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The Orphan Kitten
Orphaned kittens represent a highly vulnerable population requiring specialized attention and immediate care. Orphaned kittens encounter numerous challenges, including nutritional deficiencies, susceptibility to infectious diseases, and deficits in social... moreOrphaned kittens represent a highly vulnerable population requiring specialized attention and immediate care. Orphaned kittens encounter numerous challenges, including nutritional deficiencies, susceptibility to infectious diseases, and deficits in social skills, all of which increase their risk of developmental complications and mortality. Addressing these challenges requires the implementation of effective care strategies, which should encompass clinical stabilization, monitoring of body weight, and nutritional provision via foster mother adoption or hand-rearing. A comprehensive approach is crucial for mitigating the detrimental effects associated with maternal absence, thereby reducing mortality rates, and facilitating a successful transition into adulthood for orphaned kittens. less
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Complications of Liver Disease
Hepatobiliary disease in dogs and cats can lead to various complications. Vomiting is a common clinical sign in liver disease, and antiemetic therapy should be considered on a case-by-case basis. Ascites is managed by feeding a moderate sodium diet, thera... moreHepatobiliary disease in dogs and cats can lead to various complications. Vomiting is a common clinical sign in liver disease, and antiemetic therapy should be considered on a case-by-case basis. Ascites is managed by feeding a moderate sodium diet, therapy with spironolactone, and judicious use of furosemide. Hepatic encephalopathy is managed by feeding an appropriate diet and treating with lactulose and possibly an antimicrobial. Because coagulant and anticoagulant factors are affected in patients with hepatic dysfunction, they may be in an altered but balanced hemostatic state. This balance is fragile and bleeding or thrombosis can occur if it is disrupted. less
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Nutritional Management of Hepatobiliary Diseases in Dogs and Cats
Dogs and cats with liver disease often benefit from nutritional modifications. The most important consideration for patients with severe disease is often providing sufficient energy intake to prevent a catabolic state. Additionally, targeted nutritional m... moreDogs and cats with liver disease often benefit from nutritional modifications. The most important consideration for patients with severe disease is often providing sufficient energy intake to prevent a catabolic state. Additionally, targeted nutritional modifications address specific clinical signs and liver disease pathogenesis. For instance, patients with hepatic encephalopathy often benefit from a diet with a reduced amount of protein, or a vegetarian diet as these modifications can help reduce the severity and frequency of clinical signs. This article aims to guide the clinician in understanding the indications and considerations for nutritional intervention in patients with hepatobiliary disease. less
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Emerging Issues of Importance in Canine and Feline Hepatology
We are excited to present a new issue of Veterinary Clinics of North America: Small Animal Practice on canine and feline hepatology. Since the last hepatology issue in 2017, significant advances have been made in understanding the pathophysiology, diagnos... moreWe are excited to present a new issue of Veterinary Clinics of North America: Small Animal Practice on canine and feline hepatology. Since the last hepatology issue in 2017, significant advances have been made in understanding the pathophysiology, diagnosis, and management of many hepatobiliary diseases. Clinicians face many challenges in diagnosing and treating companion animal hepatobiliary disease. However, the veterinary profession is making continuous progress through the tireless efforts of our colleagues, who have dedicated their research careers to better understanding these important diseases. less
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Congenital Intrahepatic Disease
