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minibabyqq 2006-12-28 01:47 AM

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[color=Magenta][size=5][b]血壓管理Blood Pressure Management   [/b][/size][/color]


1)     推薦

a)      一般方法

i)        所有被麻醉的患者應該一致地被監測使用間接oscillometric 或多譜勒儀血壓螢幕

(1)   主要優先權將維護心臟收縮的血壓(樹汁) 在或在90 毫米百克之上

(a)    80 mmHg 經常被談論作為極小的樹汁

(2)   卑鄙動脈壓力(地圖) 應該是維護在或在70 毫米百克之上

(3)  舒張血壓是最少準確的血壓由間接oscillometric 方法測量。

ii)       Oscillometric 螢幕

(1)   比多譜勒儀螢幕較不勞動密集型但傾向於是較不一致的在他們的能力登記血壓為更小的患者

(2)   集合自動地循環每2 到3 分鐘

(a)    1 周詳週期傾向於創造一個局部缺血的挑戰對肢

(3)   袖口寬度應該是40% 肢體圓周為狗和貓

(a)    過份地寬袖口將導致血壓的低估

(b)   過份地狹窄的袖口將導致血壓的過高估計

(4)   袖口的地點重要

(a)    多數一致的袖口地點為小患者是中間前肢

(i)      不要猶豫嘗試所有地點依照必要

(b)   好地點為更大的動物包括掌、跗基節, 和末端脛骨在tarsus 之上

(c)    尾巴基地也許是一個充分站點為一些患者包括貓

iii)     多譜勒儀

(1)   更加一致地有效當監測小患者

(2)   措施收縮壓唯一

(a)    在貓有一些證據, 您測量地圖而不是樹汁特別是如果袖口寬度是太大的

(3)   地點包括腹尾巴、尾部掌, 和尾部metatarsal 區域

(4)   頭髮一般被截去在探針站點

(a)    消沉在探針必須用aquasonic 聯結膠凝體被填裝

(b)   一旦您聽見swishing 的聲音, 把探針錄音到位

(i)      過份和不充分的壓力可能創造困難測量壓力

(5)   它經常是可能獲得讀書由第一wetting 站點與酒精, 然後應用聯結膠凝體嚮站點和探針沒有截去任何根頭髮

(6)   袖口被安置的公正接近對探針

(a)    袖口寬度是一樣重要以多譜勒儀BP 測量像以oscillometric BP 測量

(i)      袖口寬度應該是40% 肢體圓周為狗

(ii)     袖口寬度應該是30% 肢體圓周為貓

(iii)   過份地寬袖口將導致血壓的低估

(iv)  過份地狹窄的袖口將導致血壓的過高估計

b)      前麻醉劑療程

i)        一opioid 單獨或與benzodiazepine 通常提供優選的血壓最佳的維護

ii)       有效的premeds, 重點放在opioid 鎮痛藥, 是極端重要第一步在處理一名患者幫助得最好保存組織灌注的時尚

c)      歸納

i)        歸納代理為最優選的血壓的維護

(1)   Etomidate

(2)   Hydromorphone 或oxymorphone 與苯甲二氮卓(犬)

d)      維護

i)        如果血壓是太降低:

(1)   減少inhalant 麻醉的水平如果可能

(a)    如果收縮壓是至少80 毫米百克, 等候外科刺激是一個合理的短期選擇

(b)    認為芬太奴IV 一小團0.002 mg/kg (0.001 mg/lb) 或hydromorphone 0.10 mg/kg (0.05 mg/lb)

(c)   認為苯甲二氮卓IV 一小團0.2 mg/kg (0.1 mg/lb)

(2)   增加可變的率如果可能

(a)    增加從10 ml/kg/hr 到20 ml/kg/hr (5 ml/lb/hr 到10 ml/lb/hr)

(i)      考慮10 ml/kg 快的一小團(5 ml/lb) 5 分鐘

(3)   調遷螢幕站點(主要附屬對oscillometric 螢幕)

