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Congress on Demand 2021: Feline Medicine and Surgery
We are pleased to present a selection of live and on-demand lectures from BSAVA virtual Congress 2021 that cover feline medicine and surgery. This collection can be purchased as a standalone item, with a discount for BSAVA members. Visit our Congress on Demand information page for information about how to access the rest of our 2021 congress lectures.
Collection Contents
13 results
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A practical approach to jaundice in cats
BSAVA Congress Proceedings 2021Author Penny WatsonThe cat presenting with jaundice is rewarding to investigate because it already gives us a strong clue as to where its disease may be and there are a limited number of differentials for jaundice. Obviously, the cat is yellow because of increased circulating bilirubin. Considering the normal metabolism and pathway of bilirubin production and breakdown reminds us of pre-hepatic, hepatic and post-hepatic causes which need to be differentiated. Prehepatic jaundice is caused by increased production of bilirubin exceeding the capacity for hepatic excretion due to red blood cell destruction. It is distinguished from the others by a low haematocrit but icterus is very unlikely to occur unless anaemia is severe. Hepatic jaundice is associated with impaired hepatic uptake, conjugation or excretion into bile and occurs with hepatic disorders in which severe intrahepatic cholestasis develops, e.g. inflammatory liver diseases and feline hepatic lipidosis. Post-hepatic jaundice is associated with interruptions in flow in the extrahepatic bile ducts such as with choleliths; pancreatitis and biliary tract infection. Careful investigation with a combination of blood samples, ultrasonography, bile aspirates and (when indicated) liver biopsies should allow effective diagnosis and treatment.
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Approach to feline inflammatory skin disease
BSAVA Congress Proceedings 2021Author Debbie GowInflammatory skin disease in cats can pose many difficulties owing to varied presentations. In particular, with hypersensitivity type skin disease (feline atopic skin syndrome, FASS), cats present with different clinical signs compared with dogs, respond differently to treatment, and may not tolerate many of our therapies aimed at improving the skin barrier. This presentation reviews the most common clinical presentations of FASS are reviewed (miliary dermatitis, eosinophilic dermatoses, self-induced alopecia and head and neck pruritus), and explains how to form a logical approach to these challenging cases. Reaction patterns provide information of a likely inflammatory/hypersensitivity condition, but they do not help guide in terms of the underlying reason for the inflammation. For this reason, other causes of inflammation and/or pruritus such as parasites (fleas/demodex), infectious organisms (dermatophytosis, bacterial, yeast or more rarely viral infections), behavioural or drug reactions should be investigated and excluded. In rare cases, other causes of inflammation such as neoplasia or a paraneoplastic condition may also be considered – however, these unusual cases will have distinct features or characteristics. Other causes of a potential hypersensitivity such as fleabite, cutaneous adverse food reaction and mosquito-bite must also be excluded before a diagnosis of FASS can be made. This presentation provides a clear and logical workflow to investigate feline inflammatory skin disease focusing on history, clinical exam and diagnostic investigations.
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Are all feline abdominal masses lymphomas?
BSAVA Congress Proceedings 2021Author Sarah MasonAbdominal masses are a common presentation in feline patients, and clinical signs commonly include weight loss, inappetence, vomiting and diarrhoea. The first step in investigation is to consider the likely differential diagnoses and obtain base line haematology and biochemistry to assess for red or white blood cell changes. Investigation of the mass should include abdominal ultrasound to confirm organ of origin, and needle aspirates or trucut biopsy. Ultrasound may give a good indication of the likelihood of successful resection and guide the decision to proceed with additional staging or surgery. The most common abdominal mass in cats is intestinal lymphoma, staging should include testing for FIV/FeLV, and thoracic radiographs if the budget permits. As lymphoma is a systemic disease, chemotherapy is indicated, regardless of staging and surgical intervention. In some patients, however, it is of benefit to excise the mass prior to chemotherapy, in the case of obstruction for example. Other intestinal tumours in felines include carcinoma, mast cell tumour and sarcoma. Abdominal masses may also arise from mesenteric lymph nodes and other organs such as liver, spleen pancreas, bladder or adrenal gland. This session uses a case-based approach to discuss differentials for and investigation of feline abdominal masses.
