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Clinical Case 1 - Page 2 (view source)
Revision as of 15:23, 26 January 2008
, 15:23, 26 January 2008no edit summary
*What are ALP and ALT short for? Where in the body do these enzymes come from?
*What are ALP and ALT short for? Where in the body do these enzymes come from?
**<font color="white"> ALP is short for alkaline phosphatase. This enzyme is bound to the plasma membrane of hepatocytes and is also present in bone. ALT is short for alanine aminotransferase. This enzyme is found in the cytoplasm of hepatocytes and in muscle. </font>
**<font color="white"> ALP is short for alkaline phosphatase. This enzyme is bound to the plasma membrane of hepatocytes and is also present in bone. ALT is short for alanine aminotransferase. This enzyme is found in the cytoplasm of hepatocytes and in muscle. </font>
*What else might cause an increase in ALP in a cat, in the absence of jaundice?
**<font color="white"> If an increase in ALP is due to liver damage, this is almost always severe enough to cause jaundice. In a cat that is not jaundiced, an increase in ALP is almost always due to hyperthyroidism. </font>
*How would you treat this case?
*How would you treat this case?
**<font color="white"> Shakespeare was treated with methimazole. The licenced product is called Felimazole (Arnolds Veterinary Products). The initial dose is 2.5mg twice daily. By re-taking the total T4 level 3 weeks later the adequacy of the dose can be determined. If the T4 is still high the dose is increased and another blood sample taken 3 weeks later. It is important to satisfy yourself that the client is managing to give the tablets. There are other treatment options. Surgical removal of the thyroid gland is possible. However, with unilateral excision there is a risk of recurrence and with bilateral excision there is a risk of iatrogenic hypoparathyroidism. Since hyperthyroid cats are high risk anaesthetic patients, they should be treated medically first. The current treatment of choice is radioactive iodine treatment. Radioactive iodine concentrates in the thyroid gland and destroys it. However, few practices carry out this treatment, so the animal must usually be referred and the cat must remain at the centre for a long time. </font>
**<font color="white"> Shakespeare was treated with methimazole. The licenced product is called Felimazole® (Arnolds Veterinary Products). The initial dose is 2.5mg twice daily. By re-taking the total T4 level 3 weeks later the adequacy of the dose can be determined. If the T4 is still high the dose is increased and another blood sample taken 3 weeks later. It is important to satisfy yourself that the client is managing to give the tablets since in that case the cause of a second high T4 may be due to failure of the owner to administer the tablets! There are other treatment options. Surgical removal of the thyroid gland is possible. However, with unilateral excision there is a risk of recurrence (even if the other gland looks normal) and with bilateral excision there is a risk of iatrogenic hypoparathyroidism. Since hyperthyroid cats are high risk anaesthetic patients, they should be treated medically first. Another treatment, the current treatment of choice, is radioactive iodine treatment. Radioactive iodine concentrates in the thyroid gland and destroys it. However, few practices carry out this treatment, so the animal must usually be referred and the cat must remain at the centre for a long time. </font>