(a)    核實適當的袖口選擇

(4)   Hetastarch

(a)    狗

(i)      5 ml/kg (2.5 ml/lb) 5 分鐘

1 。      能小心地被重覆直到樹汁到達80 mmHg 或一共計20 ml/kg/day (10 ml/lb/day) 被到達

(b)   貓

(i)      2 ml/kg (1 ml/lb) 5 分鐘

1 。      能小心地被重覆直到樹汁到達80 mmHg 對一共計20 ml/kg/day (10 ml/lb/day)

(5)   考慮執行的dobutamine 或多巴胺

(a)    Dobutamine

(i)      狗- 0.001 到0.010 mg/kg/min (0.0005 到0.005 mg/lb/min)

(ii)    貓- 使用狗藥量範圍的末端

(iii)   食譜為0.002 mg/kg/min (0.001 mg/lb/min) 藥量

1 。      4.8 機器語言@ 12.5 mg/ml = 60 毫克

2 。      增加來250 機器語言0.9% 鹽為0.24 mg/ml

3 。      給0.5 ml/kg/hour

a 。       要求注入泵浦或注射器泵浦為準確交付

(iv)  為擅長Dobutamine CRI 報表點擊這裡

(v)   中斷dobutamine 如果重大增加在心率或如果任何心率失常顯現出

(b)   多巴胺 (可利用在多力量)

(i)      狗- 0.002 到0.010 mg/kg/min (0.001 到0.005 mg/lb/min)

(ii)    貓- 使用狗藥量範圍的末端

(iii)   食譜為0.002 mg/kg/min (0.001 mg/lb/min) 藥量

1 。      1.5 機器語言@ 40 mg/ml = 60 毫克

2 。      增加來250 機器語言0.9% 鹽為0.24 mg/ml

3 。      給0.5 ml/kg/hour

a 。       要求注入泵浦或注射器泵浦為準確交付

(iv)  為擅長多巴胺CRI 報表點擊這裡

(v)   中斷多巴胺如果重大增加在心率或如果任何心率失常顯現出

(7)   為 狗, 考慮轉換從isoflurane/sevoflurane 對:

(a)    Hydromorphone 或oxymorphone 作為週期性一小團與苯甲二氮卓週期性一小團(參見麻醉的維護部分為細節在Hydromorphone 和Oxymorphone 維護指南)

(b)   芬太奴和midazolam CRI

(i)      Ketamine 和lidocaine 也許增加來CRI 除非有具體禁忌症候

(c)    為 貓 這些協議也許使用減少inhalant 需要但它不太可能是一個成功的戰略沒有另外的麻醉的代理

e)      支持

i)        參見上面

2)     防備措施

a)      前麻醉劑療程

i)        Acepromazine 可能導致低血壓症

(1)   這是藥量受撫養者作用

b)      歸納

i)        執行propofol 可能太迅速地導致心肌消沉和在血壓的瞬變減退

c)      維護

i)        任一個inhalant 代理是能導致重大低血壓症在外科麻醉的水平

(1)   交換的inhalant 代理也許是有利的

(2)   交換對可注射的代理也許是有利的

d)      支持

i)        作為需要的基地在討論之上
1)     RECOMMENDATIONS

a)      General Approach

i)        All anesthetized patients should be consistently monitored using indirect oscillometric or doppler blood pressure monitors

(1)   Main priority is to maintain systolic blood pressure (SAP) at or above 90 mm Hg

(a)    80 mmHg is often discussed as a minimum SAP

(2)   Mean arterial pressure (MAP) should be maintain at or above 70 mm Hg

(3)  Diastolic blood pressure is the least accurate of the blood pressures measured by the indirect oscillometric method.

ii)       Oscillometric Monitors

(1)   Are less labor intensive than Doppler monitors but tend to be less consistent in their ability to register blood pressures for smaller patients

(2)   Set to automatically cycle every 2 to 3 minutes

(a)    1 minute cycles tend to create an ischemic challenge to the extremity

(3)   Cuff width should be 40% of limb circumference for dogs and cats

(a)    Excessively wide cuffs will lead to an under-estimation of blood pressure

(b)   Excessively narrow cuffs will lead to an over-estimation of blood pressure

(4)   Location of cuff is important

(a)    Most consistent cuff location for small patients is the mid-foreleg

(i)      Don’t hesitate to try all locations as needed

(b)   Good locations for larger animals include metacarpus, metatarsus, and distal tibia just above tarsus

