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Chronic liver failure

by admin on December 2nd, 2019

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The liver is a vital organ – animals and people cannot survive without their livers. The liver performs many complex functions that are essential to life and good health. Its main functions are:

  • To convert food into useful substances such as proteins for repair and growth of the body
  • To maintain normal functions such as blood clotting, fighting infection and secretion of substances to the bloodstream
  • Bile production, which assists with the absorption of fat and certain vitamins
  • To store the body’s primary sugar (glucose) as glycogen and be able to release it into the bloodstream when it is needed
  • To neutralise and break down toxic substances such as chemicals and some medications, for later elimination in bile or through the kidneys

What is chronic liver failure?
Chronic liver failure occurs due to long-term damage to the liver, resulting in a liver that fails to work. Chronic liver failure can be caused by chronic exposure to toxins, heavy metals (copper, iron and zinc), chronic infections, chronic inflammation/irritation, cancer, blood vessel abnormalities (congenital portosystemic shunt – an abnormal blood vessel that a pet is born with that bypasses the liver), immune disease and fatty liver syndrome in cats.

The liver is very good at regenerating itself (unlike other organs such as the kidneys), but serious ongoing damage to the liver can cause long-term failure of its function – this is known as chronic liver failure. Over 75% of the liver is usually damaged before liver failure occurs.

What are the signs of chronic liver failure?

  • Reduced appetite
  • Lethargy
  • Increased thirst
  • Strange behaviours
  • Vomiting
  • Diarrhoea – occasionally blood in the stools, or dark, tarry stools
  • Bloated tummy due to fluid accumulation
  • Yellow skin, urine, gums (jaundice)
  • Weight loss

How is chronic liver failure diagnosed?
Liver failure is diagnosed by blood tests which indicate dysfunction of the liver. Further investigations, such as ultrasound scans, urine cultures, blood cultures or other tests for infections, may be required in individual cases. Samples of the liver may be required to diagnose the cause of liver failure in many cases – these may be obtained through a needle placed in the liver under guidance on an ultrasound scan; alternatively the liver may be visualised by using keyhole surgery (laparoscopy) or by a full surgical procedure. The technique that is chosen will depend on a number of factors, and these will be discussed with you in the event that biopsies are required. In some cases of chronic liver disease the initial cause of the problem may no longer be present at the time of investigation, but the disease itself may still cause symptoms, and the damage to the liver may also continue.

How is chronic liver failure treated?
Chronic liver failure requires multiple treatments. It is important to try to remove the initiating cause (e.g. toxins, infections, cancer etc). Sometimes, this is not possible and it is best to support liver function and make the patient as comfortable as possible. Some diseases e.g. blood vessel abnormalities such as congenital portosystemic shunts (abnormal blood vessels that bypass the liver) can be corrected by Specialist surgical procedures.

Treatments which may be required in chronic liver failure include:

  • removing fluid from the abdomen that accumulates due to scarring of the liver
  • antibiotics to prevent infections
  • antacids to reduce gastrointestinal ulceration
  • drugs to support the liver including anti-oxidants, anti-scarring drugs and drugs that bind to heavy metals i.e. copper and zinc
  • dietary modification to reduce protein and copper levels in some patients
  • nutritional support – an adequate intake of vital nutrients including calories is very important in cases of chronic liver failure.

What is the long term outlook?
Considering the severity of this disease process, this is a challenging condition to treat. Early intervention and aggressive treatment can be successful in some cases where the extent of damage is not too severe. At the present time, liver transplants are not available in veterinary medicine.
If your pet develops chronic liver failure, we will discuss the treatment options in detail with you and give you the help you need in making decisions about what you wish us to do to help your pet.

Dog Jaundiced

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Pet of the month – December 2019

by admin on December 2nd, 2019

Category: Pet of the Month, Tags:

Our Pet of the month for December is Henry; he is also our Slimmer of the Month having lost a whopping 5 kilos!

Henry had been struggling with his weight and came to see our weight management nurse Sienna. She has helped his owners devise a feeding plan and weight loss plan to ensure he has a steady and easily maintainable weight loss. Being a British Bulldog it is very important for him to be as slim as possible to optimise his breathing and there are many other associated health benefits for this breed. Henry has made great progress and can even jump up on the furniture now as seen in the accompanying picture.

If you would like more information on Sienna’s weight clinics then please call us, we’d be happy to help!

HENRY

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Special Offer – December 2019

by admin on December 2nd, 2019

Category: Special Offers, Tags:

Dec-18 Arthritis Awareness Month smaller image

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Hiatal Hernia

by admin on November 5th, 2019

Category: News, Tags:

What is a Hiatal Hernia?
A hiatal hernia is the abnormal movement of part of the stomach from its normal position in the abdomen into the chest.