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Cats hurt too – feline analgesia: peri-operative analgesic techniques for cats
BSAVA Congress Proceedings 2021Author Claire WoolfordCats are masters at hiding their pain, but the clues are there if you look closely. Cats are often given less analgesia than their canine friends, sometimes this is because we don’t think they are painful and sometimes it’s because we are unsure what we can do for them. There are many analgesia techniques out there that can be used for cats as well as dogs, using multi-modal and preventive analgesia ensures that your patient has a good experience throughout their stay with you. This webinar covers preventative analgesia, easy local anaesthetic blocks and how to put together an analgesic constant rate infusion for your feline patients so you can ensure they do not suffer in silence.
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Causes of chronic diarrhoea in cats and their investigation
BSAVA Congress Proceedings 2021Author Fergus AllertonThe value of GI biopsies in cats: Chronic diarrhoea in cats can be a thoroughly frustrating affliction for patients, owners and vets alike. What are the common underlying aetiologies? Do these change according to the age of the cat? Or the breed? Which extra-digestive causes should be considered? Can faecal analysis ever be useful? How can you get the most out of such samples? Does abdominal imaging provide any helpful clues? If you’re going to collect gastrointestinal biopsies, does it matter which parts of the gastrointestinal tract you sample? Is endoscopy as good as surgical biopsy? Do therapeutic trials have a role to play in the diagnostic algorithm? This lecture delves into some of the common (and not so common) causes of chronic diarrhoea in cats and try to answer at least a few of the questions listed above.
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Corneal sequestrums in cats: diagnosis and treatment options
BSAVA Congress Proceedings 2021Author Richard EversonCorneal sequestrum is a common condition in cats, rarely reported in other species. Brachycephalic breeds including the Persian, Himalayan and Burmese appear to be predisposed. It is characterised by an area of brown to black discolouration of the corneal stroma, with or without overlying corneal ulceration. Light and transmission electron microscopy studies have revealed necrotic keratocytes and disarranged collagen. The cause of the brown discolouration remains unclear, and the pathogenesis is not fully understood. Feline corneal sequestrum is known to occur after chronic corneal ulcers or keratitis caused by FHV-1 and following keratitis caused by entropion. The treatment of choice for corneal sequestrum is surgical excision (keratectomy) +/- repair of the cornea using techniques such as corneoconjunctival transposition or conjunctival grafts. This presentation covers how to recognise corneal sequestrum, considers underlying causes, and discusses the treatment options.
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Feline IMHA
BSAVA Congress Proceedings 2021Author Nikki ReedImmune-mediated haemolytic anaemia occurs less commonly in cats than dogs. Young to middle-aged cats appear most commonly affected. In addition, it may be more difficult to diagnose for several reasons: jaundice is less commonly seen on clinical examination; spherocytosis is not reliable in cats, as their normal red blood cells are smaller and lack central pallor; cats are more prone to haemolysis from oxidative damage due to e.g. drugs or toxins (methimazole, paracetamol, garlic, onions), Heinz Body anaemia (diabetes mellitus) enzymopathies (pyruvate kinase deficiency); cat erythrocytes commonly form rouleaux, which can be misinterpreted as agglutination; IMHA may be non-regenerative, decreasing the index of suspicion of IMHA as the cause of anaemia. As with canine disease, primary IMHA must be differentiated from secondary IMHA. Recognised causes of secondary IMHA include infections (e.g. M. haemofelis, Feline Coronavirus, retrovirus infection, Babesia), inflammatory disease processes (e.g. pancreatitis, cholangiohepatitis) and drugs (e.g. propylthiouracil). There is no evidence that vaccination can act as a trigger for IMHA in cats, and the evidence for neoplasia acting as a trigger appears weak. Prednisolone forms the mainstay of therapy, with additional immunosuppressive drugs such as ciclosporin, chlorambucil and mycophenolate mofetil also having been used in conjunction with prednisolone.