The spectrum of congenital intrahepatic diseases described in canine and feline patients is broad, and the etiopathogenesis is complex. Developmental dysregulation of the intrahepatic biliary tree and vasculature leads to malformations of the ductal plate... moreThe spectrum of congenital intrahepatic diseases described in canine and feline patients is broad, and the etiopathogenesis is complex. Developmental dysregulation of the intrahepatic biliary tree and vasculature leads to malformations of the ductal plate and aberrant vascular connections. Occasionally, intrahepatic congenital disorders occur as a constellation of biliary and vascular anomalies. Diagnosis requires clinical data, advanced diagnostic imaging, and, in the case of hepatic fibropolycystic disease, liver histopathology. Clinical prognosis is variable. less
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Biliary Tract Infections in Dogs
Bacterial biliary tract infections are increasingly recognized in dogs and should be considered in any dog presenting with vomiting, anorexia, and jaundice, particularly if they have abdominal discomfort or pyrexia. Commonly recognized clinicopathologic f... moreBacterial biliary tract infections are increasingly recognized in dogs and should be considered in any dog presenting with vomiting, anorexia, and jaundice, particularly if they have abdominal discomfort or pyrexia. Commonly recognized clinicopathologic findings include increased liver enzyme activities, hyperbilirubinemia, and an inflammatory leucogram. Hepatobiliary ultrasound forms a key component of the diagnostic approach to these cases, aiding the identification of dogs that require urgent surgical management due to biliary tract rupture, or that have another surgical condition. Ultrasound also allows guided percutaneous bile sampling to gain a sample for cytology and culture, guiding rational antimicrobial therapy. less
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Aminoaciduric Canine Hypoaminoacidemic Hepatopathy Syndrome
Aminoaciduric canine hypoaminoacidemic hepatopathy syndrome is a multifaceted clinical condition that remains insufficiently understood, with its pathophysiology not yet fully delineated. Current evidence suggests a link between hypoaminoacidemia and the ... moreAminoaciduric canine hypoaminoacidemic hepatopathy syndrome is a multifaceted clinical condition that remains insufficiently understood, with its pathophysiology not yet fully delineated. Current evidence suggests a link between hypoaminoacidemia and the development of superficial necrolytic dermatitis and hepatocutaneous lesions (hypoaminoacidemia/hepatocutaneous-associated canine hepatopathy), although the underlying mechanisms driving these associations are not clearly defined. The presence of aminoaciduria, along with impaired amino acid transporter function in critical organs such as the skin, liver, and intestines, may play a significant role in the progression of this syndrome. Additionally, elevated glucagon levels may further contribute to the exacerbation of hypoaminoacidemia, worsening clinical signs. less
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Domestic Cat Hepadnavirus, a Hepatitis B-like Virus Associated with Feline Liver Disease
In 2018, a surprising finding was reported; cats are naturally infected with a virus related to hepatitis B virus (HBV), domestic cat hepadnavirus (DCH). HBV causes chronic hepatitis and hepatocellular carcinoma in people, and HBV-like viruses cause simil... moreIn 2018, a surprising finding was reported; cats are naturally infected with a virus related to hepatitis B virus (HBV), domestic cat hepadnavirus (DCH). HBV causes chronic hepatitis and hepatocellular carcinoma in people, and HBV-like viruses cause similar diseases in rodents. If DCH negatively impacts feline health then demand for diagnostics, therapeutics, and vaccination will follow. Hence, understanding pathogenic potential of DCH for cats, and the size of any associated disease burden are critical goals. Here we evaluate progress made towards these goals by reviewing published studies of DCH against the backdrop of our understanding of HBV and HBV-like viruses. less
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Cytologic Evaluation of the Liver
Liver fine needle aspiration (FNA) and bile cytology are valuable diagnostic tools for evaluating various hepatobiliary diseases in veterinary medicine. Although FNA of the liver is less invasive and faster than histopathology, it may not always provide a... moreLiver fine needle aspiration (FNA) and bile cytology are valuable diagnostic tools for evaluating various hepatobiliary diseases in veterinary medicine. Although FNA of the liver is less invasive and faster than histopathology, it may not always provide a definitive diagnosis, but will often provide information regarding pathologic processes occurring in the liver. Cytologic evaluation is most effective when integrated with clinical information including bloodwork, imaging, and results of other diagnostic tests. less