The diaphragm is a sheet of muscle which separates the chest and abdomen. The oesophagus (food pipe) and major blood vessels and nerves pass through the diaphragm via small openings within the muscle. During the development of a puppy, these openings may be excessively large, allowing organs which should remain in the abdomen to pass into the chest. The stomach can become permanently displaced but more commonly slides back and forth between the abdomen and the chest.

What breeds are affected?
English Bulldogs are the breed most commonly seen with this condition in the UK. Brachycephalic dogs (those with a shortened nose such as English Bulldogs, French Bulldogs and Pugs) are at an increased risk of displacement of the stomach into the chest as the negative pressures within the chest created by their abnormal airway, act to ‘suck’ the stomach through the opening in the diaphragm.

What are the symptoms?
Dogs with hiatal hernia frequently vomit or regurgitate (passive reflux of stomach contents) due to the abnormal position of the stomach. These signs most commonly occur during peak exercise or when the dog becomes excited. Reflux of acidic stomach contents into the oesophagus results in inflammation (reflux oesophagitis) which can trigger a self-perpetuating cycle of regurgitation causing further inflammation.

Other symptoms which may be observed include excessive salivation, poor appetite and weight loss. Vomiting and/or regurgitation of stomach contents can result in inhalation of this material and the development of secondary pneumonia. In this scenario symptoms such as a cough, nasal discharge and breathing difficulties will be observed.

How is the diagnosis made?
Hiatal hernia is most commonly diagnosed via fluoroscopy (a moving x-ray study). Whilst the dog is eating, a continuous run of X-rays are taken which allows the swallowing process and position of the stomach to be closely observed. Typical findings consistent with a diagnosis of hiatal hernia are food entering the stomach and then passing back up the oesophagus (reflux) along with movement of the stomach back and forth across the diaphragm.

As the stomach typically slides back and forth from a normal to abnormal position, there is the possibility that the imaging study documents a normal stomach position. This does not exclude the diagnosis of hiatal hernia as the most likely explanation for a normal stomach position is that the stomach has not been ‘captured’ in an abnormal position at the time of the imaging study. If this scenario arises, a presumptive diagnosis of hiatal hernia may be made based on the breed of the dog and the symptoms.

What treatment options are available?
The management of hiatal hernia can be broadly divided into medical and surgical options.

Medical management consists of the use of medication to reduce inflammation within the oesophagus (antacids) and aid motility of the gastrointestinal tract. Medication often reduces the severity and frequency of the symptoms but is unlikely to eliminate them completely due to the persistently abnormal position of the stomach.

Surgical correction is often indicated to resolve the clinical problems. In some patients surgical correction of the upper airway problems, as seen in Brachycephalic dogs, eliminates the problems. In other patients the surgery will consist of reducing the size of the overly large opening in the diaphragm and stitching the oesophagus and stomach permanently in a normal position. This technique prevents movement of the stomach into the chest.

What is the outlook (prognosis) for my dog?
The prognosis following surgery is good. The aim is to eliminate the symptoms (regurgitation and vomiting) completely. Rarely, dogs may continue to regurgitate and/or vomit after surgery although with a markedly reduced frequency compared to before surgery. If this is the case, these mild symptoms can usually be controlled with the use of medication.

Hiatal Hernia

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Special Offer – November 2019

by admin on November 5th, 2019

Category: Special Offers, Tags:

Nov Diabetes Offer

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Pet of the month – November 2019

by admin on November 5th, 2019

Category: Pet of the Month, Tags:

Pet of the month for November is Hubble, a delightful Chocolate Labrador, seen here recovering from his fourth laparotomy to remove an intestinal foreign body; on this occasion we recovered a sock!

On previous occasions, in addition to socks, Hubble has swallowed a tea towel and a stone.

Let’s hope this is the last time!

Hubble 2

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Canine Flank Alopecia

by admin on October 1st, 2019

Category: News, Tags:

What is canine flank alopecia?
Canine flank alopecia is a localised, often cyclic, disease of the hair follicles resulting in hair loss over the flanks of affected dogs. It is also known by the names cyclic flank alopecia, recurrent flank alopecia and seasonal flank alopecia, but these terms are not always accurate as the condition can appear at various times of the year, vary in duration, be continuous or be sporadic in nature.

What causes flank alopecia?
The cause of this condition is not known. However, as hair loss often occurs at times of the year when day length is at its shortest, light exposure may be involved. The mechanisms by which this might occur are not understood at present.

What are the clinical signs?
Canine flank alopecia occurs in dogs with ages ranging from 1 year to 11 years, although most cases develop between 3 and 6 years. This condition is seen more commonly in breeds such as Boxers, Airedale terriers, English Bulldogs and Schnauzers.

The condition causes areas of non-itchy hair loss over the flanks of affected dogs (Figure 1). The skin at the affected sites usually appears normal, although it often becomes very dark with pigmentation, and hair re-growth of a different colour sometimes occurs. Surrounding hair and skin is usually normal. Canine flank alopecia can occur on both sides of the dog or be limited to one side, and hair loss can also occur over the base of the back (Figure 2). The disease in some dogs is cyclic, with hair loss occurring at the same time each year and hair re-growth occurring in the times between. In other dogs, hair loss is more permanent, and no re-growth is seen following the initial loss. Some dogs are reported as only having one cycle of hair loss and re-growth in their lives.

