Question

Case study of Cocker Spaniel with pancreatitis. You are a nurse a vet emergency clinic. Research the drugs, fluids and other medications you will be given to the cocker spaniel with pancreatits. List a set of 10 math problems for the emergency case. Include drugs to go home when the cocker spaniel problem is resolved. You( the nurse) should select a realistic weight for thr patient and give the signalment.

Answer 1

English cocker spaniels appear to show a distinctive histological appearance of chronic pancreatitis, which shares similarities with human autoimmune pancreatitis (Watson et al 2011). The most common clinical signs of pancreatitis are abdominal pain, a reduction or lack of appetite, vomiting, lethargy and diarrhoea.

Most mild cases of pancreatitis recover after 2 to 3 days of therapy and have a good prognosis. The more severe cases have a guarded prognosis and often require a hospital stay of a week or longer.

Definition

The pancreas is an organ in the abdomen (tummy) which is responsible for releasing enzymes (types of proteins) to digest food. The pancreas also releases important hormones (such as insulin) into the bloodstream.

Pancreatitis occurs when the pancreas becomes inflamed (tender and swollen). In most cases pancreatitis occurs for no apparent underlying reason, although sometimes it can have a particular cause (such as scavenging food). Pancreatitis most commonly affects middle aged to older dogs, but in addition, dogs of certain breeds (e.g. Cocker Spaniels and Terrier breeds) are more prone to developing the condition.

Signs and Symptoms of pancreatitis

Pancreatitis can cause a variety of symptoms,

• · Ranging from
• · Relatively mild signs (e.g. a reduced appetite)
• · Very severe illness (e.g. multiple organ failure).

The most common symptoms of pancreatitis include

• · Lethargy,
• · Loss of appetite,
• · Vomiting,
• · abdominal pain (highlighted by restlessness and discomfort) and
• · diarrhoea.

· Treatment of Pancreatitis in Dogs

Treatment of canine pancreatitis is generally supportive. The dog's body systems must be supported and the toxins flushed out of the system as much as possible. To this end, any or all of the following treatments may be necessary:

• · Resting the gut. Many veterinarians will treat pancreatitis in dogs by stopping any oral intake of food or water for a period of time. This allows the gut to settle and decreases the amount of digestive enzymes being pumped out by the pancreas.
• · Aggressive fluid therapy. Intravenous (IV: into a vein) fluids are usually needed to treat dogs with pancreatitis. The fluids flush detrimental toxins from the system and also support the dog while he is unable to take in food or water.
• · Pain medications and anti-nausea drugs. Pancreatitis is usually quite painful for dogs. Pain medications are required to keep the dog comfortable while the illness is being treated. Anti-nausea medications are also helpful in calming down the urge to vomit because some dogs will continue to heave and bring up stomach fluids even when they are not being fed or given any water, further dehydrating them.
• · Antibiotics. Antibiotic use for pancreatitis is a bit controversial because the cause of pancreatitis is not normally bacterial, but many veterinarians do treat pancreatitis supportively with antibiotics and feel that it improves recovery rates.
• · Plasma transfusion. Dogs with liver failure secondary to pancreatitis may need plasma transfusions to recover.
• · Early intervention. This is probably the single most important factor in whether a dog will recover fully from a bout of pancreatitis. Owners should be aware of the signs of the illness and be ready to visit the veterinarian quickly.
• · Ultra low-fat diet. Once the veterinarian is comfortable starting food in the pancreatitis dog, a low-fat diet is usually begun in an attempt to decrease the dog's pancreatic work-load. These diets may be short- or long-term depending on the severity of the dog's illness and how well and thoroughly he recovers.

· fluid therapy

Objectives:

• (1) To replace dehydration deficits,
• (2) To maintain normal hydration,
• (3) To replace essential electrolytes and nutrients, and
• (4) To serve as a vehicle for the infusions of certain intravenous medications.

Most dogs with acute pancreatitis (AP) require IV fluid therapy to correct fluid and electrolyte deficits.

In dogs with more severe clinical signs,

the current rationale is to give fluid boluses generally ¼ blood volume over 15–20 minutes to effect - with careful monitoring of the heart rate and blood pressure.

Kind of IV fluids for dogs

Commonly used

• · Isotonic solutions include lactated Ringer's, 0.9 percent (normal or physiologic) saline;
• · Ringer's, acetated Ringer's, and 2.5% dextrose in 0.45% saline.
• · Lactated Ringer's solution (LRS) is a polyionic, isotonic (273 mOsm/L) solution

Complication

In severe cases, administration of too much fluid can cause

• · pulmonary or interstitial edema,

“Too little fluid can result in

• · tissue hypoperfusion

ROUTES OF ADMINISTRATION

In general, fluids can be given by the following routes:

• · oral,
• · subcutaneous,
• · intraperitoneal,
• · intravenous, and
• · intraosseous.