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Feline chronic gingivitis and stomatitis: an update
BSAVA Congress Proceedings 2021Author Boaz ArtiFeline chronic gingivitis stomatitis part 1 – what it is and managing expectations: Feline chronic gingivostomatitis (FCGS) is a painful oral mucosal inflammatory disease presented in cats. The observable characteristics of FCGS is ulcerative and/or proliferative mucosal inflammation in the area lateral to the palatoglossal folds with or without gingival inflammation. The cause of feline gingivostomatitis is currently elusive, but it can be inferred that a chronic antigenic stimulation, such as a viral infection, results in an inappropriate immune response. Full-mouth tooth extraction is the current standard of care to treat FCGS. About 70% of affected cats will have significant improvement with this dental procedure, but approximately 30% of cats will not respond and will have a poor quality of remaining life. Non-responding cats will need lifelong medical management and severely affected cats will often be euthanized. Therefore, managing client expectations is a very important aspect of managing the disease. This lecture covers current evidence-based knowledge on FCGS as well as therapeutic approaches.
Feline chronic gingivitis stomatitis part 2 – stem cell therapy: FCGS is an immune mediated oral mucosal disease. In that context, cats affected by FCGS demonstrate systemic elevation of cytotoxic T cells (CD8 cells) and other abnormalities indicating an aberrant immune system. Mesenchymal stem cells (MSC) are multipotent stem cells. MSC reside in most organs and tissues such as bone marrow, adipose, and periodontal ligament. Furthermore, MSC has a profound regenerative ability attributed in part to their ability modulate both innate and adaptive immunity. Hence, a therapeutic approach was designed whereby mesenchymal stem cells (MSCs) capable of immunomodulation and significant regenerative capacity were administered systemically to cats that did not respond to extraction therapy. MSCs immune modulatory properties include decreased T-cell and B cell proliferation and function and altered lymphocytes phenotypes. The efficacy of MSCs for the treatment of non-responsive FCGS has been an ongoing study, for the past 9 years, tested in several clinical trials. In these clinical trials, approximately 60-70% of cats had a positive response rate. This lecture discusses the general concept of MSC immunomodulation therapy as well as the clinical outcome of MSC therapy for cats with FCGS and future directions.
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Feline chronic gingivostomatitis: recent updates and future perspectives
BSAVA Congress Proceedings 2021Author Boaz ArtiFeline chronic gingivostomatitis (FCGS), a severe inflammatory oral disease of cats, is characterised by immune-mediated oral inflammation affecting the caudal oral mucosa as well as the gingival mucosa. In the past 10 years, several key studies paved the road towards better understanding of the etiopathogenesis of FCGS and improving treatment options. This lecture focuses on recent discoveries and current understandings in both etiopathogenesis and therapeutic options including stem cell therapy and immune modulation. Moreover, with the emerging field of regenerative medicine, this lecture informs practitioners on the practicability of stem cell therapy for FCGS. Finally, a path from current discoveries towards clinical applications is discussed.
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How should we deal with anaemic cats in our practice
BSAVA Congress Proceedings 2021Authors: Nikki Reed and Elle HaskeyWhich tests to do and in what order? The presence of anaemia may be harder to detect in cats compared to dogs, as their mucous membranes are typically slightly paler than those of dogs, and clinical signs such as exercise intolerance and weakness may manifest as sleeping more in cats, and therefore may go unnoticed by the owner. As a result, cats may be more severely affected by the time investigations are undertaken. Clinical assessment of cardio-vascular stability is therefore important before proceeding to performing diagnostic testing. The minimum volume of blood should be obtained, but it is also important to think in advance what tests might be required to reduce the number of blood draws that have to be performed. For cats that are cardio-vascularly compromised, stabilisation may be required before full diagnostic investigations can be undertaken, whereas for mild to moderate anaemia the aim should be to identify the cause. The use of in-house automated haematology analysers has facilitated rapid diagnosis of the presence of anaemia, but the limitations of these machines must be borne in mind. Further in-house tests can increase the information given from the automated analyser, namely assessing PCV and total solids, blood smear evaluation and auto-agglutination, before submitting samples to external labs for further testing.