How is it diagnosed?
The diagnosis of canine flank alopecia can often be made based on the clinical findings, since the lesions are so striking. Some hormonal diseases of dogs can present with non-itchy hair loss, so blood and urine tests may be warranted if there is a concern about these diseases.
Additionally, biopsies of affected skin can be taken which are then sent off for analysis at a laboratory. Biopsies can be supportive of a diagnosis of canine flank alopecia.

What are the treatments available?
Canine flank alopecia is a cosmetic disease. As dogs remain healthy, with many re-growing their hair eventually, a decision not to treat the affected dog is often taken.
If treatment is requested, melatonin is generally considered the treatment of choice as it is relatively safe and inexpensive. It is difficult to judge the response to medication though due to the high rate of spontaneous hair re-growth.

What is the outlook/prognosis?
The prognosis for this cosmetic disease is good, with dogs remaining systemically healthy despite unpredictable hair growth. The prognosis for full and normal hair re-growth at affected sites is also often good, but the disease is highly variable.

Seasonal_flank_alopecia

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Pet of the month – October 2019

by admin on October 1st, 2019

Category: Pet of the Month, Tags:

We had a very lovely visitor today, meet Princess Buttercup!

Four years ago she came to us as a stray and suffering from a condition called Hydrocephalus, which means she had an increased volume of fluid surrounding her brain.

We also found out shortly after her arrival that she was pregnant and she gave birth at the practice a couple of weeks later!

Now all her kittens have grown up and been rehomed, Buttercup lives in a wonderful home and enjoys a very happy life.

Here she is having her annual vaccination.

Buttercup

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Special Offer – October 2019

by admin on October 1st, 2019

Category: Special Offers, Tags:

Oct FIREWORKS

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Nasal Disease

by admin on September 2nd, 2019

Category: News, Tags:

What diseases can affect the inside of the nose?

There are several different types of problem that can affect the nasal cavity of dogs and cats. The most common conditions in dogs include inflammation of the nasal cavity (rhinitis) and nasal tumours (cancer). Rhinitis in dogs can be due to a number of problems including allergy (called lymphoplasmacytic rhinitis), fungal infection (most commonly a fungus called Aspergillus) and foreign bodies (such as grass blades). In cats fungal disease is rare, whilst polyps (benign outgrowths of tissue) in the nose/ throat, rhinitis of unknown cause and tumours are more common. Bacterial infection can occur as a consequence of the underlying disease but does not cause nasal disease by itself.

What are the signs of nasal disease?

  • Sneezing
  • Snorting
  • Nasal discharge
  • Nose bleeds
  • Nasal pain
  • Nasal ulceration or loss of pigment around the nostrils
  • Reverse sneezing (this can look like spasms of choking or difficulty breathing and can be quite disturbing to see but is not a life threatening problem)

How is nasal disease diagnosed?
Bloods tests may be performed as part of an initial investigation, looking at general organ health prior to performing an anaesthetic or other tests. Sometimes blood tests are performed to look at how well the patient’s blood is clotting in patients with nose bleeds. Most commonly X-rays or a CT scan of the nasal cavity are performed under general anaesthesia and a procedure called rhinoscopy is carried out, in which an endoscope camera is inserted up the nose or used to look at the back of the throat.

Nasal X-rays may show damage to the small bones in the nose and they may reveal the presence of fluid or tumours. X-rays can sometimes look normal even when nasal disease is present, however.

A CT scan is a much more effective and sensitive way of detecting disease in the nose and will not uncommonly reveal abnormalities that haven’t shown up on an X-ray. A CT scan will also help to define the extent of any damage or the location of a tumour.

Rhinoscopy (passing a small camera inside the nose) is performed to look for abnormalities including fungal infection, tumours, and foreign bodies and to help take a tissue biopsy from the nose to send for analysis.

How is nasal disease treated?
The treatment for nasal disease depends upon its underlying cause and severity. Sometimes medication in the form of tablets is prescribed; anti-fungal solution must be put into the nose or the sinuses to treat the fungal infection Aspergillus, whilst either radiation therapy or chemotherapy may be required for the treatment of nasal tumours.

What is the long term outlook (prognosis)?
The long term outlook depends upon the underlying disease. Patients usually recover well from removal of a foreign body. Allergic rhinitis is not a life-threatening problem, but treatment is generally aimed at controlling rather than curing the problem and some patients may not respond as well as would be hoped. Aspergillus can respond well to therapy, but the condition may be recurrent and difficult to cure in some patients.
More specific advice and guidance about treatment of nasal disease for individual patients can be given once the diagnosis has been made and detailed information has been obtained from the diagnostic work-up.

Dog Boxer (1)

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