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Granulomatous Hepatitis
Granulomatous hepatitis (GH) is a subset of chronic hepatitis in which the predominant inflammatory infiltrate consists of macrophages. It can be associated with systemic granulomatous disease or confined to the liver. When associated with systemic diseas... moreGranulomatous hepatitis (GH) is a subset of chronic hepatitis in which the predominant inflammatory infiltrate consists of macrophages. It can be associated with systemic granulomatous disease or confined to the liver. When associated with systemic disease, infectious causes (bacterial, fungal, protozoal, or metazoan) are more common, while disease confined to the liver is often idiopathic. Dogs with idiopathic GH most often present acutely ill, with fever, high white blood cell counts, and with ultrasound finding of a large liver often with nodules and characteristic hyperechoic parenchymal bands. less
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Current Practices and Considerations in Therapeutic Farriery for Equine Tendon and Ligament Injuries
The overall objective of therapeutic farriery for equine tendon and ligament injuries is to provide a biomechanical environment conducive to healing by limiting excessive strain on the injured structure. With an understanding of equine limb anatomy and th... moreThe overall objective of therapeutic farriery for equine tendon and ligament injuries is to provide a biomechanical environment conducive to healing by limiting excessive strain on the injured structure. With an understanding of equine limb anatomy and the pathophysiology of tendon/ligament injuries, the rationale used in therapeutic farriery for soft tissue injuries of the distal limb is quite logical. Through therapeutic farriery, foot manipulation is used to reduce the tension on the injured tendon(s) or ligament(s). less
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Diagnosis and Strategies for the Treatment of Infectious Equine Tendon and Ligament Disorders
Diagnostic and treatment strategies for infectious equine tendon and ligament disorders are continually evolving where recent progress is focused on advanced imaging and evidence supporting endoscopic lavage and regional antimicrobial therapy.
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Current and Emerging Quantitative Imaging Modalities for Diagnosing and Monitoring Equine Tendon and Ligament Injuries
Technological developments in imaging modalities have advanced the diagnostic capabilities for equine tendon and ligament injuries beyond the traditional methods. This review examines elastography techniques in ultrasonography that assess tissue stiffness... moreTechnological developments in imaging modalities have advanced the diagnostic capabilities for equine tendon and ligament injuries beyond the traditional methods. This review examines elastography techniques in ultrasonography that assess tissue stiffness and strain properties, computed tomography (CT) innovations including PET/CT fusion and dual-energy CT, and emerging applications of diffusion-weighted MRI for evaluating fiber microstructure and functionality. These complementary approaches offer veterinarians improved means to detect early injuries, assess structural integrity, monitor healing progression, and potentially predict functional outcomes of equine soft tissue injuries, addressing limitations of conventional imaging methods. less
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Guidelines for Formulating Rehabilitation Strategies for Equine Tendon and Ligament Injuries
Rehabilitation for tendon/ligament injury requires a multimodal approach to reduce pain, restore range of motion, improve proprioception/neuromotor control, and improve strength/endurance. Multiple tools are available to accomplish these goals. The rehabi... moreRehabilitation for tendon/ligament injury requires a multimodal approach to reduce pain, restore range of motion, improve proprioception/neuromotor control, and improve strength/endurance. Multiple tools are available to accomplish these goals. The rehabilitation program must be tailored to the individual patient regardless of injury type in order to return the horse to full athletic activity and reduce the risk of reinjury.