(c)    The tail base may be an adequate site for some patients including cats

iii)     Doppler

(1)   More consistently effective when monitoring small patients

(2)   Measures systolic pressure only

(a)    In cats there is some evidence that you are measuring MAP rather than SAP especially if cuff width is too large

(3)   Locations include ventral tail, caudal metacarpus, and caudal metatarsal area

(4)   Hair is generally clipped at the probe site

(a)    The depression in the probe must be filled with aquasonic coupling gel

(b)   Once you hear the swishing sound, tape the probe in place

(i)      Both excessive and inadequate pressure can create difficulties measuring pressures

(5)   It is often possible to obtain readings by first wetting the site with alcohol, then applying coupling gel to the site and the probe without clipping any hair

(6)   The cuff is placed just proximal to the probe

(a)    Cuff width is as important with doppler BP measurement as with oscillometric BP measurement

(i)      Cuff width should be 40% of limb circumference for dogs

(ii)     Cuff width should be 30% of limb circumference for cats

(iii)   Excessively wide cuffs will lead to an underestimation of blood pressure

(iv)  Excessively narrow cuffs will lead to an overestimation of blood pressure

b)      Pre-anesthetic Medications

i)        An opioid alone or with a benzodiazepine usually provides the best maintenance of optimal blood pressures

ii)       Effective premeds, with an emphasis on opioid analgesics, are an extremely important first step in handling a patient in a fashion that helps best preserve tissue perfusion

c)      Induction

i)        Induction agents for maintenance of the most optimal blood pressures

(1)   Etomidate

(2)   Hydromorphone or oxymorphone with diazepam (canines)

d)      Maintenance

i)        If blood pressures are too low:

(1)   Decrease inhalant anesthetic level if possible

(a)    If systolic pressures are at least 80 mm Hg, awaiting surgical stimulation is a reasonable short term option

(b)    Consider an IV bolus of fentanyl 0.002 mg/kg (0.001 mg/lb) or hydromorphone 0.10 mg/kg (0.05 mg/lb)

(c)   Consider an IV bolus of diazepam 0.2 mg/kg (0.1 mg/lb)

(2)   Increase fluid rate if possible

(a)    Increase from 10 ml/kg/hr to 20 ml/kg/hr (5 ml/lb/hr to 10 ml/lb/hr)

(i)      Consider a quick bolus of 10 ml/kg (5 ml/lb) over 5 minutes

(3)   Relocate monitor site (mainly pertains to oscillometric monitors)

(a)    Verify proper cuff selection

(4)   Hetastarch

(a)    Dogs

(i)      5 ml/kg (2.5 ml/lb) over 5 minutes

1.      Can be repeated with caution until SAP reaches 80 mmHg or a total of 20 ml/kg/day (10 ml/lb/day) is reached

(b)   Cats

(i)      2 ml/kg (1 ml/lb) over 5 minutes

1.      Can be repeated with caution until SAP reaches 80 mmHg to a total of 20 ml/kg/day (10 ml/lb/day)

(5)   Consider administering dobutamine or dopamine

(a)    Dobutamine

(i)      Dog – 0.001 to 0.010 mg/kg/min (0.0005 to 0.005 mg/lb/min)

(ii)    Cats - use low end of dog dose range

(iii)   Recipe for 0.002 mg/kg/min (0.001 mg/lb/min) dose

1.      4.8 ml @ 12.5 mg/ml = 60 mg

2.      Add to 250 ml 0.9% saline for 0.24 mg/ml

3.      Give 0.5 ml/kg/hour

a.       Requires infusion pump or syringe pump for accurate delivery

(iv)  For Excel Dobutamine CRI spreadsheet click here

(v)   Discontinue dobutamine if significant increase in heart rate or if any arrhythmias develop

(b)   Dopamine (available in multiple strengths)

(i)      Dog – 0.002 to 0.010 mg/kg/min (0.001 to 0.005 mg/lb/min)

