Pet Conditions

Adverse Reactions

Adverse reactions may occur secondary to medications; such as, antibiotics, hormones, and chemotherapy agents. Reactions to parasiticides, vaccinations, insect bites, snake bites, a food ingredient, or exposure to certain plants and other environmental allergens can also occur. Clinical signs are facial swelling, hives, pruritus, vomiting, diarrhea, lethargy, respiratory distress, and collapse. Diagnosis is based on a known exposure. Diagnostic testing includes bloodwork, blood pressure, and chest x-rays if difficulty breathing. Therapy may involve fluid therapy, antihistamines, steroids, epinephrine, oxygen therapy, and medications for specific symptoms.

Dentistry

Eosinophilic Granuloma Complex is a chronic inflammatory and ulcerative condition affecting the oral cavity, lips, and skin with an unknown underlying cause. It is most commonly seen in cats and may have an associated viral component. It produces painful sores in the mouth and on the tongue and lips. Clinical signs include difficulty eating, dropping food, anorexia, hypersalivation, and malodor to breath. It is diagnosed based on examination; however, a biopsy of the sores may be performed for definitive diagnosis. Treatment includes immunosuppressive medications.

Jaw Fractures occur secondary to trauma, severe periodontal disease, cancer, or metabolic disease. It is diagnosed by physical exam, bloodwork, and skull or dental x-rays.Treatment involves pain control and restoring proper occlusion and ability to eat. This can involve a therapeutic muzzle, canned/pureed diet, or surgical correction.

Malocclusion is an abnormal position of the teeth affecting normal alignment of the jaw. Diagnosis is based on oral examination. Therapy involves ensuring the pet is free from pain and has a functional bite. This may involve in no treatment, extraction of teeth, or orthodontic treatment.

Oral Neoplasia is cancer of the oral cavity that can be benign, locally invasive, or malignant. Oral tumors in cats are rarely benign. Clinical signs include the owner visualizing the tumor, pet having difficulty chewing, hypersalivation, malodor, and bleeding from the mouth. Diagnosis is based on oral examination, bloodwork, x-rays or advanced imaging, and biopsy of the mass. Treatment depends on the type of tumor diagnosed, but can include pain control or palliative therapy, removal of the mass, jaw resection, or radiation therapy.

Oronasal Fistula is a connection between the oral and nasal cavities as a result of severe periodontal disease. The upper canine teeth are most often affected. Clinical signs include nasal discharge, sneezing, or malodorous breath. Diagnostic testing involves an oral examination, bloodwork, x-rays, and a thorough dental examination under anesthesia. Treatment includes extraction of the affected tooth, oral antibiotics, pain medication, and closure of the fistula.

Periodontal Disease is inflammation and infection of the gingiva, periodontal ligaments, and alveolar bone surrounding the tooth root. Clinical signs include malodorous breath, difficulty chewing, no longer chewing hard toys, loose teeth, and general malaise. Diagnosis is based on oral exam, bloodwork, and a thorough dental assessment and x-rays under anesthesia. Treatment can include pain medications, oral or local antibiotics, and extraction of the affected teeth.

Resorptive Lesions in Felines is progressive loss of the tooth as a result of resorption. Clinical signs can include difficulty chewing, decreased appetite, and hypersalivation. Diagnosis is made by an oral exam. Pre-operative bloodwork is often performed. Treatment includes a thorough dental exam, dental x-rays, and extraction of the affected teeth.

Retained (Persistent) Deciduous Teeth is a condition where the "baby" teeth fail to come out on their own. There is a higher prevelance in small or toy breed dogs. This can lead to periodontal disease, malocclusion, malposition of permanent teeth, or trauma to the gingiva. Diagnosis is made through an oral examination. Treatment involves extraction of the deciduous teeth.

Salivary Mucocele occurs when saliva leaks and accumulates into the tissue surrounding the salivary gland. Clinical signs depend on location of the salivary gland affected. There can be a swelling of the side or under the jaw or tongue. This can cause hypersalivation, difficulty chewing, or reluctance to eat. Diagnostic testing includes a fine needle aspirate for cytology or, rarely, a sialogram. Treatment depends on location. Draining or excising the affected salivary gland may be performed. If it is located under the tongue, then marsupialization (suturing open) of the gland is performed. There is recurrence if incompletely removed.

Stomatitis is inflammation of the mouth that leads to oral ulcers. This may be associated with a virus in cats and hereditary in Maltese dogs. Clinical signs include reluctance to eat or anorexia, weight loss, difficulty chewing, malodor to breath, bleeding from mouth, and a painful mouth. Diagnostic testing involves bloodwork, viral blood testing, oral examination under anesthesia, dental x-rays, and extraction of teeth. The inflammation and ulceration often resolve with complete extraction of teeth. Some pets may also require antibiotics and immunosuppressive medications.

Temporomandibular Joint Luxation is complete displacement of the condyle of the mandible out of its fossa as a result of trauma, fracture, or dysplasia. Clinical signs include an inability to close the mouth, painful when chewing, reluctant to eat, and an audible click when opening the mouth. Diagnostic testing includes bloodwork and skull x-rays. Advanced imaging may also be performed. Treatment involves manual reduction of the condyle in the fossa, a therapeutic muzzle, feeding soft/canned food, or in more severe cases surgical removal of the condyle may be performed.

Tooth Fractures occur following trauma. Uncomplicated fractures may not require treatment. Complicated fractures with pulp or root exposure require treatment. This can include removal of the pulp, capping and restoration, or extraction of the affected tooth. Other therapy includes oral antibiotic and pain medications.

Tooth Root Abscess is an infection at the periapical region of the tooth. Clinical signs include a painful tooth, reluctant to eat, hypersalivation, swollen or reddened gum, or fever. Diagnosis is made with an oral examination, bloodwork, and dental x-rays. Treatment involves extraction of the affected tooth, oral antibiotics, and pain medication.

Unerupted Teeth are teeth that have not emerged into the oral cavity. The tooth appears to be missing. Diagnosis is made with dental x-rays and can be associated with cyst formation. The unerupted tooth may be encouraged into its proper location with orthodontic procedures or extraction of the tooth and the surrounding area may be necessary.

Dietary

Dietary problems can arise as a result of improper nutrition. Imbalances in nutrition may cause malnutrition, pancreatitis, gastrointestinal problems, and obesity. Malnutrition occurs with vitamin and mineral deficiencies or excesses. This can impact the immune system and cause gastrointestinal disease, orthopedic problems, or diabetes. Nutrient-deprived animals can present with failure to grow, general malaise, or anorexia. These animals may have a thin body condition, poor haircoat, skeletal abnormalities or fractured bones, muscle wasting, and broken or missing teeth. Overnourished animals are obese. They may present with lameness, endocrine problems, skin problems and poor grooming, inability for activity, and labored breathing. Therapy is directed at correcting the nutritional deficiency or excess, and often includes calculating an ideal daily calorie intake for weight gain or loss. Fluid therapy, medication, and supplements may also be indicated.

Ears

Aural Hematoma is a fluctuant fluid-filled swelling on the inside surface of the pinna as a result of head shaking or scratching of the ear. This condition is most often associated with otitis externa (nflammation of the external ear canal), but can also be associated with trauma or increased fragility of the capillaries of the pinna. This is diagnosed based on physical examination. Ear cytology is performed to determine if otitis externa is the underlying cause. Treatment involves placement of a cannula for drainage or surgery to drain the fluid and remove the clots and fibrin. Any underlying ear infection is also treated at the same time. If no therapy is pursued, the fluctuant swelling will become firm and thickened, and will eventually become fibrosed to have a "cauliflower" appearance.

Aural Masses can be benign or malignant, and occur on the ear pinna or in the external, middle, or inner ear canals. Often times, a mass in the canal will not be apparent until an otic exam or imaging diagnostics are performed. Masses in the middle and inner ear are best diagnosed with advanced imaging; such as CT scan or MRI. Therapy involves removal of the mass and treating secondary infections caused by the mass.

Otitis Externa is acute or chronic inflammation of the external ear canal as a result of a change in the normal canal environment. There can be genetic or breed predispositions which may involve glandular hyperplasia, hair within the canals, pendulous pinnae, or stenotic ear canals. Food or environmental allergens may also contribute to the inflammation. Risk factors may include swimming and excessive ear care. The development of benign or malignant masses in the ear canals can also cause significant inflammation. Clinical signs include head shaking or rubbing and ear scratching, malodor and discharge from ears, head tilt, or hearing deficit. Diagnostic testing involves an otic exam, neurologic exam, ear cytology, ear canal cultures or biopsies, advanced imaging (CT scan or MRI) for inner ear disease, and food allergy trials and allergy testing. Therapy is directed toward treating the underlying cause and the secondary infection and inflammation. It can include ear cleaning or flushing, ear medications, oral medications, a prescription hydrolyzed diet, and surgery to remove masses or a severely diseased ear canal.

Endocrine (Hormones)

Diabetes Insipidus is when a dog or cat has an insufficient amount of antidiuretic hormone (ADH) secretion (central diabetes insipidus) or insufficient action of ADH (nephrogenic diabetes insipidus). This results in inadequate urine concentrating ability. Clinical signs include increased thirst and urination, difficulty in house-training, and perceived urinary incontinence. If underlying neurologic disease, then disorientation, ataxia, and seizures may be present. Diagnostic testing includes bloodwork, urine analysis, urine culture, bloodwork for infectious disease (such as leptospirosis), and abdominal ultrasound. Advanced imaging of the brain may also be pursued. Treatment goals are aimed at resolving the symptoms. Desmopressin acetate is prescribed in order to aid in diagnosis and is then continued for treatment if a positive response is appreciated.

Diabetes Mellitus (Canine) is a deficiency of insulin usually as a result of destruction of the pancreatic islet beta cells. Risk factors include obesity, recurring pancreatitis, diseases causing insulin resistance, and insulin antagonistic medications. Clinical signs include increased thirst and urination, urinary house soiling, increased appetite, weight loss, lethargy, blindness from cataracts, hindlimb weakness, and decreased jumping ability. Insulin-dependent diabetes mellitus is called Type 1 diabetes and is seen in 99% of dogs. Insulin injections are mandatory to control symptoms of the disease. Diagnostic testing includes bloodwork, urine analysis, and urine culture. The primary goal is to eliminate symptoms and stabilize weight. Potential complications include cataracts, peripheral neuropathy, urinary tract infection, and diabetic ketoacidosis. Treatment involves a prescription diet, daily insulin administration, fluid therapy, and antibiotics in the case of urinary tract infections.

Diabetes Mellitus (Feline) is a deficiency of insulin usually as a result of destruction of the pancreatic islet beta cells. Risk factors include obesity, recurring pancreatitis, diseases causing insulin resistance, and insulin antagonistic medications. Clinical signs include increased thirst and urination, urinary house soiling, increased appetite, weight loss, lethargy, lack of grooming, hindlimb weakness, decreased jumping ability, and a flat-footed stance (plantigrade). Insulin-dependent diabetes mellitus is called Type 1 diabetes and is seen in 50-70% of cats. Insulin injections are mandatory to control symptoms of the disease. Non-insulin-dependent diabetes mellitus is called Type 2 diabetes and is seen in approximately 30% of cats. This type is defined by a reduced amount of pancreatic islet beta cells. Cats can also have a transient or subclinical diabetes which is when diabetes resolves weeks to months after insulin treatment is initiated. This type may recur. Diagnostic testing includes bloodwork, urine analysis, and urine culture. The primary goal is to eliminate symptoms and stabilize weight. Potential complications include peripheral neuropathy, urinary tract infection, and diabetic ketoacidosis. Treatment involves a prescription diet, daily insulin administration, fluid therapy, and antibiotics in the case of urinary tract infections.

Hyperadrenocorticism (Cushing's Disease) is caused by an excess of cortisol production. This is most common in dogs and rare in cats. Types of this disease incude pituitary-dependent or secondary to an adrenal tumor. Clinical signs include increased thirst and urination, urinary house soiling, increased appetite, pendulous abdomen, lethargy, tendency to bruise, thin skin, skin and haircoat changes, muscle wasting, and obesity. Diagnostic testing includes bloodwork, urine analysis, urine culture, blood pressure, abdominal and chest x-rays, and abdominal ultrasound. Treatment is directed toward resolving the clinical signs. Medications, such as Trilostane, may be prescribed. Surgery may be performed to remove an adrenal tumor.