Blood transfusion: Currently there is no UK feline blood bank, so in-house feline blood donations are sometimes required as a life-saving therapy. This session looks at the requirements of a feline blood donor and how to make this a safe and stress-free procedure. The post-donation care of feline donors differs to canine donors, and this session reviews the current recommendations of feline donor care. There are also a number of nursing considerations which RVNs should be able to add to the care plan of the recipient cat including pre, during and post transfusion.
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How should we deal with cats with chronic diarrhoea in our practice?
BSAVA Congress Proceedings 2021Authors: Fergus Allerton and Nikki ReedThe value of GI biopsies in cats: Chronic diarrhoea in cats can be a thoroughly frustrating affliction for patients, owners and vets alike. What are the common underlying aetiologies? Do these change according to the age of the cat? Or the breed? Which extra-digestive causes should be considered? Can faecal analysis ever be useful? How can you get the most out of such samples? Does abdominal imaging provide any helpful clues? If you’re going to collect gastrointestinal biopsies, does it matter which parts of the gastrointestinal tract you sample? Is endoscopy as good as surgical biopsy? Do therapeutic trials have a role to play in the diagnostic algorithm? This lecture delves into some of the common (and not so common) causes of chronic diarrhoea in cats and try to answer at least a few of the questions listed above.
The value of diets in the management of feline IBD: Inflammatory bowel disease (IBD) has a complex aetiology in which dietary antigens play a role but are not the sole cause. Dietary management alone can be effective in resolving around 50% of cases of feline IBD, but in order to optimise response to this line of treatment, it is essential to have obtained a good dietary history. Three types of diets are available for dietary trials – highly digestible; restricted ingredient; hydrolysed. The dietary history should enable the clinician to identify a novel protein source to which the patient has not previously been exposed, as well as food preferences of the patient (e.g. wet vs dry; fish vs meat flavours). There are a huge number of commercial diets to choose from and many diets advertised as hypoallergenic contain multiple ingredients. Highly digestible diets are not the same as restricted ingredient diets, hence some diet trials can fail due to selection of an inappropriate diet. It is therefore important to understand the rationale behind performing a diet trial for IBD and be able to advise clients on what are appropriate diets to use.
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Investigation and management of behavioural factors in recurrent feline cystitis
BSAVA Congress Proceedings 2021Author Sarah HeathFeline interstitial cystitis is commonly encountered in general practice. The recurrent nature of its presentation can make it frustrating to treat. This presentation considers the importance of investigating the emotional component of this disease and discuss how to gather information about the cat’s social and physical environment in order to assess their impact on the physical health of the patient. Once that information has been gathered the presentation considers practical ways in which the environmental needs of the cat can be provided in order to optimise emotional health and contribute to the successful long term management of their physical health condition.
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What is the current thinking on feline triaditis: does it even exist?
BSAVA Congress Proceedings 2021Author Penny WatsonThe term ‘triaditis’ is used to refer to concurrent pancreatitis, cholangiohepatitis and inflammatory bowel disease (IBD) in cats. It was first reported in a case series in 1996 in which an association with nephritis was also found. The disease associations were controversial for many years, but more recent clinical, post mortem and imaging studies provide strong evidence for concurrent disease in two or three of the gut, pancreas and liver in a significant number of cats. The reason for these associations remain speculative. It is very likely that cats suffer from not one but several different biliary tract diseases, some of which may be associated with pancreatitis and/or IBD and some of which might not. The relative involvement of bacteria, immune-mediated disease or sphincter of Oddi dysfunction remain unclear, the optimal treatment is unknown and even studies on the long term follow up of cases are lacking. Many questions still remain and future studies hope to characterise the disease better including advanced imaging of the biliary tract and the role of feline autoantibodies. Ultimately, we need better understanding to allow more effective diagnosis and treatment of cats in the future.
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