemia in combination are virtually diagnostic of pituitary adenoma. <br><br>
Further confirmatory tests might include:
*thyrotropin releasing factor (TRF) stimulation test,
*plasma insulin concentration,
*plasma ACTH concentration (the sample must be promptly frozen and remain frozen until the assay is performed for ACTH measurement). <br><br>
There are many other tests that could be performed but none appear to be as sensitive and specific as the TRF response or ACTH measurement or as easy as the plasma insulin (a single sample is all that is required). <br><br>
A tracheal wash or bronchoalveolar lavage would be indicated to help confirm the diagnosis of COPD.
|l2=
|q3=How might the elevation in liver enzymes be related to one of the physically apparent disorders?
|a3=
*An ultrasound examination of the liver would be indicated. In this case it did not look abnormal.
*A liver biopsy might also be indicated since the cause of the elevated liver enzyme activity is not proven.<br><br>
In this case the microscopic diagnosis was hepatic lipidosis. This is likely to be related to the pituitary adenoma and the resulting increase in lipolysis.
|l3=
</FlashCard>
{{#tag:imagemap|Image:Next Question.png{{!}}center{{!}}200px
rect 0 0 860 850 [[Equine Internal Medicine Q&A 05|Next question]]
desc none}}
[[Category:Equine Internal Medicine Q&A]]