Hypoadrenocorticism (Addison's Disease) is a hormone disorder caused by adrenocortical insufficiency. This occurs as a result of destruction of the adrenal gland cortices, destruction or defects of the hypothalamus or pituitary gland, or secondary to excess exogenous corticosteroids causing adrenal gland atrophy. It occurs in dogs and is very uncommon in cats. Clinical signs are usually waxing and waning over weeks or months, and seem to worsen in stressful situations. Severity can be mild, progressive, and intermittent; or acute and life-threatening. Clinical signs include weakness, lethargy, anorexia, vomiting, diarrhea, weight loss, trembling, increased thirst and urination, regurgitation, collapse, and death. Diagnostic testing involves bloodwork (including ACTH stimulation testing), urine analysis, fecal testing, electrocardiogram, and chest and abdominal x-rays. Initial treatment involves fluid therapy, glucocorticoid medication, dextrose for hypoglycemia, and additional medications for specific symptoms. Lifelong therapy of glucocorticoid medication and mineralocorticoid supplementation are indicated.

Hypothyroidism occurs when there are decreased thyroid hormones. Hypothyroidism is most common in dogs and very rare in cats. This condition is most often acquired, but rare congenital forms of this condition exist. Clinical signs include weight gain, lethargy, exercise intolerance, cold intolerance, alopecia and hair thinning, pyoderma, a "rat-tail" appearance, reproductive disorders, and weakness or neurologic signs. Diagnostic testing includes bloodwork, thyroid blood testing, and urine analysis. Treatment involves oral thyroid supplementation.

Hyperthyroidism results from excessive thyroid hormone secretion. Hyperthyroidism is most common in cats. Canine hyperthyroidism is a result of thyroid carcinoma. Clinical signs include increased appetite, increased thirst and urination, weight loss despite a good appetite, hyperactivity, vomiting, unkempt haircoat, and heat avoidance. Diagnostic testing includes bloodwork, thyroid blood testing, blood pressure, and chest ultrasound if a cardiac murmur is present. Therapy includes medication or a prescription diet to block the iodination process, radioactive iodide therapy, or surgical removal of a thyroid tumor.

Eyes

Cataract is an opacity of the lens of the eye. A cataract can be present at birth, develop at a young age, develop at an older age, or occur secondary to other disease. Clinical signs include vision disturbance and cloudiness to the appearance of the eye. Diagnostic testing includes a complete eye examination, intraocular pressure testing, bloodwork, urine analysis, ocular ultrasound, and electroretinogram. Treatment involves topical treatment for secondary uveitis and glaucoma, treatment of an underlying disease, and cataract surgery.

Conjunctivitis (feline) is inflammation of the conjunctiva. It can occur secondary to infection, trauma, irritation, systemic illness, or cancer. Clinical signs include a painful and red eye, elevation of the third eyelid, squinting, eye or nasal discharge, sneezing, or decreased appetite. Diagnostic testing involves a complete eye exam, blood testing if infectious suspected, or conjunctival biopsy is cancer is suspected. Treatment includes topical or oral antibiotics, or anti-inflammatories. Reduction of stress is beneficial if underlying herpesvirus infection is suspected.

Conjunctivitis (canine) is inflammation of the conjunctiva. It can occur secondary to allergies, infection, irritation, "dry eye", systemic disease, or cancer. Clinical signs include a painful and red eye, elevation of the third eyelid, squinting, and ocular discharge. Diagnostic testing includes a complete eye exam, blood testing, and conjunctival biopsy. Treatment is based on treating the underlying cause; and eliminating the infection and discomfort is indicated.

Corneal or Scleral Trauma occurs as a result of a blunt or sharp trauma to the eye. Symptoms include painful and red eye, eye discharge, elevation of the third eyelid, hemorrhage, and squinting. Diagnostic testing involves a complete eye exam, bloodwork, and an ocular ultrasound. Treatment includes foreign body removal, surgical laceration repair, and controlling inflammation.

Corneal Sequestrum occurs in cats and is an area of necrotic cornea with pigmentation. It occurs secondary to infection (such as herpesvirus infection) or corneal irritation or trauma. Clinical signs are a dark discoloration to the cornea, squinting, elevation of the third eyelid, painful and red eye, and eye discharge. Diagnostic testing includes a complete eye exam and testing for herpesvirus infection. Therapy involves topical eye medications or surgical removal in severe cases.

Corneal Ulceration is a loss of the superficial (top layer) corneal epithelium. It can occur as a simple ulcer, complex ulcer, or indolent/refractory ulcer. An ulcer can occur as a predisposition in certain breeds (Boxer dogs and Persian or Himalayan cats) or secondary to trauma or irritation of the eye, "dry eye", or infection. Clinical signs include a painful and red eye, eye discharge, elevation of the third eyelid, squinting, and visible defect in the cornea. Diagnostic testing includes a complete eye exam, exam for eyelid deformities, exam for neurologic disorders, and keratectomy for biopsy evaluation. Treatment varies for the type of ulcer present. Simple corneal ulcers are treated with topical eye medications. Complex and indolent corneal ulcers are treated with topical eye medications, autogenous topical serum, corneal debridement, and surgical repair via grid keratotomy or graft.

Distichiasis, Ectopic Cilia, Trichiasis occur when there are eyelashes growing or directed toward the cornea. These lashes then cause corneal irritation. Clinical signs include a painful and red eye, eye discharge, elevation of the third eyelid, and squinting. Diagnostic testing includes a complete eye exam and exam for eyelid deformities. Treatment involves removal of the inciting eyelashes surgically or by cryotherapy, electrolysis, or laser. Trichiasis is treated with surgical reconstruction or removal of the folds causing the eyelids to turn in toward the cornea.

Ectropion or Entropion are abnormalities of the upper or lower eyelid where the entire eyelid goes away from the eye (ectropion) or goes toward the eye (entropion). This condition is more common in dogs, and can be developmental or acquired. Clinical signs include a painful and red eye, eye discharge, elevation of the third eyelid, squinting, and a visible inrolling or drooping of the eyelid. Therapy goals are to resolve underlying painful eye disease and surgically correcting the entropion or ectropion.

Episcleritis or Scleritis is inflammation of the superficial layer of the sclera (episcleritis) or inflammation and thickening of the sclera (scleritis). Episcleritis is usually painless and can be nodular (pinkish-red growth on the sclera) or diffuse. Scleritis is more diffuse and causes sensitivity to light, squinting, and excessive tearing. These conditions are often immune-mediated. Inflammation ranges from minor localized lesions to severe ocular disease. Diagnostic testing includes a complete eye exam, cytology of a nodular lesion, blood titer testing, immune-mediated blood testing, ocular ultrasound, and biopsy. Treatment is directed at relieving ocular discomfort, and promoting and maintaining regression of the disease with lifelong therapy.

Glaucoma is an increase in the pressure in the eye as a result of primary eye disease (abnormal drainage angle), secondary eye disease (ie. lens luxation, cataract, infection, or mass/cancer), and congenital/hereditary disease. Clinical signs involve vision loss, a red or cloudy eye, eye discharge, sensitivity around the head or face, and squinting. Diagnostic testing includes a complete eye exam, gonioscopy, and ocular ultrasound. Treatment is directed at decreasing the pressure in the eye with topical eye medications or surgery to address an underlying cause. Removal of the eye is indicated in chronic, severe, and painful conditions.

Keratoconjunctivitis Sicca ("Dry Eye") is a result of a decrease in tear production by the lacrimal gland of the eye. Clinical signs include a red or painful eye, eye discharge, and squinting. This is diagnosed by a complete eye exam. Therapy involves topical eye medications to stimulate tear production, to lubricate the eye, and topical treatment for secondary eye infections or inflammation.

Lens Luxation is a complete dislocation of the lens in the eye due to abnormal development or degeneration, or secondary to rupture or degeneration of the fibers that hold the lens in place. A subluxation is a partial dislocation of the lens. Terrier breeds are predisposed. The luxated lens falls to the front of the eye (anterior chamber) or the back of the eye (posterior chamber). Secondary glaucoma can develop with an anterior lens luxation as a result of blocking the drainage angle. Symptoms include a red or painful eye, tearing, and squinting. The condition is diagnosed by a complete eye exam and may include an ocular ultrasound. Acute anterior lens luxation is considered a surgical emergency for removal of the lens.

Pannus (Chronic Superficial Keratitis) is a progressive, immune-mediated inflammatory disease of the cornea in dogs. Clinical signs include a corneal reddish or brown discoloration which slowly or rapidly covers the surface of the eye. Diagnostic testing includes a complete eye exam. Therapy is directed toward suppressing the disease and maintaining remission with a lifelong topical corticosteroid or immunosuppressive.

Proptosis of Globe is a forward displacement of the globe from the eye socket. Brachycephalic breeds are predisposed due to the globe positioned more shallow in the orbit. The condition is usually a result of a mild or significant force to the head. Diagnosis is based on the malpositioned appearance of the globe and a complete eye exam. Skull and chest x-rays are indicated in cases of more significant blunt traumas. Treatment involves returning and maintaining the globe to its proper anatomic location, and preserving vision. Chronic treatment may involve topical eye medications. Removal of the eye may be indicated with vision loss or persistent discomfort.

Retinal Degeneration is deterioration of the retina due to inherited conditions (progressive retinal atrophy), or acquired disorders (sudden acquired retinal degeneration, retinal detachment, glaucoma, cancer, nutritional deficiency, toxicity, or metabolic disease). Clinical signs include vision loss, a red or painful eye, an enlarged eye, and a greenish shine to the eye. Diagnostic testing includes a complete eye exam, retinal exam, genetic blood testing, and electroretinography. There is no available treatment to reverse retinal degeneration. Therapy is to treat the underlying cause, when possible.

Retinal Detachment is separation of the retina from the underlying epithelium. This is a result of hereditary or acquired disorders. Clinical signs include vision loss, a red or painful eye, an enlarged eye, and a greenish shine to the eye. Diagnostic testing includes performing a complete eye exam, retinal exam, blood pressure, and ocular ultrasound. Therapy involves treating the underlying cause and restoring vision, when possible.

Third Eyelid Abnormalities include eversion, prolapse ("cherry eye"), protrusion, or cancer of the third eyelid. Clinical signs include an abnormal appearance of the third eyelid, a red or painful eye, eye discharge, and squinting. Diagnostic testing may involve a complete eye exam, bloodwork, or biopsy. Topical eye medications, surgical correction, preserving tear production, and removing cancer are indicated therapies based on the abnormality.

Uveal Cysts are benign, round to ovoid, pigmented structures in the globe of the eye. Animals are usually asymptomatic and the cyst is found incidentally during an eye examination. Treatment is usually not indicated. However, larger cysts should be removed if they are causing increased eye pressure.

Uveitis is inflammation of the iris, ciliary body, and choroid of the eye. The condition is a result of immune-mediated disease or hereditary disorder, or secondary to infection or cancer in cats and dogs. Clinical signs include light sensitivity, a red or painful eye, eye discharge, squinting, or changes in color appearance inside the eye. Diagnostic testing involves a complete eye exam, bloodwork, urine analysis, infectious disease blood testing, an eye ultrasound, chest x-rays, and cytology. Treatment of the underlying disease and relieving eye discomfort with topical eye medications is indicated.

Gastrointestinal

Anal Sac Diseases includes inflammation, infection, impaction, or cancer of the anal sacs. The pair of anal sacs are positioned on either side of the anus. The specific anatomy of an animal's anal sacs, loose stools, and food or environmental allergies may be related to the pathology of the anal sacs. Dogs and cats may "scoot" or lick their hindend, or owners may also notice a foul odor leading them to seek veterinary attention. A proper diagnosis is made by a visual and digital rectal examination. Treatment of the inflamed or infected anal sac(s) may include flushing or infusing the gland(s), medical therapy, or removal of the glands surgically. If there is concern for cancer, a needle biopsy and abdominal x-rays should be performed.

Antibiotic-responsive diarrhea (ARD) , or intestinal dysbiosis, is diarrhea that is responsive to antibiotic therapy. In healthy animals the bacterial ecosystem has several important functions. It protects the host from pathogenic bacteria, makes a variety of vitamins that can be used by the body, and plays a crucial role in the development of the intestinal immune system. Any disease process that affects one or more of the intestinal ecosystem's protective mechanisms can lead to ARD. Diagnostic testing may include bloodwork, fecal examinations, abdominal x-rays, or abdominal ultrasound. Probiotics and antibiotics are often prescribed to help restore the balance of the healthy intestinal flora.

