Congress on Demand 2021: Top Ten

There are a number of conditions that can cause acute or intermittent vomiting, including gastrointestinal foreign bodies, pancreatitis and gastroenteritis. With foreign bodies, palpation may be diagnostic though in most cases, imaging confirmation of gastrointestinal foreign bodies is paramount, using radiographs, ultrasound or CT. On radiographs, signs consistent with obstruction include masses (soft tissue or radio-opaque, distended loops of small intestine (diameter > twice the height of L5) and plication. Ultrasound can be very useful in the hands of a skilled operator, often giving location of obstruction and any evidence of peritoneal effusion with high sensitivity and specificity. Surgical considerations include enterotomy versus enterectomy, suture techniques, needle type, stapling versus sutures and use of drains to aid post-operative surveillance. Post-operative management is crucial, with early enteral feeding important and careful monitoring and management of pain and ileus. Post-operative analgesia will be examined, including the evidence base for the use (or with-holding) of non-steroidal anti-inflammatories. Known risk factors for increased complications are covered and methods of decreasing complications such as the surgical check list discussed.

Do you worry that echocardiography has become the only method of imaging to evaluate cardiac patients? Unless you have managed to develop your echo skills, it would be easy to feel left behind. Even for vets with a particular imaging interest, echocardiography can be difficult to learn, even after undertaking practical CPD. Even the best echocardiographers cannot get as much information about the lungs and pulmonary vasculature as we can gain from reviewing a good chest radiograph. In this session, we will review how to get the most information about the heart that we can from thoracic radiographs in dogs and cats, and feature some top tips on how to differentiate cardiac from respiratory disease.

Radiology is the most widely-available imaging modality used to assess the lower respiratory tract in veterinary practice, although CT (if available) will generally give the optimal visualisation of the pulmonary structures. Interpretation of pulmonary disease on radiographs can be challenging, and obtaining images of good diagnostic quality is critical (some apparent pulmonary pathology can easily be mimicked by underexposed radiographs) – a complete radiographic examination is also important as unilateral lesions can be missed if only one radiograph is obtained. When assessing pulmonary pathology, important factors to consider are the lung pattern(s) present and their distribution – these will significantly affect the priority given to the potential differential diagnoses. The most common lung changes seen are bronchial, alveolar and nodular patterns – genuine unstructured interstitial and abnormal vascular patterns are less frequently identified. For a bronchial pattern, the most common causes are incidental age-related mineralisation and chronic bronchitis. Alveolar change (classically seen as air bronchograms) can be due to pulmonary collapse or consolidation – when consolidation is distributed ventrally (and often asymmetrically), this is more suggestive of aspiration pneumonia or haemorrhage, while bilaterally symmetric peri-hilar and caudodorsal change would be more typical of pulmonary oedema. In the UK, nodular lesions are most commonly seen with neoplastic disease.

Corneal opacities: In order to function properly the cornea should be transparent, any opacity will impair function. If you can correctly identify the different types of corneal opacities and their cause, then you will know whether or not appropriate treatment (medical and/or surgical) will improve or restore corneal clarity. Do a thorough examination of the cornea, look from different angles, use a bright light and magnification. Think about the colour of the opacity, is it blue/grey, red, white or black/brown? There may be more than one colour present in an affected cornea, as there are only a limited number of ways that it can respond to insult. Blue/grey opacity is due to oedema, which may be the result of epithelial or endothelial cell loss. Red can be due to vascularisation, which may be superficial or deep, or more rarely due to intrastromal haemorrhage. White opacites are the most frequently seen and may be due to fibrosis, cellular infiltrate, lipid or calcium deposition. Black deposits are most likely to be pigmentation, usually superficial and sub-epithelial, but also occasionally endothelial. In cats, brown pigmentation associated with a sequestrum is also a possibility. There is one more opacity that doesn’t follow the above rules and that is a corneal foreign body, which can come in all shapes, sizes and colours!

Anterior chamber, lens and vitreous: A number of different lesions, resulting from different disease processes, can cause an opacity of the ocular media, affecting the visual axis. This short presentation covers opacities affecting the anterior chamber, lens and vitreous. The focus is on recognising and identifying the opacity by looking at numerous examples. Lesions discussed include uveal cysts, hypopyon, hyphaema, cataract and asteroid hyalosis.

Options: Atopic dermatitis is a very common condition that severely compromises quality of life for affected dogs and their owners. It is a lifelong disease that requires ongoing treatment to maintain remission and prevent flares. Atopic dermatitis is a complex disease that involves a poor skin barrier, abnormal skin inflammation, allergies (in most but not all dogs) to environmental and/or food allergens, and secondary skin and ear infections. It is important to identify the triggers for each dog and then use a multimodal treatment programme to address these. Treatment options include topical emollients, essential fatty acid (EFA) supplements or enriched diets, palmitoylethanolamide (PEA), allergen specific immunotherapy (ASIT), antihistamines, and anti-inflammatory medication. Anti-inflammatory treatments with good evidence of high efficacy include systemic and topical steroids, ciclosporin, oclacitinib and lokivetmab. It is essential that these treatment options are understood so that they can be used effectively in the management of canine atopic dermatitis.

Strategy: Canine atopic dermatitis is a common skin disease in dogs. Affected patients and their owners can have severely reduced quality of life. Different treatment modalities need to be combined strategically for each patient to formulate a treatment plan that suits the given patient and carer. This may involve treatment of flare factors, symptomatic anti-pruritic therapy, immunotherapy and treatments to strengthen the skin barrier function. Optimal therapy depends on the patient, breed, temperament, body areas affected, severity of the skin disease, financial considerations and owner attitude and ability all come in the equation. Different scenarios are discussed in this presentation.