Intravenous infusion is the preferred means of delivering fluids to severely dehydrated animals and medium to large dogs.

It allows for a controlled delivery rate to meet the patient's changing needs. Intravenous treatment requires the insertion of a cannula into a vein using sterile technique and the subsequent sterile maintenance of the intravenous delivery system.

FLUID SELECTION--CRYSTALLOIDS

Isotonic fluids contain the same osmolality as the extracellular fluids (approximately 290 to 310 mOsm/L).

They are excellent solutions, therefore, for providing rehydration and maintenance needs, especially because they can be administered intravenously, intraosseously, subcutaneously, and intraperitoneally.

Commonly used isotonic solutions include

• · lactated Ringer's,
• · 0.9 percent (normal or physiologic) saline;
• · Ringer's, acetated Ringer's, and
• · 2.5% dextrose in 0.45% saline.

• Lactated Ringer's solution (LRS) is a polyionic, isotonic (273 mOsm/L) solution. It is more physiologic than isotonic saline because its electrolyte concentration is similar to that of plasma.

LRS is commonly used as a routine rehydrating and maintenance solution, as a plasma space volume expander in the treatment of shock, and as the fluid of choice in the acidotic patient.

COLLOIDS

• Whole blood, plasma, and colloidal plasma expanders are valuable for increasing the circulating blood volume when shock is present.
• Most of the solution is retained within the vascular system, where it increases the osmotic pressure of the blood above that of the extravascular fluid spaces.
• Consequently, water passes from the interstitial fluid space into the blood, increasing the circulating blood volume.

Plasma is the most commonly used colloid solution in veterinary medicine.

• Dextrans are synthetic colloids derived from sugar beets.
• Dextran 70 and 40 are available in 5% dextrose or saline solutions.

Hydroxyethyl starch (Hetastarch) is a synthetic polymer derived from a waxy starch composed mostly of amylopectin. Like albumin, it expands the circulating plasma volume.

The volume of fluid needed to correct dehydration is calculated from either of the following formulas:

• 1.  Volume (ml) of fluid needed = % dehydration x body weight (lb) x 500
• 2.  Volume (ml) of fluid needed = % dehydration x body weight (kg) x 1000

DRUGS USED Category Dose Route Interval Anti emetics Dolasetron 0.6 mg/kg PO.SC.IV 24 hrs Maropiant 1mg/kg 2mg/kg SC PO 24 hrs 24 hrs Ondansetron 0.1 mg/kg IV Slow 6-12 hrs Analgesic Buprenorphine 0.005-0.015mg/kg PO,SC,IM,IV 6-12 hrs Fentanyl 0.004-0.01 mg/kg IV,IM,SC 2hrs Meperidine 5-10 mg/kg SC,IM 30mts-1 hr Morphine 0.5=2 mg/kg SC, IM 3-4 hrs

Emergency problems in dogs with Pancreatitis

Despite the fact that it generally occurs in dogs who are middle aged or older and those dogs are well cared for, pancreatitis is an emergency, which is why stopping it early on is crucial. If it progresses, it can be fatal in some cases.

Emergency problems include

• Lack of appetite
• Hunching of the back (indicates pain)
• Retching of the neck (our dog did this a lot – indicates pain)
• Vomiting
• Weakness
• Difficulty breathing
• Excessive panting
• Diarrhea
• Abdominal pain to touch
• Abdominal distention
• Air licking (lip smacking) – sign of nausea
• No interest in drinking water
• Increased temperature

Management of diet at home

• Getting the diet right is absolutely crucial for managing chronic pancreatitis and preventing future acute episodes. These guidelines are meant for adult maintenance only
• The aim should be to reduce the workload on the pancreas as much as possible so you should aim for a diet that is...
• Low in fat (between 5% and 10% dry matter)
• Highly digestible (good quality and free from any potentially problematic ingredients)

And, as an added precaution, also recommend looking for,

• Moderate protein (between 20% and 30% dry matter)
• Not too starchy (avoid foods with large amounts of starchy ingredients like maize, white potato, white rice, tapioca, pea starch etc)
• No added sugars
• Supplements

Certain supplements may also help reduce the risk of acute pancreatitis or control the effects of chronic pancreatitis..

• Pancreatic digestive enzyme supplements have been reported to help some dogs with pancreatitis while fish oils (such as salmon oil or EPA oil but not cod liver oil), can help to lower blood lipid levels which may reduce the workload on the pancreas.
• Probiotics and prebiotics can help with digestion and may aid in the management of pancreatitis. The most common prebiotics in pet food include mannan- oligosaccharides, fructo-oligosaccharides.

Most mild cases of pancreatitis recover after 2 to 3 days of therapy and have a good prognosis. The more severe cases have a guarded prognosis and often require a hospital stay of a week or longer.

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