Gastrointestinal Parasites (includes intestinal worms and protozoa)

Roundworm Infection: Puppies and kittens under 6 months of age are most commonly infected. The primary mode of transmission is transplacental from the infected bitch to the puppies. Puppies and kittens may also be infected by nursing an infected lactating dam or queen (transmammary transmission). The transmammary route is the most commone route of infection in kittens. A third route of transmission is feco-oral transmission. After infection, the parasite may migrate through the liver into the lungs, within the wall of the gastrointestinal tract, or within other body tissues. Eggs are then shed in the feces. The eggs are long-lived in the environment and highly resistant. The eggs also adhere to fomites (bedding, surrounding environment). There is contagious and zoonotic potential through ingestion by people or other dogs or cats. In people, it can lead to human visceral and ocular larval migrans. Young children are most susceptible. The eggs are usually easily detected in a fecal flotation. However, sometimes the worms are in larval or adult worm stages, and the eggs are not found on a fecal flotation. Therefore, deworming of puppies and kittens during their vaccination visits is recommended. Thankfully, many preventives used for monthly heartworm prevention now include dewormer for this intestinal parasite.

Hookworm Infection: This is a type of intestinal worm that can cause blood loss anemia. Commonly affects young puppies and kittens. Dogs can become infected via soil contamination or from the bitch to the offspring through transplacental and transmammary transmission. Cats are infected via ingestion or skin penetration. There is contagious and zoonotic potential to people via infective larva penetrating and migrating through the skin (Cutaneous Larval Migrans). Eggs only develop into infective larvae above 59 degrees fahrenheit, so infection typically occurs in warmer months. The hookworms attach to the small intestinal mucosa which leads to gastrointestinal bleeding. If the intestinal blood loss is significant, the pet may become anemic and a blood transfusion is required. The eggs are usually easily detected in a fecal flotation. However, sometimes the worms are in larval or adult worm stages, and the eggs are not found on a fecal flotation. Therefore, deworming of puppies and kittens during their vaccination visits is recommended. Thankfully, many preventives used for monthly heartworm prevention now include dewormer for this intestinal parasite.

Whipworm Infection: This is an intestinal worm infection that occurs primarily in dogs, and rarely in cats. Infection occurs with ingestion of embryonated eggs. The eggs then hatch in the small intestine and larvae burrow into the mucosa. There is a three month prepatent period for the eggs to be found in feces. The eggs are extremely resistant in the environment, surviving 4 to 5 years, without any seasonality. The contagious and zoonotic potential in humans is rare. As a result of whipworms being intermittently shed (and often in low numbers), this makes multiple fecal examinations necessary for diagnosis. Empirical treatment with fenbendazole or febantel often recommended if whipworm infection is suspected. Due to their persistence in the environment, a specific heartworm prevention that is also effective against whipworms may be prescribed.

Tapeworm Infection: Infection occurs through ingestion of an intermediate host (fleas or rodents). The intermediate host carries the eggs that infect the dog or cat. Zoonosis potential exists for humans if infected feces is ingested. Diagnosis is based on the evidence of tapeworm segments (called proglottids) that look like grains of rice in the feces or on the fur surrounding the anus. The eggs can also be found in a fecal flotation. Deworming is recommended with a confirmed diagnosis or empirically with high risk animals, such as, outdoor cats that like to hunt or animals that have fleas.

Giardiasis: Giardia is a protozoan parasite that can be found in the intestinal tract of humans and most domestic animals. It is spread through the ingestion of feces or from fomites (bedding, surrounding environment). It can cause intermittent diarrhea in some, but can exist as a latent infection in others. There is increased risk in immunodeficient adults, young animals, and animals confined in large groups. Infection occurs by the ingestion of cysts. When excreted in feces, cysts can survive for days to weeks in a cool, moist environment. Zoonosis from dogs and cats should be considered possible. Most infections produce no symptoms. Clinical signs of diarrhea may be acute, intermittent, or chronic. Diagnosis may be made by observation of trophozoites in fresh feces, but a negative result does not rule out infection. There are ELISA test kits available to detect Giardia antigens in the feces. Treatment involves medication to resolve the diarrhea and eliminate the shedding of the infective cysts in the environment.

Coccidiosis: Coccidia, or Isospora, is a protozoan parasite that can be found in the intestinal tract of dogs and cats. It is spread through the ingestion of infected feces or fomites (bedding, surrounding environment). There is increased risk in immunodeficient adults, animals less than one year of age, and stressed animals. Zoonosis may be possible in humans that are immunocompromised. Diarrhea and vomiting are the main clinical signs. Diagnosis is based on oocysts found on fecal examination. Treatment is aimed at resolving the diarrhea and eliminating the shed of oocysts in feces to the environment.

Cryptosporidiosis: Cryptosporidia is a coccidian parasite that can cause chronic diarrhea in dogs and cats after ingestion of infected feces. Increased risk exists for puppies less than 6 months of age, immunosuppressed animals, adult animals with severe intestinal disease, and in overcrowded unsanitary conditions. Clinical signs include chronic diarrhea and, less likely, vomiting. Cats may have a subclinical infection or diarrhea with flatulence. Diagnosis by fecal examination is challenging and ELISA testing determines that an animal has been exposed, and not necessarily an active infection. Therapy is directed at resolving the infection and preventing further oocyst shedding.

Campylobacter Enteritis is a bacterial infection that most commonly occurs in young dogs or cats, immunocompromised animals, or crowded conditions (kennels and animal shelters). It is commonly spread by ingestion of feces and contaminated food and water sources. Zoonotic transmission can occur to humans. Animals can be subclinical, or have acute or chronic diarrhea. This bacteria is found in low numbers in the normal intestinal flora. Therefore, clinical disease depends on the number of bacteria ingested. Diagnosis is based on fecal examination, fecal cultures, or serology. Antibiotics are prescribed for treatment.

Dietary Intolerance is an adverse reaction to the contents or contaminants of an ingested food that can cause vomiting, diarrhea, abdominal pain or distention, and flatulence. This is distinguished from a food allergy due to its nonimmune response. Diagnosis is based on response to treatment with a dietary change or prescription diet. Chronic treatment should involve strict avoidance of offending foods or ingredients.

Food Allergy is an immune response to certain foods causing vomiting, weight loss, diarrhea, abdominal pain, flatulence, or skin disease (dermatitis). An elimination food trial is the diagnostic test of choice. Treatment involves feeding a prescription hydrolyzed diet. Long term control includes continued feeding of the hydrolyzed diet with avoidance of other protein and carbohydrate food sources (flavored medications or flavored heartworm preventions, table food, non-prescription dog treats).

Foreign Bodies include the lodging of foreign solid material in the oral cavity, esophagus, stomach, and intestines.

Oral foreign bodies often get lodged in the roof of the mouth, but can become lodged under the tongue, in the gums, or in the pharynx. Animals at risk have a habit of chewing bones, sticks, and other foreign objects. Clinical signs include oral discomfort, pawing of the face, reluctance to eat, anorexia, difficulty swallowing, or malodor to the animal's breath. Diagnosis is usually a result of a good oral and/or pharyngeal exam. Other diagnostic tests may include x-rays or advanced imaging. Sedation may be needed to completely evaluate the oral cavity. Treatment involves removal of the foreign object and resolving the inflammation or infection.

Esophageal foreign body is any solid object that lodges in the esophagus. Clinical signs include acute regurgitation, gagging, anorexia, and ptyalism (hypersalivation). This condition may be diagnosed by cervical and chest x-rays, endoscopy, or advanced imaging (such as, CT scan or MRI). Treatment involves the removal of the foreign object.

Gastric (stomach) foreign body occurs with the ingestion of a solid object that lodges in the stomach. Clinical signs include acute or chronic and persistent or intermittent vomiting, abdominal discomfort, anorexia, depression, or lethargy. Diagnosis is acheived with bloodwork, abdominal x-rays, ultrasound, endoscopy, or surgical exploratory. Treatment involves removal of the foreign object by endoscopy or abdominal surgery.

Intestinal foreign body involves solid object(s) becoming lodged in the intestinal tract. Symptoms include acute persistent vomiting, abdominal discomfort, anorexia, depression, lethargy, or fever. Diagnosis may involve abdominal x-rays, ultrasound, bloodwork, or surgical exploratory. Treatment includes the removal of the foreign material and treatment of the infection and inflammation. Concerning sequela to intestinal foreign bodies are localized necrosis or perforation of the intestines. Linear foreign bodies (strings, string-like fibers) are particularly concerning due to the intestinal plication ("bunching") that occurs as the intestines move along the string.

Gastrointestinal Cancer are benign or malignant tumors of the gastrointestinal tract. Clinical signs include chronic vomiting, vomiting with blood, black or bloody stools, anorexia, weight loss, depression, lethargy, abdominal discomfort, or restlessness. Diagnosis is based on symptoms, bloodwork, x-rays, ultrasound, or advanced imaging (such as CT scan or MRI). Diagnosis is confirmed by biopsy with histopathology. Treatment includes resolving the vomiting and dehydration, pain management, blood transfusion, dietary modification, removal of the tumor, or chemotherapy.

Gastric Ulcer is a disruption of the gastrointestinal tract lining that may cause vomiting (often with blood or black flecks), black or bloody stools, anorexia, hypersalivation, anemia, or abdominal discomfort. Diagnosis is based on symptoms, bloodwork, abdominal x-rays, or ultrasound. Treatment is aimed at treating the ulceration, resolving the vomiting and diarrhea, and addressing the underlying cause of the ulcer. In pronounced cases, a blood transfusion or surgical intervention may be needed.

Helicobacter Gastritis is inflammation of the stomach caused by Helicobacter bacteria. The mode of transmission is unknown, but may be possible via oral-oral contact, fecal-oral contact, or vector transmission. There is possible transmission from humans to cats, but potential of transmission from animals to humans is thought to be very low. Clinical signs include chronic vomiting, inappetance, or pica. Bloodwork, urinalysis, and fecal flotation are performed to rule out other potential causes for the symptoms. Diagnosis may be made via biopsy for histopathology, culture, urease testing, and PCR. Treatment involves antibiotic therapy and resolving the vomiting. The chance for recurrence is high, so repeat treatment may be necessary.

Hemorrhagic Gastroenteritis (HGE) occurs in dogs and is the sudden loss of intestinal mucosal health leading to vomiting and diarrhea containing blood. This can develop rapidly to a decrease in blood volume and progress to shock. Clinical signs may include anorexia, lethargy, acute bloody vomiting and diarrhea, or abdominal discomfort. The diarrhea may have a "strawberry jam-like" appearance or become very watery. Often times, it occurs without a known underlying cause. Diagnosis is based on symptoms, bloodwork, fecal examination and cytology, and abdominal x-rays. Treatment involves IV fluid therapy, antibiotics, resolving the vomiting and diarrhea, and feeding a low-fat easily digestible diet. Approximately 10-15% of dogs will have repeated episodes of HGE.

Inflammatory Bowel Disease is a chronic disease associated with gastrointestinal inflammation causing anorexia, vomiting, and diarrhea. In severe cases, the condition can lead to protein loss and fluid accumulation in the abdomen. Diagnosis is based on bloodwork, specialized blood tests, bile acids testing, urine analysis, fecal flotation, abdominal x-rays and ultrasound, and intestinal biopsies. Therapy is targeted toward resolving the vomiting and diarrhea and maintaining a strict hydrolyzed prescription diet that is easily digestible. Long term management may also include probiotics, antibiotics, vitamin B12 injections, or steroids.

Lymphangiectasia occurs as a lymphatic drainage abnormality of the intestines. Dilation of the intestinal lacteals results in protein loss causing symptoms of weight loss, intermittent vomiting, diarrhea, anorexia, abdominal distention or discomfort, or respiratory distress. Diagnostic testing may include bloodwork, specialized blood tests, fecal examinations, urine analysis, x-rays, ultrasound, fluid analysis of abdominal fluid, and intestinal biopsies by endoscopy or surgery. Treatment goals are directed toward improving the fluid balance, resolving the respiratory distress, and prescribing proper nutritional support. Long term treatment often involves a prescription ultra-low fat easily digestible or hydrolyzed diet, steroids, antibiotics, and antithrombotic medication.