(ii)    Cats - use low end of dog dose range

(iii)   Recipe for 0.002 mg/kg/min (0.001 mg/lb/min) dose

1.      1.5 ml @ 40 mg/ml = 60 mg

2.      Add to 250 ml 0.9% saline for 0.24 mg/ml

3.      Give 0.5 ml/kg/hour

a.       Requires infusion pump or syringe pump for accurate delivery

(iv)  For Excel Dopamine CRI spreadsheet click here

(v)   Discontinue dopamine if significant increase in heart rate or if any arrhythmias develop

(7)   For dogs, consider switching from isoflurane/sevoflurane to:

(a)    Hydromorphone or oxymorphone as a periodic bolus with periodic boluses of diazepam (see Anesthetic Maintenance section for details on Hydromorphone and Oxymorphone maintenance guidelines)

(b)   Fentanyl and midazolam CRI

(i)      Ketamine and lidocaine may be added to the CRI unless there is a specific contraindication

(c)    For cats these protocols may be used to reduce the inhalant need but it is unlikely to be a successful strategy without additional anesthetic agents

e)      Support

i)        See above

2)     PRECAUTIONS

a)      Pre-anesthetic Medications

i)        Acepromazine can cause hypotension

(1)   This is a dose dependent effect

b)      Induction

i)        Administering propofol too rapidly can cause myocardial depression and a transient decrease in blood pressure

c)      Maintenance

i)        Any inhalant agent is capable of causing significant hypotension at surgical anesthetic levels

(1)   Switching inhalant agents may be beneficial

(2)   Switching to injectable agents may be beneficial

d)      Support

i)        As needed base upon above discussion

minibabyqq 2006-12-28 01:48 AM

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[color=Magenta][b][size=5]ISOPATHIC-HOMOEOPATHIC 治療   [/size][/b][/color]


"治療瓶頸的" 概念當前是許多文章和紙題材, 假設現代食品衛生適應並且變化在法律體系上在歐共體之內導致對從前共同地被使用由多數獸醫在他們的治療的許多實踐的制約。一個進一步使複雜化的因素並且漸增了音量: 這是細菌長被預言的抵抗對抗生素由於頻繁地物質的不加鑒別的就業以一次抗藥性行動。這並且代表一種直接風險對消費者。所以, 有利於消費者保護法, 它是高時間為變動和修改被做對獸醫實習者的貿易的工具, 保證病的動物也許繼續成功地被對待在"崗位抗生素" 時代。我們必須這樣作考慮到特殊分成不用的那些自然治療形式當信念在抗生素裡變得越來越流行。

微生物共生- 生物一種原始的現象。

醫學照原樣今天一般被教被著陸在多孔的病理學VIRCHOW 裡(1821-1902), 和它的依據是干擾的描述在細胞裡、組織和器官或系統。因而疾病一個monomorphistic 看法顯現了出; 即各個組織、各種器官和各個干擾在健康被描述根據症狀圖片, 被記錄, 和分開地被對待。

德國動物學家和微生物學家, G5unther Enderlein (1872-1968) 博士教授執行了持續數十年和被記錄完全成功500 篇科學專題論文研究的節目。他走向結論, 疾病這個monomorphistic 看法能不再被維護。他認為, 每個人和動物有機體包含在它的紅血球之內proto 種子菜起源(endobiont) 。因而為ENDERLEIN 所有生活處理基於菜和動物原則共生。這是戰勝的看法的反題PASTEUR (1822-1895) 那微生物存在但簡單地不是依於任一個發展過程。ENDERLEIN 然而能顯示出, 微生物是完全能接受一個變形過程由於外生和內在影響。ENDERLEIN'S 這個看法與制定為多形性的依據以他的"microzymas 的" 理論的那B3ECHAMP 確切地相符(1816-1908) 。這種理論闡明, 在精確地指定的情況下, 指定的微生物可能發生在各種各樣的發展形式和階段, 排列在大小從最微觀由大和高度發展的階段決定, 譬如細菌和真菌。ENDERLEIN 的研究關鍵的題材是多形性, 共生和cyclogeny 微生物, 特別如同它發生在人和動物身體, 確定是否有疾病或健康。早在1925 年在他的精液書"細菌Cyclogeny 裡", ENDERLEIN 描述了這個重大過程在可示範的時尚。(Enderlein 1925) 致病性發展階段也許積累在endobiont, 由於共生干擾。ENDERLEIN 的看法這導致"endobiosis" 或傾向綜合症狀往壅塞, 由血液的增加的黏滯描繪為有害充血的條件以危險涵義為血液供應對組織和。