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Adjunct Therapies for Tendon/Ligament Healing
High-power laser therapy and extracorporeal shock wave therapy (ESWT) can be safely used to treat tendon and ligament injuries in horses, and the potential beneficial effects have been described. The power of low level lasers is not sufficient for treatme... moreHigh-power laser therapy and extracorporeal shock wave therapy (ESWT) can be safely used to treat tendon and ligament injuries in horses, and the potential beneficial effects have been described. The power of low level lasers is not sufficient for treatment of tendon and ligament injuries in horses. ESWT is used more often to treat tendon and ligament injuries than it is for any other type of condition in horses, but there is limited supporting scientific evidence. Further research should focus on establishing dosage and treatment protocols for both laser therapy and ESWT in horses with clinically relevant long-term follow-up. less
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Current and Emerging Biologic Therapies for Equine Tendon and Ligament Injuries
This review explores the use of biologics in the treatment of tendon and ligament injuries in horses, focusing on current and emerging therapies aimed at enhancing tissue repair and regeneration. It discusses the role of scaffold-based therapies, growth f... moreThis review explores the use of biologics in the treatment of tendon and ligament injuries in horses, focusing on current and emerging therapies aimed at enhancing tissue repair and regeneration. It discusses the role of scaffold-based therapies, growth factors, blood-derived and tissue-derived biologics, and gene therapy as biologic regenerative therapies for improving healing outcomes. The review evaluates the mechanisms, efficacy, and challenges of biologics in clinical applications, highlighting recent advances and clinical studies. It provides an overview of current trends and future directions for biologic therapies in equine musculoskeletal injuries. less
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Cellular and Matrix Dynamics of the Equine Tendon
Our understanding of tendon homeostasis and repair following injury has made great strides through basic science, clinical veterinary medicine, and preclinical translational research. We have now gleaned a greater understanding of the cellular and matrix ... moreOur understanding of tendon homeostasis and repair following injury has made great strides through basic science, clinical veterinary medicine, and preclinical translational research. We have now gleaned a greater understanding of the cellular and matrix dynamics that are being orchestrated within the tendon, which provide therapeutic opportunities. This article will focus on how utilizing the horse and equine tissues have advanced our understanding of tendinopathy and the cellular and matrix dynamics at play while also identifying continued gaps in our knowledge where the horse as a veterinary patient and preclinical model could advance our understanding of tendon biology. less
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Suspensory Ligament Injuries
The location of a suspensory ligament (SL) injury heavily influences the clinical presentation, prognosis, and treatment options. Diagnostic imaging is necessary to provide an accurate diagnosis and is critical to ensure the institution of the most approp... moreThe location of a suspensory ligament (SL) injury heavily influences the clinical presentation, prognosis, and treatment options. Diagnostic imaging is necessary to provide an accurate diagnosis and is critical to ensure the institution of the most appropriate treatment. The hindlimb proximal SL in particular can be challenging to diagnosis, carries a guarded prognosis, and typically requires aggressive treatment to achieve soundness.
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Diagnosis and Minimally Invasive Surgical Treatment for Enhancing Intrathecal/Intrasynovial Tendon Injuries
Intrathecal and intrasynovial tendon and ligament injuries can result in extrusion of tendon/ligament fibers, granuloma, and adhesion formation that not only impairs healing of the original injury but can create new injuries that negatively affect adequat... moreIntrathecal and intrasynovial tendon and ligament injuries can result in extrusion of tendon/ligament fibers, granuloma, and adhesion formation that not only impairs healing of the original injury but can create new injuries that negatively affect adequate healing and return to athletic work. In these cases, endoscopic evaluation and debridement, not only of the lesion, but also any other secondary injury present, can enhance the healing of the tendon or ligament and improve the athletic prognosis. Careful planning of the approach, positioning, instrumentation, and thorough knowledge of the anatomy are vital features that can enhance a successful outcome. less
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Techniques for Equine Tendon Tenorrhaphy
Equine tendon lacerations are not uncommon secondary to traumatic wounds and degloving lacerations. These wounds are often contaminated and, therefore, basic principles of wound assessment and management are critical to identify the extent of an injury. A... moreEquine tendon lacerations are not uncommon secondary to traumatic wounds and degloving lacerations. These wounds are often contaminated and, therefore, basic principles of wound assessment and management are critical to identify the extent of an injury. Ancillary tools to aid physical examination include radiography, ultrasonography, and synoviocentesis (eg, if involving a joint and/or tendon sheath). Prolonged convalescence period, continued external coaptation, and controlled exercise are mainstays of treatment following tenorrhaphy. A poor prognosis for return to full athletic function is expected following flexor tendon laceration. less