Megaesophagus is dilation of the esophagus due to weakness of the esophageal muscles. This condition occurs most commonly in dogs. It can be congenital (born with the condition) or acquired (develops over time). Clinical signs involve weight loss or failure to gain weight, regurgitation, cough (secondary to aspiration in the lungs), or drooling. Animals born with the disease have a defect in part of the neural reflex that helps control swallowing. Acquired megaesophagus can occur secondary to neurologic, neuromuscular, muscular, or metabolic diseases. Diagnostic testing involves bloodwork, chest x-rays, fluoroscopy, testing for Myasthenia Gravis or hypoadrenocorticism, or electromyography. The primary therapeutic goal is aimed at finding and resolving the underlying cause. Other therapies include treating the aspiration pneumonia, modifying the diet, and prescribing prokinetic and antacid medications.

Perianal Fistula is a chronic inflammatory disease of the tissues surrounding the anus of dogs. The lesions are painful, ulcerative, and may have draining tracts. There is a predisposition in German Shepherds. This condition may be associated with food allergies. Clinical signs include excessive licking of the hindend and a foul odor. Bloody stools, fecal incontinence, self-mutilation, inappetance, lethargy, and weight loss may also occur. Diagnostic testing includes bloodwork, x-rays, cytology, biopsy, and bacterial culture. Treatment includes decreasing the size and severity of the fistulae and treating the infection. Chronic therapy with immunosuppressive medication is often indicated to maintain remission.

Pancreatitis (Canine) is acute or chronic inflammation of the pancreas usually as a result of dietary indescretion or trauma. Clinical signs include vomiting, diarrhea, anorexia, weakness, and abdominal discomfort. Diagnosis is based on the results of bloodwork, specialized blood tests, abdominal x-rays, or abdominal ultrasound. Treatment targets rehydration, pain control, and resolving the vomiting. Long term management for dogs with chronic pancreatitis includes a prescription low-fat diet.

Pancreatitis (Feline) is acute or chronic inflammation of the pancreas. Chronic pancreatitis in cats is a much different inflammatory process than that seen in most dogs. The most common symptoms in cats are anorexia, lethargy, dehydration, vomiting, and weight loss. Diagnostic testing includes bloodwork, specialized blood tests, and/or abdominal ultrasound. Treatment involves dietary modification with a novel protein source or hydrolyzed diet, maintaining hydration or fluid therapy, pain management, resolving vomiting, and stimulating an appetite.

Hematologic Diseases

Anemia can be divided into blood loss anemias, decreased production of red blood cells, or destruction of red blood cells.

Blood Loss Anemia is the loss of red blood cells from the vascular space. This can occur as a result of trauma, ulcers, post-surgical hemorrhage, intestinal worms, bleeding tumors, clotting disorders, or iron deficiency. Clinical signs include weakness, lethargy, collapse, anorexia, bloody stools, abdominal distention, and pale gums. Diagnostic tests involve bloodwork, a coagulation blood panel, x-rays, ultrasound, and thoraco- or abdominocentesis. Therapy includes cessation of blood loss, medical therapy, blood or plasma transfusions, and supportive care.

Anemia secondary to decreased production of red blood cells is a result of aplasia, or nonregeneration of red blood cells from the bone marrow. This can occur only to red blood cells, or to all blood cells produced in bone marrow. There can be numerous causes to this condition; however, sometimes an underlying cause is not found. Clinical signs include pale gums, lethargy, inappetance, weakness, elevated respiratory rate, fever, or collapse. Diagnosis is based on bloodwork, bone marrow aspirate, and infectious disease testing. Therapy is directed at resolving the underying cause and treating the anemia. Blood transfusions and immunosuppressive medications may be indicated in some cases.

Anemia from destruction, or hemolysis, of red blood cells can be a result of inherited red blood cell defects (PFK or PK deficiencies), infection, certain toxins, cancer, low phosphorus, or immune-mediated disease. Clinical signs of pale gums, lethargy, anorexia, weakness, elevated respiratory rate, fever, or collapse. Diagnosis is based on bloodwork, infectious disease testing, hereditary disease testing, x-rays, or cytology. Therapy targets correcting the underlying cause and addressing the anemia. Blood transfusions may be indicated in some cases.

Disseminated Intravascular Coagulation (DIC) is abnormal coagulation that is inappropriately activated as a result of an underlying disease process. This can occur secondary to shock, cancer, sepsis, organ dysfunction syndrome, and severe inflammatory and immune reactions. Clinical signs vary depending on the underlying disease, but progress to include collapse, pale gums, diffuse bruising, bloody stools, or icterus. Diagnostic testing includes bloodwork, coagulation testing, urine analysis, and chest and abdominal x-rays. Therapy is directed toward treating the underlying disease, fluid therapy, oxygen therapy, blood or plasma transfusions, and anticoagulation therapy.

Hemophilias are hereditary defects that impair clotting factors from being produced. As a result, severe bleeding disorders can be seen at 6 to 12 months of age. The symptoms reflect the inability to clot appropriately: hematomas, a large amount of bleeding from minor wounds, nose bleeds, or prolonged bleeding after surgery or a traumatic injury. Diagnostics include bloodwork and coagulation screening tests. Therapy involves controlling active bleeding, transfusions, and medical care. Long term care includes avoidance of surgery and trauma.

Hyperviscosity Syndrome is an increase in blood viscosity due to an increase in the blood components (plasma proteins, white blood cells, or red blood cells) which leads to sludging of the blood. Various underlying causes exist. Cinical signs include lethargy, weakness, weight loss, neurologic signs, and blindness. Diagnostic testing involves bloodwork, retinal exam, blood pressure, chest and abdominal x-rays, ultrasound, serum protein electrophoresis, coagulation testing, bone marrow aspirate, and testing for infectious diseases. Treatment of the underlying disease process is indicated. Plasmapheresis or phlebotomy may also be required to decrease the viscosity of the blood.

Immune-Mediated Neutropenia is destruction of neutrophils (a type of white blood cell) by the immune system as a result of medication, infection, or unknown cause. Clinical signs include weakness, lethargy, anorexia, and fever. Bloodwork, urine analysis, abdominal ultrasound, and infectious disease blood testing may be performed to assess for an underlying cause. Treatment may include antibiotic or steroid therapy. Sepsis is a potential complication.

Platelet Dysfunction is a defect in the platelet activation which can lead to bleeding tendencies. Dysfunction of the platelets can be inherited or acquired. Acquired disease can occur secondarily to systemic disease, certain medications, or disseminated intravascular coagulation. Diagnostic testing includes bloodwork and coagulation testing. Therapy is directed at treating the underlying disease, discontinuing medication, blood and/or plasma tranfusions, and controlling hemorrhage.

Immune-Mediated Polyarthritis occurs when there is inflammation of two or more joints because of attack by the immune system as a result of medication, vaccination, or unknown cause. Clinical signs include limping, stiffness, weakness, loss of appetite, lethargy, and weight loss. Bloodwork, urine analysis, x-rays, arthrocentesis for joint fluid analysis and culture, tick titers, and antinuclear antibody and rheumatoid factor testing are often performed for a diagnosis. Therapy includes immunosuppressive medications.

Shar-pei Fever is an inherited sterile inflammatory disorder in Shar-pei dogs that causes recurrent fever, swelling of the tibiotarsal joint, and amyloid deposition. It is diagnosed by excluding other potential causes for the clinical signs. This includes bloodwork, urine analysis, blood pressure measurement, tick titers, abdominal ultrasound, and kidney or liver biopsies. Treatment may include intravenous fluid therapy, anti-inflammatory medication, and antihypertensive medication.

Systemic Lupus Erythematosus is an inherited autoimmune disorder causing inflammation of at least two different organ systems. If the skin is affected, it may worsen with exposure to UV light. Clinical signs include skin lesions, oral ulcers, lameness, poor appetite, and fever. Diagnostic testing involves bloodwork, urine analysis, biopsies, x-rays, arthrocentesis, antinuclear antibody titer, LE cell testing, tick titers, and other infectious disease testing. Treatment with immunosuppressive or anti-inflammatory medications, antibiotics, and intravenous fluid therapy may be necessary.

Immune-Mediated Thrombocytopenia is an autoimmune destruction of the platelets that occurs secondary to medication, vaccination, or unknown cause. This leads to the inability to clot appropriately and bleeding tendencies. Diagnostic testing includes bloodwork, urine analysis, coagulation blood testing, tick titers, x-rays, and abdominal ultrasound. Therapy may involve blood or plasma transfusion and immunosuppressive medication.

von Willebrand Disease is a hereditary defect caused by a deficiency in von Willebrand factor (vWF), which is necessary for proper clot formation. Clinical signs include prolonged bleeding and may involve mild bleeding tendencies or more severe hemorrhage. This condition may occur in any breed, but Doberman pinschers may be over-represented. Bloodwork, coagulation testing, and vWF concentration testing are performed for diagnosis. Treatment may include blood or plasma transfusion, cryoprecipitate therapy, or administration of desmopressin acetate for preoperative therapy. Medications that prolong bleeding time should be avoided.

Heart Disease

Aortic Thromboembolism occurs in felines and is an occlusion of a systemic artery by clot. This can occur secondary to heart disease or cancer. Clinical signs involve pain, paralysis, difficulty or labored breathing, and the affected limb feels cold. Diagnostic testing includes bloodwork, thyroid bloodwork, x-rays, blood pressure assessment, coagulation blood panel, cardiac ultrasound, and electrocardiogram. Therapy involves pain management, supportive care, oxygen therapy, treatment of underlying heart disease, and clot dissolution.

Arrhythmias is an irregular heart beat as a result of heart or systemic disease. Clinical signs may include difficulty or labored breathing, fainting, anorexia, or lethargy. Diagnosis is based on physical examination, bloodwork, x-rays, electrocardiogram, and cardiac and/or abdominal ultrasound. Treatment depends on the underlying cause and type of arrythmia, but may include oral medications, placement of a pacemaker, or abdominal surgery.

Atrial Septal Defect is a congenital defect of the heart where there is a communication between the left and right atrium through the septum. There may be no clinical signs, or difficulty breathing, fainting, anorexia, or lethargy may be present. Diagnosis is based on the presence of a murmur, and may include testing in the form of chest x-rays, cardiac ultrasound, electrocardiogram, bloodwork, and arterial blood gas analysis. Treatment may include oral medications and, rarely, surgical repair.

Boxer Cardiomyopathy is an inherited heart abnormality of boxer dogs causing ventricular arrythmias. Clinical signs include weakness, exercise intolerance, weakness, collapse, sudden death, or, less commonly signs of congestive heart failure. This condition is diagnosed by electrocardiogram and Holter monitor. Treatment involves oral medication to reduce the frequency and severity of the arrythmias.

Cardiogenic Pulmonary Edema, or Congestive Heart Failure, occurs when fluid from the vessels builds up in interstitial and alveolar space of the lungs as a result of left-sided heart disease. Clinical signs include a dry progressive cough, difficulty or rapid breathing, open mouth breathing in cats, weakness, lethargy, decreased appetite, and collapse. The condition is diagnosed with auscultation of a heart murmur and pulmonary crackles or wheezes on exam, chest x-rays, bloodwork, urine analysis, heart ultrasound, and electrocardiogram. Therapy is directed at stabilizing the patient with oxygen therapy and diuretics. Long-term therapy includes oral medications to improve heart function and to prevent pulmonary fluid accumulation.

Dilated Cardiomyopathy is heart enlargement and failure of the heart to pump properly that occurs secondarily to heart disease. Clinical signs include dry progressive cough, difficulty or fast breathing, open mouth breathing in cats, weakness, lethargy, decreased appetite, and collapse. The condition is diagnosed with auscultation of a heart murmur and pulmonary crackles or wheezes (if congestive heart failure is also present) on exam, chest x-rays, bloodwork, urine analysis, heart ultrasound, and electrocardiogram. Therapy is directed at stabilizing the patient with oxygen therapy and diuretics, if indicated. Long-term therapy includes oral medications to improve heart function and to prevent pulmonary fluid accumulation.

Endocarditis is inflammation or infection of the endocardium of the heart. This can occur secondarily to a bacterial infection (bacterial endocarditis) or vegetation deposits (vegetative endocarditis). Clinical signs include auscultation of a heart murmur on exam, fever, general malaise, and lameness. Diagnosis is made with bloodwork, blood cultures, urine analysis, chest x-rays, heart ultrasound, and electrocardiogram. Treatment includes oral antibiotic medication and may also include anticoagulant therapy for prevention of clot formation.

Heart Base Tumor is any mass located at the base of the heart and is associated with the ascending aorta and the pulmonary trunk. Clinical signs typically occur as a result of fluid accumulation in the sac surrounding the heart (pericardial effusion). These include lethargy, cough, difficulty and fast breathing, weakness, exercise intolerance, decreased appetite, weight loss, abdominal distention, and collapse. The condition is diagnosed based on auscultation of muffled heart sounds, chest and abdominal x-rays, bloodwork, urine analysis, heart ultrasound, electrocardiogram, and cytology of the mass. Treatment is directed at relieving the pericardial effusion through pericardiocentesis or pericardectomy. Rarely, are these masses removed due to the extensive involvement of the major vessels.

Heartworm Disease is an infestation of the heart with the intravascular worm, Dirofilaria immitis. This condition occurs as a result of transmission from female mosquitoes, which serve as intermediate hosts. Mosquitoes feed on microfiliaria positive dogs or cats. The microfiliara then go through larval stages in the mosquito to become L3 larvae which then infect another dog or cat during subsequent meal feedings. The L3 larvae then migrate to the pulmonary artery of the heart and become adult worms. These worms grow and accumulate causing an obstruction of blood flow which can lead to dilation of the heart and congestive heart failure. Therapy is directed at preventing the L3 larvae from becoming adult worms. This is accomplished with regularly administered heartworm preventive medication.

Canine Heartworm Disease: Clinical signs in dogs include cough, exercise intolerance, lethargy,  weight loss, collapse, and abdominal distention. This condition is diagnosed by performing a heartworm antigen test, microfilaria testing, bloodwork, chest x-rays, and/or electrocardiography. Treatment involves killing the adult worms in the heart with a series of melarsomine injections. Additional therapies include regularly administered heartworm prevention, oral steroids to decrease the inflammation, and oral antibiotics to treat the bacteria associated with the heartworm. There are a series of tests following treatment to confirm resolution of the disease.

Feline Heartworm Disease: Cats may or may not exhibit clinical signs. If so, they include cough, difficulty breathing, vomiting, decreased appetite, weight loss, lethargy, exercise intolerance, and abdominal distention (rarely). Unlike dogs, heartworm disease is difficult to diagnose in cats due to the lower worm burden and microfilaria counts. Therefore, heartworm antigen and microfilaria testing may provide false negative results. Diagnostic testing may include bloodwork, heartworm antigen and antibody testing, chest x-rays, and cardiac ultrasound. Cardiac ultrasound yields better results for a definitive diagnosis. Treatment in cats is different than in dogs because melarsomine is toxic to cats. Therefore, therapy usually involves steroids, antibiotics, and/or anticoagulation medication. Surgical extraction of the worms is a consideration, but is rarely performed.

Hemangiosarcoma is a malignant tumor of vascular origin that involves the heart as a primary or metastatic site which commonly causes fluid to build up in the sac surrounding the heart (pericardial effusion). Clinical signs include general malaise, lethargy, decreased appetite, exercise intolerance, abdominal distention, and collapse. Diagnosis includes ausculting muffled heart sounds, bloodwork, chest and abdominal x-rays, cardiac and abdominal ultrasound, and cytology of pericardial fluid. Treatment targets removing the pericardial fluid with pericardiocentesis or pericardectomy. Removal of the tumor is rarely performed due to most cases having pulmonary metastasis at the time of diagnosis.

Hypertrophic Cardiomyopathy is a type of heart disease in the cat that is characterized by increased wall thickness of the left ventricle. This can occur as a genetic predisposition or secondary to other conditions, such as, hyperthyroidism. Clinical signs may or may not be present. When present, they may include difficulty or rapid breathing, open mouth breathing, lethargy, decreased appetite, vomiting, lameness or inability to move extremity, or sudden death. Diagnostic testing involves bloodwork (including thyroid testing), urine analysis, blood pressure testing, chest x-rays, cardiac ultrasound, and electrocardiogram. Treatment may include oral medication to treat the underlying cause, aid in heart function, decrease fluid accumulation in the lungs, and decrease tendency for clot formation.

Patent Ductus Arteriosus is a persistent communication between the aorta and pulmonary artery that normally closes within the first 24 hours of birth. The condition is suspected based on examination during puppy or kitten visit. It is confirmed with cardiac ultrasound. Clinical signs may or may not be present. If present, they include exercise intolerance, failure to thrive, dry cough, difficulty or rapid breathing, open mouth breathing in cats, weakness, lethargy, decreased appetite, and collapse. Treatment involves closure of the communication surgically by ligation or coil placement. If left untreated, the condition progresses to congestive heart failure.

Pericardial Effusion is the accumulation of fluid in the sac surround the heart (pericardial sac). It can occur secondary to cancer, left atrial rupture, congestive heart failure, infection, ingestion of rodenticide, or unknown cause. Clinical signs include exercise intolerance, dry cough, difficulty or rapid breathing, open mouth breathing in cats, weakness, lethargy, decreased appetite, and collapse. The condition is diagnosed by ausculting muffled heart sounds, bloodwork, chest and abdominal x-rays, cardiac and abdominal ultrasound, and cytology of pericardial fluid. Treatment targets removing the pericardial fluid with pericardiocentesis, pericardectomy, and addressing the underlying cause.

Pericarditis is inflammation of the pericardium as a result of infection or chronic inflammatory disease. Clinical signs can include lethargy, episodic weakness, exercise intolerance, difficulty or rapid breathing, collapse, fever, and ascites. Diagnosis is made by bloodwork, cardiac ultrasound, electrocardiogram, and cytology and culture of effusion (if present). Treatment involves antibiotic medication and removal of effusion, if present. Subtotal pericardectomy may also be performed to prevent further accumulation of pericardial fluid.

Pulmonary Hypertension is increased pulmonary artery pressure with or without a known underlying cause. This leads to exercise intolerance, difficulty breathing, collapse, abdominal distention, or rear limb weakness. Diagnostic testing includes bloodwork, heartworm blood testing, chest x-rays, fecal testing, cardiac ultrasound, and electrocardiogram. Treatment includes oxygen therapy, specific treatment for an underlying cause, oral anti-hypertensive medication.

Pulmonary Thromboembolism occurs when there is an occlusion of a pulmonary artery or arteriole by thrombus. This condition is considered a medical emergency. Clinical signs can include a sudden onset of difficulty or rapid breathing, cough, exercise intolerance, and abdominal distention. Diagnostic testing involves bloodwork, heartworm blood testing, urine analysis, plasma D-dimer testing, chest x-rays, cardiac ultrasound, and blood gas analysis. Treatment includes oxygen therapy, medication for thrombus dissolution, and specific treatment for the underlying cause.

Systemic Hypertension is elevation in the arterial blood pressure. In cats, this condition is most often secondary to kidney disease or hyperthyroidism. In dogs, it is most often associated with kidney disease, hyperadrenocorticism, diabetes mellitus, or pheochromocytoma. Clinical signs are related to the underlying cause and also may include lethargy, acute blindness, and neurologic signs. Diagnostic testing involves bloodwork, thyroid function testing, urine analysis, blood pressure testing, x-rays, and chest and abdominal ultrasound. Treatment is directed at the underlying cause and anti-hypertensive medication is prescribed.

Valvular Disease is the degeneration of the mitral and/or tricuspid valves of the heart as a result of fibrous tissue development. This causes the valves to close abnormally, leading to valvular regurgitation and eventually congestive heart failure. Clinical signs may or may not be present. These can include cough, lethargy, or exercise intolerance. Diagnosis is made following auscultation of a heart murmur, with x-rays and a cardiac ultrasound. Treatment includes oral medications.

Vascular Ring Anomaly is a congenital malformation of one or more parts of the aortic arch so that the vessels encircle the esophagus and trachea causing compression. The most common type is a persistent right aortic arch. Megaesophagus and aspiration pneumonia are secondary conditions associated with this condition. Clinical signs include regurgitation after eating, failure to thrive, cough, or respiratory distress. Diagnostic testing includes chest x-rays, bloodwork, and barium esophagram. Therapy is directed at dividing the vascular ring surgically and treating the regurgitation.

Ventricular Septal Defect is a congenital defect of the heart where there is a communication between the left and right ventricle through the septum. There may be no clinical signs, or difficulty breathing, fainting, anorexia, or lethargy may be present. Diagnosis is based on the presence of a murmur, and may include testing in the form of chest x-rays, cardiac ultrasound, electrocardiogram, bloodwork, and arterial blood gas analysis. Treatment may include oral medications and, rarely, surgical repair.

Liver, Gall Bladder, and Pancreas

Acute Hepatic Injury is a sudden injury to the liver as a result of trauma, shock, infectious disease, or drug, chemical, or toxin exposure. Clinical signs involve anorexia, vomiting, diarrhea, increased thirst or urination, or lethargy. Diagnostic testing includes, bloodwork, urine analysis, x-rays, abdominal ultrasound, liver cytology or biopsy, and infectious disease testing. The condition is treated by addressing the underlying cause and protecting the liver from additional damage.

Cholangitis/Cholangiohepatitis Complex of Cats is inflammation of the biliary tree and surrounding liver which can occur as a primary, coexisting, or secondary problem. When this condition occurs in conjunction with inflammatory bowel disease and pancreatitis, it is called a Triaditis. Clinical signs can include fever, jaundice, anorexia, vomiting, and weight loss. Diagnosis is can involve bloodwork, infectious disease testing, pancreatic blood testing, coagulation testing, abdominal ultrasound, liver cytology or biopsy, and culture and susceptibility. Therapy includes intravenous fluid therapy, nutritional support, treatment of the underlying cause, and protecting the liver from additional damage.

Cholecystitis is inflammation of the gall bladder. Clinical signs include vomiting, diarrhea, appetite loss, lethargy, jaundice, and weight loss. Diagnostic testing involves bloodwork, abdominal x-rays, abdominal ultrasound, and biopsy and culture once the gall bladder is removed. Treatment involves medication mild cases and surgical removal in moderate to severe cases.

Cirrhotic Liver Disease occurs when fibrotic tissue and regenerative nodules form in the liver causing irreversible damage. Clinical signs include lethargy, weight loss, anorexia, vomiting, diarrhea, abdominal distention, increased thirst and urination, and jaundice. Diagnosis is made by bloodwork, urine analysis, analysis of the abdominal fluid, coagulation testing, x-rays, abdominal ultrasound, and liver biopsy. Therapy involves nutritional support, treatment of the underlying cause, and protecting the liver from additional damage.

Exocrine Pancreatic Insufficiency is the insufficient secretion of pancreatic digestive enzymes resulting in maldigestion. Clinical signs include weight loss, ravenous appetite, loose stools or diarrhea, and poor haircoat. Diagnostic testing includes bloodwork, fecal testing, and TLI blood testing. Treatment involves pancreatic enzyme replacement, vitamin supplementation, and treating concurrent intestinal disease.

Hepatic Encephalopathy is a metabolic neurologic disease as a result of liver disease. Clinical signs include neurologic signs (wandering, head pressing, disorientation, seizures, blindness, or coma), gastrointestinal signs (vomiting, decreased appetite, diarrhea, and poor weight gain), and urinary signs (increased thirst and urination, straining to urinate, or blood in the urine). The condition is diagnosed with bloodwork, urine analysis, bile acids testing, abdominal ultrasound,  and liver biopsy. Treatment includes fluid and electrolyte therapy, controlling seizures, medications, nutritional therapy, and vitamin supplementation.

Hepatic Lipidosis is the excessive accumulation of fat as a result of prolonged anorexia by the cat. Clinical signs include anorexia, lethargy, depression, vomiting, constipation, or diarrhea. Diagnostic tests include bloodwork, urine analysis, chest and abdominal x-rays, abdominal ultrasound, bile acid and pancreatic blood testing, and liver cytology or biopsy. Treatment includes fluid therapy, vitamin supplementation, appetite stimulant medication for feeding tube placement, and additional therapies dependent on severity of the illness.

Hepatic Neoplasia is a primary malignant cancer of the liver or biliary tract. Clinical signs include anorexia, vomiting, diarrhea, lethargy, weight loss, increased thirst and urination, and abdominal distention. The condition is diagnosed by performing bloodwork, bile acids blood testing, chest and abdominal x-rays, abdominal ultrasound, and liver cytology or biopsy. Treatment may involve supportive care, removal of the tumor, or chemotherapy.

Hepatic Nodules are benign nodules found in the liver usually as an incidental finding on routine bloodwork and abdominal ultrasound. This condition rarely causes clinical signs. Additional diagnostic testing may include bile acids testing and liver cytology or biopsy. No treatment is necessary unless occurring in conjunction with cirrhosis of the liver.

Hepatitis is a chronic progressive inflammation and necrosis of the liver with an often unknown underlying cause. Clinical signs may or may not occur. If clinical signs are present, they include anorexia, vomiting, diarrhea, weight loss, lethargy, increased thirst and urination, or abdominal distention. Diagnostic testing is directed at finding an underlying cause. Testing includes bloodwork, bile acids blood testing, urine analysis, abdominal x-rays, coagulation testing, infectious disease testing, abdominal ultrasound, abdominal fluid testing, liver cytology or biopsy, or liver metal quantitative analysis. Treatment may include fluid therapy, therapy for coagulopathy or sepsis, nutritional support, liver supplementation, and treating a known underlying cause.

Microvascular Dysplasia is a congenital disorder of dogs resulting in shunts within the liver. Most affected dogs do not show clinical signs. If clinical signs exist, they include lethargy, ataxia, weakness, abnormal behavior, bumping into objects, pacing or circling, seizures, coma, anorexia, vomiting, diarrhea, or urinary signs. Diagnostic testing may include bloodwork, bile acids blood testing, coagulation blood testing, urine analysis, abdominal x-rays, abdominal ultrasound, and liver biopsy. Treatment involves reducing protein intake and preventing the absorption of toxins through the gastrointestinal tract.

Pancreatic Adenocarcinoma is a malignant and highly metastatic cancer of the pancreas. Clinical signs include anorexia, weight loss, vomiting, diarrhea, abdominal distention, and hair loss (cats). Diagnostic testing may include bloodwork, chest and abdominal x-rays, abdominal ultrasound, abdominal fluid cytology, or pancreatic cytology and biopsy.

Pancreatitis, Feline is an acute or chronic inflammation of the pancreas. Clinical signs include lethargy, anorexia, and vomiting. Diagnostic testing may involve bloodwork, pancreatic lipase testing, abdominal ultrasound, and trypsin-like immunoreactivity testing. Therapy is directed at nutritional support, intravenous fluids, pain medication, and anti-nausea medication. Treatment for inflammatory bowel disease and cholangiohepatitis is also indicated if the gastrointestinal tract and liver are additionally involved.

Pancreatitis, Canine is an acute or chronic inflammation of the pancreas which, in dogs, can occur secondary to the ingestion of high fat foods. Clinical signs include anorexia, vomiting, diarrhea, weakness, and abdominal pain. Diagnostic testing may include bloodwork, pancreatic lipase blood testing, abdominal x-rays, and abdominal ultrasound. Treatment involves fasting or reducing fat intake, intravenous fluids, pain medication, and anti-nausea medication. Dogs with chronic pancreatitis should receive a diet low in fat and pancreatic enzyme supplementation if chronic pain exists.

Portosystemic Shunt is a congenital or acquired condition where there is an abnormal vascular communication between the portal and systemic circulation without first passing through the liver. Clinical signs include lethargy, ataxia, weakness, abnormal behavior, bumping into objects, pacing or circling, seizures, coma, anorexia, vomiting, diarrhea, or urinary signs. Diagnostic testing may include bloodwork, bile acids blood testing, coagulation blood testing, urine analysis, abdominal x-rays, abdominal ultrasound, and radiographic mesenteric portography. Treatment for a congenital shunt may involve surgical ligation. Treatment for both types includes reducing protein intake and preventing the absorption of toxins through the gastrointestinal tract.

Vacuolar Hepatopathy is a benign reversible liver lesion that occurs secondary to excess glucocorticoids or other systemic disorders. Excess glucocorticoids can occur from oral or injectable steroid administration or secondary to hyperadrenocorticism. Clinical signs may or may not exist. If clinical signs occur, they can include increased thirst and urination, increased appetite, distended abdomen, lethargy, and panting. Diagnostic testing includes bloodwork, bile acids blood testing, abdominal x-rays, abdominal ultrasound, low dose dexamethasone testing, and liver cytology or biopsy. Therapy is directed at treating the underlying cause and the administration of liver protectants or supplements.

Lung

Bronchiolar and Pulmonary Neoplasia is cancerous growth that originates in the bronchi and lungs. Clinical signs include cough, difficulty or rapid breathing, and lethargy. Diagnostic testing includes bloodwork, chest x-rays, CT scan, or bronchoscopy. Treatment may involve supportive care, removal of the tumor, chemotherapy, radiation therapy, or palliative therapy.

Calicivirus is a viral disease in cats that may cause ocular or respiratory problems, oral ulceration, and acute arthritis. Clinical signs vary and cats may be asymptomatic, or display lethargy, anorexia, sneezing, eye or nasal discharge, drooling, or reluctance to walk or limping. The infection is spread by direct contact with an infected cat or fomites. Diagnostic testing includes viral isolation or PCR. Prevention involves vaccination for the virus. Treatment may include fluid therapy, nutritional support, pain medications, anti-viral medication, and managing flare ups of the virus.

Chronic Bronchitis is a common noninfectious airway disease affecting older adult dogs. Clinical signs include a dry cough, exercise intolerance, or collapse. Diagnostic testing involves chest x-rays, bloodwork, bronchoscopy with cytology, and arterial blood gas measurement. Therapy is directed at reducing coughing with cough suppressants, bronchodilators, and anti-inflammatory medication. Oxygen therapy may be indicated in severe cases.

Chylothorax is the accumulation of chyle within the pleural space of the chest cavity. Clinical signs may include difficulty or rapid breathing, lethargy, coughing, and respiratory distress. Diagnostic testing involves chest x-rays, cytology of the fluid, chest and cardiac ultrasound, or advanced imaging (CT scan or MRI). Treatment may include oxygen therapy, draining the fluid from the chest, treating the underlying cause if found, Rutin supplementation, and feeding a reduced fat diet.

Collapsing Trachea occurs when the cartilage supports of the trachea weaken over time narrowing of the airway and cause coughing. The cough tends to worsen with excitement or exercise. Diagnostic testing may include bloodwork, chest x-rays, fluoroscopy, and bronchoscopy. Therapy involves weight loss in obese dogs and antitussive, anti-inflammatory, and bronchodilating medications. Surgical management can include placement of external prosthetic rings around the outside of the trachea or stent placement within the tracheal lumen.

Diaphragmatic Hernia is a disruption of the diaphragm leading to shifting of the abdominal organs into the chest cavity. This condition is usually the result of trauma. Clinical signs include difficulty breathing, anorexia, vomiting, constipation, diarrhea, difficulty lying down, and weight loss. Diagnostic testing includes bloodwork, chest and abdominal x-rays, contrast x-rays, or ultrasound. Treatment is directed at supportive care, oxygen therapy, and surgical repair of the defect.

Emphysema and Pulmonary Bullae is the accumulation of air or a distinct air-filled space  within the lung. The condition may be found incidentally on x-rays or cause clinical signs leading to the diagnosis. Clinical signs may include cough, difficulty breathing, anorexia, or lethargy. Diagnostic testing involves bloodwork, fecal examination, chest x-rays, and CT scan. Treatment is directed at stabilizing the patient with oxygen therapy and treating any found underlying cause. Partial or complete lung lobectomy to remove the affected part(s) of the lung may be indicated in some cases.

Feline Asthma occurs when the immune system is triggered by allergens causing coughing, wheezing, or difficulty or rapid breathing. The condition is diagnosed by performing bloodwork, fecal examination, heartworm antigen/antibody testing, chest x-rays, cardiac ultrasound, and bronchoscopy with cytology. Treatment may include oxygen therapy, and anti-inflammatory and bronchodilating medications. Chronic therapy with aerosolization of anti-asthmatic medication may be indicated.

Laryngeal Masses can be a benign or malignant proliferation of laryngeal tissue which can lead to acute or chronic upper airway obstruction. Clinical signs may include difficulty breathing, voice change, cough, exercise intolerance, gagging, hypersalivation, collapse, or noting a mass in the neck. The condition is diagnosed by performing bloodwork, neck and chest x-rays, laryngoscopy, ultrasound, or advanced imaging (CT scan or MRI). Treatment includes oxygen therapy, tracheostomy, surgical removal, or radiation therapy.

Laryngeal Paralysis is the lack of opening of the vocal folds and arytenoid cartilages as a result of their associated muscle or nerve dysfunction. Clinical signs include voice change, coughing or gagging when eating, exercise intolerance, difficulty or "raspy" breathing, and collapse. Diagnostic testing may include bloodwork, chest x-rays, thyroid blood testing, examination of the larynx during light sedation, or laryngoscopy. Treatment may involve oxygen therapy, reducing laryngeal edema, and sedation in severe cases. Nonsurgical long term management includes weight loss, restricting exercise, reducing stress, and prevention of hyperthermia in warm conditions. Surgery may be indicated depending on severity. This involves suturing open one or both of the cartilages. There is a lifelong risk of aspiration pneumonia following surgical treatment.

Long Lobe Torsion is the rotation of a lung lobe along its axis usually associated with pleural effusion. Diagnostic testing includes bloodwork, chest x-rays, chest ultrasound, cytology of the pleural fluid, and possibly CT scan. Therapy is directed at stabilizing the patient, improving respiratory function, and removing the affected lung lobe.

Lung Parasites are worms that develop in the major airways or lungs after infection with the larval form of the worm. Clinical signs of infection include coughing, wheezing, exercise intolerance, or respiratory distress. Diagnosis is by fecal testing, Baermann fecal testing, chest x-rays, bloodwork, or bronchoscopy and tracheal or bronchial washes. Treatment includes supportive care and paraciticidal medication.

Mediastinal Disease occurs when air, inflammation, fluid, or a mass develop in the space between the right and left sides of the lungs. Clinical signs can include reluctance to eat, difficulty eating, regurgitation, lethargy, coughing, difficulty breathing, or facial, neck, and/or forelimb swelling. Diagnostic testing involves chest and abdominal x-rays, bloodwork, chest ultrasound, or cytology and culture of the area. Therapy is directed at treating the underlying cause.

Nasal Neoplasia is cancer (usually malignant) occurring in the nasal passages. Clinical signs include hemorrhagic nasal discharge (either one-sided or two-sided), sneezing, reverse sneezing, difficulty or open-mouth breathing, or obvious facial swellings or abnormal appearance to the eye. The condition is diagnosed with bloodwork, lymph node cytology, chest x-rays, nasal imaging (MRI or CT scan), rhinoscopy, or biopsy of affected region. Treatment involves controlling hemorrhage, pain medication, antibiotics for secondary infection, radiation therapy, or chemotherapy.

Nasopharyngeal Polyp is a benign pedunculated mass that originates in the from the middle ear. This occurs primarily in young adult cats. Clinical signs may include nasal discharge, congestion, sneezing, head shaking, pawing at ears, head tilt, malodor to ears, difficulty breathing, or difficulty eating. Diagnostic testing includes an otic exam and cytology, skull x-rays, bloodwork, oral exam under anesthesia, CT scan, and biopsy of the mass. Treatment involves oxygen therapy if respiratory distress is present, treating secondary ear infections, and, ultimately, surgical removal of the mass.

Nasopharyngeal Stenosis is the formation of a thin fibrous membrane at the internal nasal meatus causing narrowing which leads to upper respiratory tract disease. Clinical signs include nasal discharge, sneezing, and worsening of respiratory signs when eating or swallowing. Diagnosis is based on identifying the fibrous membrane with CT scan or pharyngeal exam with bronchoscopy or a dental mirror. Therapy includes removal or dilation of the membrane and anti-inflammatory medication.

Pleural Effusion is the accumulation of fluid in the pleural space in the chest. This can occur as a result of heart disease, infection, inflammation, trauma, protein loss, or cancer. Clinical signs range based on severity of the fluid build up. They can include cough, lethargy, difficulty or rapid breathing, weight loss, anorexia, or distended abdomen. The condition is diagnosed by performing bloodwork, chest and abdominal x-rays, cytology and/or culture of the fluid, or chest ultrasound. Treatment is targeted at supportive care, removal of the fluid, and treating the underlying cause.

Pneumonia, Aspiration can occur when gastric contents or other materials are inhaled into the lungs. Clinical signs include cough, lethargy, difficulty or rapid breathing, collapse, anorexia, or respiratory distress. Diagnostic testing involves bloodwork, chest x-rays, evaluation of blood oxygenation levels, transtracheal lavage for cytology and culture, or bronchoscopy. Therapy includes supportive care (oxygen therapy and intravenous fluids), bronchodilating and antimicrobial medications, courage, and/or nebulization.

Pneumonia, bacterial occurs when there is inflammation of the lungs as a result of a bacterial infection. Clinical signs include cough, nasal discharge, sneezing, lethargy, difficulty or rapid breathing, collapse, anorexia, or respiratory distress. Diagnostic testing involves bloodwork, chest x-rays, evaluation of blood oxygenation levels, transtracheal lavage for cytology and culture, or bronchoscopy. Therapy includes supportive care (oxygen therapy and intravenous fluids), bronchodilating and antimicrobial medications, courage, and/or nebulization.

Pulmonary Edema (Noncardiogenic) occurs when fluid from the vessels builds up in interstitial and alveolar space of the lungs as a result of upper airway obstruction, electrocution, trauma, sepsis, non-septic inflammatory disease, smoke inhalation, or near-drowning experience. Clinical signs include cough, difficulty or rapid breathing, open mouth breathing in cats, weakness, lethargy, decreased appetite, and collapse. The condition is diagnosed with a known underlying cause, a lack of auscultation of a heart murmur, presence of pulmonary crackles or wheezes on exam, chest x-rays, bloodwork, and urine analysis. Therapy is directed at stabilizing the patient with oxygen therapy and bronchodilating medication.

Pulmonary Hypertension (arterial) is elevated arterial pulmonary pressure, which can occur primarily or secondarily to another cause. Underlying causes may include kidney disease, Cushing's disease, cancer, pancreatitis, heartworm disease, or pulmonary thromboembolism. Clinical signs include cough, difficulty or rapid breathing, abdominal distention, weakness, lethargy, decreased appetite, and collapse. The condition is diagnosed by performing bloodwork, heartworm testing, chest and abdominal x-rays, fecal and Baermann testing, coagulation profile, and chest ultrasound. Therapy includes supportive care and treating the underlying cause for the condition.

Pulmonary Eosinophilic Infiltrates occurs when a particular type of white blood cell (eosinophil) infiltrates the respiratory tract in high numbers without a known underlying cause. Clinical signs include a chronic cough, nasal discharge, exercise intolerance, lethargy, and decreased appetite. Diagnostic testing involves bloodwork, urine analysis, fecal and Baermann testing, chest x-rays, bronchoscopy with cytology and culture, and heartworm testing. Treatment can include steroid medication or removal of solitary mass-forming infiltrates.

Pulmonary Lymphoid Granulomatosis occurs as a rare cancer of infiltrates of lymphoid cells in the lungs. Clinical signs include a cough, exercise intolerance, lethargy, decreased appetite, fever, abdominal distention, enlarged peripheral lymph nodes, or vomiting. Diagnostic testing involves bloodwork, urine analysis, fecal and Baermann testing, chest x-rays, bronchoscopy with cytology and culture, and heartworm testing. Treatment can includes supportive care and chemotherapy.

Respiratory Foreign Body occurs when foreign material lodges in the airways causing obstruction and inflammation. Clinical signs are dependent on location. Nasal foreign body: Sneezing, pawing at face, nasal discharge from one nares, difficulty breathing, or malodor to breath. Tracheal or bronchial foreign body: cough, difficulty breathing, malodor to breath, coughing blood, retching or vomiting, exercise intolerance, or respiratory distress. Bronchiole or pulmonary foreign body: cough, difficulty or rapid breathing, exercise intolerance, lethargy, anorexia, fever, and weight loss. Diagnostic testing includes bloodwork, skull, neck, or chest x-rays, advanced imaging, or bronchoscopy (with cytology and culture). Treatment is directed at supportive care, removing the foreign material, and treating secondary inflammation and infection.

Reverse Sneezing is a noisy paroxysmal sneeze that occurs in the nasopharyngeal region. The condition occurs as a result of an irritant from the environment, nasal mites, infection, or cancer. Diagnostic testing may include bloodwork, viral blood testing, skull x-rays, nasal flush with cytology and culture, rhinoscopy, or CT scan/MRI. Therapy involves treating the underlying cause: anti-inflammatory, antihistamine, or antimicrobial medication, treatment for mites, or treatment for cancer.

Rhinitis, Bacterial is the bacterial inflammation of the one of both of the nasal cavities as a result of another cause. Clinical signs that may be seen include sneezing, nasal discharge, nose bleed, pawing at the nose, head shaking, decreased appetite, or bad breath. Diagnosis is made with bloodwork, oral exam, dental and/or skull x-rays, nasal flush or rhinoscopy with cytology and culture, biopsy, or advanced imaging. Therapy is directed at treating the underlying cause, mucolytic medication, antimicrobial medication, and clearance of nasal secretions.

Rhinitis, Lymphoplasmacytic is a gradually progressive inflammatory nasal disease as a result of infiltration with lymphocytes and plasma cells. The cause is unknown. Clinical signs include sneezing, nasal discharge, nose bleed, pawing at the nose, head shaking, decreased appetite, or ocular discharge. Diagnostic testing includes bloodwork, viral blood testing, imaging of the nasal cavity and sinuses (x-ray, CT scan, or MRI), rhinoscopy with cytology and culture, or biopsy. Treatment includes mucolytic medication, low-dose steroid medication, and antimicrobial medication for secondary bacterial infections.

Sinusitis/Sinus Disorders is mucosal inflammation of one or more of the sinuses as a result of infection, trauma, dental abscess, cancer, or unknown cause. Clinical signs include nasal discharge, sneezing, facial swelling or deformity, lethargy, sensitivity to head, and anorexia. Diagnostic testing often includes bloodwork, viral blood testing, skull x-rays, advanced imaging of skull (CT scan or MRI), rhinoscopy or trephination for cytology, culture, and/or biopsy. Therapy is directed at supportive care and treating the underlying cause.

Tracheal Avulsion is a disruption or tear in the trachea. Clinical signs include subcutaneous emphysema, difficulty or rapid breathing, or respiratory distress. The condition is diagnosed based on recent known trauma, physical exam, neck and chest x-rays, or tracheoscopy. Therapy involves supportive care, treating the underlying cause, or surgical repair of the defect.

Musculoskeletal

Achilles Tendon Injury is an injury to any of the tendons that attach to the calcaneus bone. The tendons that make up the achilles mechanism include the gastrocnemius tendon, common tendon of the biceps femoris, and the superficial digital flexor tendon. Clinical signs depend upon the degree of the injury. There can be variable degrees of hindlimb lameness, flat-footed stance, dropped hock, or excessive toe flexion. Diagnosis is based on examination, hock x-rays, ultrasound, or MRI. Treatment includes surgical repair of the injury, and controlled exercise and physical therapy post-operatively.

Angular Limb Deformities are the abnormal growth of the limb following premature closure of the growth plate as a result of trauma. Clinical signs include limping, discomfort, or limb deviation or shortening. Diagnosis is based on x-rays to assess the degree of deformation. Surgical treatment is indicated to restore joint congruity and/or correct the angular deformity.

Bicipital Tenosynovitis is inflammation of the biceps brachia tendon and its associated sheath which causes forelimb lameness exacerbated with exercise. The condition is diagnosed with shoulder x-rays, ultrasound, or MRI. Treatment includes restricted activity for 6-8 weeks, oral pain medications, intra-articular steroid therapy, or surgery.

Carpal Trauma is the result of a sprain, hyperextension injury, fracture, or shearing injury. Clinical signs include forelimb lameness, carpal swelling, instability, or appearance of the carpal joint more flexed. Diagnosis is made through physical examination, x-rays, bloodwork to rule out other conditions, or CT scan or MRI. Treatment involves restricted activity and pain medication for a sprain and mild hyperextension. Surgery is the treatment of choice for more severe hyperextension, fractures, and shearing injuries.

Collateral Ligament Injuries occur as a result of trauma to the joint. The condition is diagnosed by physical exam, x-rays, or advanced imaging. Treatment depends on the the extent of the injury. Stretched or partial ligament tears may be treated by application of a splint for 2 to 3 weeks. More significant injuries are treated with surgical repair of the ligament and a splint for 3 to 4 weeks. Restricted activity is continued for an additional 3 to 4 more weeks.

Cranial Cruciate Ligament Injury occurs as a result of degeneration and traumatic injury to the cranial (anterior) cruciate ligament. This results in instability of the knee joint and limping. Diagnosis is based on physical examination with a cranial drawer sign and x-rays. Surgery followed by physical therapy are the treatments of choice. Surgical repair by extracapsular methods, tibial tuberosity advancement, or tibial plateau leveling osteotomy are recommended.

Elbow Luxation occurs as a result of trauma. It is diagnosed with physical examination and x-rays. Treatment usually involves closed reduction within the first few days of injury. If the luxation cannot be treated with closed reduction, then surgery is indicated. If there is significant collateral ligament damage or re-luxation occurs easily after closed reduction, then surgery is indicated. A modified Robert-Jones bandage is then placed for 7 days following closed reduction or surgery with restricted activity for up to 2 weeks.

Fractures occur as a result of trauma, disease, or repeated stress to the bone. They are classified based on their appearance on exam and x-rays. Physical exam indicates which bone(s) are involved, as well as, whether the fracture is closed (the bone does not break the skin) or open (the bone breaks through the skin). X-rays define where the fracture(s) is located along the bone, the type of fracture, and the best course of action for repair. Partial/incomplete fractures and some non-displaced fractures can be treated with external coaptation, or a cast. More complicated or displaced fractures have the best chance for successful healing with surgical repair (bone plates, screws, pins, or external fixators). Sometimes a combination of methods are used for treatment.

Fragmented Coronoid Process (FCP) is hereditary and a form of osteochondrosis of the elbow. It occurs when the ossification center of the medial coronoid process fails to fuse causing instability and inflammation. Physical examination reveals swelling and discomfort of the elbow joint. X-rays are performed to rule out other causes for the joint swelling; however, FCP is difficult to diagnose with this method. Often times, advanced imaging (CT scan) is required to diagnose this condition. Surgical removal of the FCP carries a better prognosis prior to the development of degenerative joint disease. Prognosis declines with surgery performed after the development of osteoarthritis. Medical and alternative management is often needed. This includes non-steroidal anti-inflammatory medication, additional pain medication, joint supplements, laser therapy, physical therapy, and acupuncture.

Hip Dysplasia is a hereditary condition that causes the abnormal development or growth of the hip joint(s). This results laxity that causes instability, malformation of the femoral head and acetabulum, and osteoarthritis. Clinical signs include weight bearing or non-weight bearing lameness, bunny hopping gait, or pain on hip extension. Diagnosis is based on the demonstration of an Ortolani sign on orthopedic examination and x-rays. If a puppy is screened by 4 months of age using PennHip x-rays, then a preventive surgery called pubic symphysiodesis can be performed. Prior to one year of age, a triple pelvic osteotomy can be performed.  If the condition is diagnosed after that time, then treatment options include medical management or surgery. The two surgical options are femoral head ostectomy or total hip replacement. When the condition is treated medically, this may include non-steroidal anti-inflammatory medication, additional pain medication, joint supplements, laser therapy, physical therapy, and acupuncture.

Hip Luxation can occur secondary to hip dysplasia or trauma. Clinical signs include the history of a traumatic incident, non-weight bearing lameness, and the appearance of limb lengthening or shortening depending on the direction of the luxation. Diagnosis is based on physical exam and x-rays. Treatment for a traumatic luxation of a healthy hip joint can include closed reduction followed by an Ehmer sling for 7-10 days or surgery via pin-and-toggle or synthetic capsule technique. Treatment of a luxated dysplastic hip involves surgery (femoral head ostectomy or total hip replacement).

Legg-Calve-Perthes is a painful hereditary hip condition caused by aseptic necrosis of the femoral head and neck as a result of interrupted blood supply with an unknown underlying cause. The disease affects small breed dogs. Clinical signs include hindlimb lameness and discomfort. The condition is diagnosed through physical examination and x-rays. Surgery (femoral head and neck ostectomy) is the treatment of choice.

Osteoarthritis is the development of bone spurs, or projections, that form along joints as a result of joint instability. Clinical signs include discomfort, limping, stiffness, and crepitation. Diagnosis is based on physical examination and x-rays. The best treatment is prevention. When a known disease is present which gives potential for osteoarthritis, then treatment is aimed at treating that disease (ie. cruciate ligament rupture, weight reduction). Medical management includes rest, heating the affected joint(s), controlled exercise, laser therapy, physical therapy, medication, supplements, or acupuncture. Surgery may involve removing the bone spurs, fusing the joint, or joint replacement surgery.

Osteochondrititis Dessicans (OCD) is a cartilage flap that results from the disturbance in normal cell differentiation in growth plates and joint cartilage. It occurs in the medial humeral trochlear ridge of the elbow joint, the caudolateral humeral head of the shoulder joint, the lateral femoral condyle of the knee joint, or the medial or lateral talus of the ankle joint. Treatment and prognosis is dependent on the location of the lesion. Surgical removal of the cartilage flap in the shoulder and elbow joints provide a good prognosis if performed prior to the start of degenerative joint disease. Surgical removal of the cartilage flap in the knee and ankle joints provide a guarded to fair prognosis; particularly, in very large breeds.

Osteomyelitis is an acute or chronic infection of the bone. The infection is usually associated with open fractures, bone surgery (particularly, involving metallic implants) or systemic illness. The condition is diagnosed with x-rays and culture of the affected bone or implant. Treatment involves antibiotic or antifungal therapy based on culture results or removal of implants, if indicated.

Panosteitis is inflammation of the longs bones of large breed young dogs. Breeds commonly affected are German Shepherds and Basset Hounds.  It causes significant lameness of one or more limbs, and can present as a "shifting leg lameness". Diagnosis is based on x-rays and treatment includes pain medications. The condition is self-limiting and resolves on its own over several months. The underlying cause is unknown.

Patellar Luxation is a hereditary condition that occurs when the alignment of the leg is such that the kneecap is pulled out of the trochlear groove either medially (to the inside of the leg) or laterally (to the outside of the leg). The degree of luxation determines the grade. There are 4 grades of luxation with grade 1 a mild subluxation and grade 4 a severe luxation. The result of the patellar luxation can be cartilage erosion, arthritis, and increased strain on the cruciate ligament predisposing to cruciate ligament tears. Diagnosis is by physical exam and/or x-rays. Treatment may involve medical management with pain medications and joint supplements. Surgical repair to ensure that the kneecap stays in the trochlear groove is ideal. Surgery involves realigning the patellar ligament so that the kneecap is in line with the femoral groove. The recovery time for the procedure is 4-6 weeks of restricted activity. During this time, no running, jumping, playing, or rough housing is allowed. The patient will also go home with a light bandage and post-operative pain medications.

Shoulder Luxation is an uncommon condition in the dog. Breeds most commonly affected are the toy poodle and sheltie. It is diagnosed with physical examination and x-rays. Treatment with surgery can be performed. Prognosis following surgery is dependent on the direction of the luxation and chronicity. Those that are more chronic have a more guarded prognosis.

Ununited Anconeal process (UAP) is hereditary and a form of osteochondrosis of the elbow. It occurs when the ossification center of the anconeus fails to fuse with the olecranon by 5 months of age. The result is instability and inflammation in the elbow joint. Commonly affected breeds include German Shepherds, Basset Hounds, and St. Bernards. The condition is diagnosed by physical examination and x-rays. Surgical treatment is indicated for removal of the anconeal process, followed by placement of a modified Robert-ones bandage for 7 to 10 days.

Neurological

Atlantoaxial Subluxation occurs when the articulation between the first and second cervical vertebra is unstable. This can occur in dogs and cats from birth and/or from trauma. This instability then causes compression of the associated spinal cord. Symptoms of hyperflexion of the neck may be present with trauma, neck pain, ataxia (staggering-type walk), and inability to walk on the limbs. Diagnosis is usually based on x-rays of the neck/spine. Treatment involves stabilization of the atlantoaxial joint. This is best achieved through surgery, as this provides the best success for stabilization. Nonsurgical treatment includes pain control, neck brace, and very restricted activity.

Brachial Plexus Neuropathy occurs as a result of trauma or cancer affecting the nerves or nerve roots located in the axilla (armpit) of the front limb. Symptoms include front limb lameness, paresis, or paralysis. Diagnosis is based on the neurologic exam. Limb amputation is the best treatment in most cases. Nonsurgical treatment involves supportive care, prevention of self-trauma to the limb, and medications.

Brain Neoplasia is cancer affecting the brain. There are different types of primary and secondary cancers that can cause symptoms. This condition usually occurs in a patient that is 5 years of age or older. These include progressive neurologic signs: most commonly seizures, circling, behavior change, altered consciousness, decreased appetite, and lethargy. Diagnosis is based on the neurologic exam, blood testing, chest and abdominal x-rays, cerebrospinal fluid analysis, and advanced imaging (CT scan or MRI). Treatment may involve surgical removal, radiation treatment, chemotherapy, and/or medications.

Caudal Occipital Malformation is a condition in which a dog is born with the caudal occipital bone overcrowding and, commonly, compressing the spinal cord in the neck (syringohydromyelia). The Cavalier King Charles Spaniel is most overrepresented, but this is a disorder of small breed dogs. Symptoms can include scratching at the shoulders and head or neck, and seizures. The signs are often intermittent and can worsen with stress or excitement. Diagnosis includes the neurologic exam and MRI. Treatment involves oral medication.

Cerebellar Abiotrophy is a suspected genetic condition in which a dog or cat is born normal at birth and then develops progressive degeneration of the cerebellum. Symptoms include progressive ataxia (staggering-type walk), wide-based stance, swaying, and intention tremors. Diagnosis is based on the neurologic exam.There are no effective treatments for this disorder.

Degenerative Myelopathy is the degeneration of the spinal cord that usually affects dogs 5 years of age and older. The cause for this condition is not known. Symptoms include progressive weakness and ataxia (staggering-type walk) of the hind limbs. Progression usually occurs over 4-6 months. Diagnosis is made by the neurologic exam, blood testing, urine testing, x-rays, and advanced imaging (CT scan or MRI). Treatment involves physical therapy, exercise, vitamin supplementation, and acupuncture. The disease eventually progresses to paraplegia.

Diskospondylitis is inflammation/infection of the intervertebral disk and adjacent end plates of the vertebra. A bacterial infection is the most common cause; however, fungal infections can also occur. Symptoms include fever, decreased appetite, weight loss, lethargy, depression, and back pain. Diagnostic testing includes blood testing and culture, urine analysis, x-ray, and MRI. Treatment involves oral antibiotics for a bacterial infection, or an antifungal medication for a fungal infection.

Epilepsy is a syndrome that occurs with chronic recurrent seizures with no identifiable cause. Young dogs 1 to 5 years of age are most commonly affected. Seizures occur intermittently or in clusters. Diagnostic testing includes the physical exam, blood testing, and advanced imaging (CT scan or MRI). Treatment is aimed at controlling seizures with medication.

Facial Paralysis can occur without a known underlying cause, as a result of trauma, or with hormone imbalance. This can be temporary or permanent. Symptoms include drooling from one side of the mouth, inability to blink, and an ear droop. Diagnostic testing includes neurologic and ophthalmic exams, blood testing, thyroid testing, eye testing, and/or MRI. Treatment involves lubricating the eye to prevent corneal irritation from dryness.

Fibrocartilaginous Embolism is a non-progressive, non-painful disease that occurs as a result of an infarction of an area of the spinal cord. It causes neurologic deficits related to the location of the embolism. Diagnostic testing includes blood testing, x-rays, cerebrospinal fluid analysis, and MRI. Treatment includes supportive care, physical therapy, and rehabilitation.

Granulomatous Meningoencephalomyelitis is a non-infectious inflammation of the central nervous system that involves the brain and/or spinal cord. The cause for this disorder is unknown. Symptoms include seizures, neck pain, abnormal mentation, and fever. Diagnostic testing includes a neurologic exam, CT scan (or MRI), and cerebrospinal fluid analysis. Treatment includes steroids, anticonvulsants, or radiation therapy (if focal).

Horner's Syndrome

Hydrocephalus

Idiopathic Tremors

Intervertebral Disk Disease

Lumbosacral Stenosis

Masticatory Muscle Myositis

Muscular Dystrophy

Myasthenia Gravis

Necrotizing Encephalitis

Nerve Sheath Tumors

Polymyositis, Autoimmune

Spinal Cord Trauma

Spongiform Encephalopathies

Steroid Responsive Meningitis

Storage Diseases

Tetanus

Tick Paralysis

Trigeminal Neuritis

Vestibular Disease

Vascular Encephalopathy

Skin

Acne

Acral Lick Dermatitis

Acute Moist Dermatitis

Alopecia

Alopecia X

Atopy

Calcinosis Cutis and Circumscripta

Callus, Hygroma, and Pressure Sores

Cheyletiellosis

Color Disorders of Hair and Skin

Contact Dermatitis

Cysts

Demodicosis

Dermatomyositis

Discoid Lupus Erythematosus

Draining Tracts

Drug Eruption

Eosinophilic Granuloma Complex

Erythema Multiforme

Feline Symmetric Alopecia

Flea Bite Allergy

Follicular Dysplasia

Food Allergy Dermatitis

Footpad Disorders

Hepatocutaneous Syndrome

Juvenile Cellulitis

Malassezia Dermatitis

Nail and Claw Disorders

Nasal Cutaneous Disorders

Neoplasia

Nodular Cutaneous Disorders

Otitis Externa

Panniculitis

Papillomas

Paraneoplastic Syndromes

Pemphigus Complex

Pododermatitits

Pruritus

Pyoderma

Recurrent Flank Alopecia

Sarcoptic Mange

Sebaceous Adenitis

Seborrhea

Ticks

Ulcerative and Erosive Skin Disorders

Vasculitis

Zinc-Responsive Dermatosis

Tick Borne Disease

Anaplasma

Ehrlichia

Lyme Disease is a bacteria (Borrelia burgdorferi) transmitted by ticks and that it is transmitted during an attachment by the tick during the initial 24 hour period. The screening test indicates that your pet may have been exposed to the bacteria previously. This tests for antibodies to certain tick-borne bacteria. Antibodies are our bodies way of reacting to the marker of the bacteria (the antigen). If increased, this indicates that there may have been exposure to that particular bacteria. That being said, there can be false positives; meaning that, other similar bacteria may have antigen that this antibody reacts to (cross-reacting spirochete bacteria). Additional testing includes performing immunofluorescent antibody testing with the lab. This is an objective measurement of tick titers. A titer of 1280 or higher is most consistent with a recent infection. A titer of 160-640 is a low to moderate titer that indicates recent infection or infection with a cross-reacting spirochete (other bacteria). A titer of less than 160 is considered negative for antibodies. Therefore, if in the low to moderate titer range, it can be presumed that there may have been exposure to lyme causing bacteria, but it is still not definitive. Treatment for Lyme disease is targeted at controlling the active infection. Symptoms of this infection include limping, swollen joints, fever, decreased appetite, or lethargy. Rarely, signs of increased thirst and urination from kidney disease can occur. Risk of Lyme disease becoming severe is low, but possibly higher in retriever dogs. Although this is not fully understood why this breed of dog can develop more severe infection, it is thought that they may have a genetic predisposition for increased inflammation and formation of immune complexes causing more significant disease. This can occur in less than 2% of exposed dogs. Treatment may be started for your pet while additional testing is pending, then continuing this medication if indicated based on those results. Vaccinating for Lyme disease is recommended in hunting and working dogs, or dogs in endemic areas. Vaccination of Lyme disease positive dogs is recommended when the risk of reinfection is high. Lyme vaccines appear to prevent seroconversion or illness in most vaccinates (although, this is not consistent among all dogs).

Toxins

- Household

- Food

- Insects/Spiders

- Plants/Fungus