他的在發斑傷寒熱病的工作其間, ENDERLEIN 觀察了形成附件對高度組織的細菌的流動結構在血液darkfield 顯微學。這個聯結子孫變得無形以閃電速度。ENDERLEIN 這裡懷疑再生過程, 造成小字母的形式, 無形根據顯微鏡。

當有在數量的任一增量, 或演變, 的endobiont, 所有過剩symbionts 從循環通常被取消通過copulatory 過程。

但是, 在過份超載情形下(即以外生醉的形式), 生物self-healing 過程成為用盡, 並且共生嚴重被削弱。根據ENDERLEIN, 生物self-healing 機制包括發展致病性階段的修改和章程由non-pathogenic 原始形式。這導致symbiont 開始性發展的過程, 帶領從卵蛋白(所謂的protite) non-pathogenic, 固定微粒通過chondrite 階段細菌寄生, 致病性階段和真菌。因而在各個案件這是這些微生物更高的階段, 根據由他們的周圍環境反過來確定, 負責對導致病症的他們的cyclogenetic 向上流動性。因而, 根據ENDERLEIN, 病症開始存在由於symbiont 的配錯和主人有機體, 主人有機體的新陳代謝由高度發展的endobiont 的新陳代謝有害地影響。當病症被治療, 這暗示因此這個相互關係的正常化。

在文字之時, 這樣透視的確是非凡, 並且他們標記ENDERLEIN 作為現代生態學認為的先驅, 至少表示疑問今天仍然被教細菌同型結構的概念。

其它研究員過去和現在給了他們各種各樣的解釋至於病毒生活形式的起源, 作為的細胞中堅力量的部份終止了從他們和變得獨立。ENDERLEIN, 另一方面, 以前移動了遠在這樣科學論文以他的研究, 數十年之外。在黑暗的領域顯微學的幫助下嚮當地血樣被運用, 他能展示這個重要微生物過程, 根據它的起源和它的週期(Bleker 1997) 。當這個重要過程離開生理homeostasis 狀態, 寄生持續所有特點。在這個狀態non-pathogenic symbionts (protites 和chondrites) 激活酵素和新陳代謝, 成為致病性微生物, 根據毒菌理論。

Isopathic-Homoeopathic 治療的本質。

Isopathic-Homoeopathic 治療是一種管理治療形式, 目標將影響被毀壞的物理過程自然恢復在homoeopathic 補救的幫助下(謝德, 1998 a & b) 。在德國獸醫isopathic 和homoeopathic 補救並且登記至於使用與動物被飼養對食品工業。在期間它是在使用中的十年在, 這種治療證明了它的價值。

這種治療主要關心是過程的自然平衡的恢復成為了disharmoniously 出軌, 並且達到這沒有對人為手段的用途, 也許並且是外籍人對身體和環境。Isopathic 補救是被規定的達成協議對原則"Similia similibus curentur" (像治療像) 。與治療對比以nosodes 從疾病產品被獲得, 挑釁一個刺激的反應因為第一步往癒合, ENDERLEIN 考慮chondrites 的行動在isopathic 準備, 被關係當他們是對身體, 在在基本的微生物過程的copulative 變革, 被毀壞了。Isopathic 治療的當中一個首要利害關係是導致壅塞所有影響的撤除。為對發病原理的理解偉大意義微生物是那些, 通過他們自己的新陳代謝, 對危險上升貢獻在血液黏度由於發展他們先進的cyclogenetic 階段。在這上下文, 最重要的微生物是 白黴屬racemosus Fresen 。 並且 Aspergillus.niger van Tieghem。

因而治療領域到達在微生物白黴屬racemosus Fresen 的 準備。工作在病態的有機體的血液, 這使更加先進, 更加寄生的黴菌階段降低到它原始的non-pathogenic 階段, 因此保證血液的自由流程通過最小的船。因而這個補救能治療循環干擾, 例如, 並且其它精神創傷各種各樣的起源。

其它準備包含chondrites 從Aspergillus.niger 文化 。這真菌非常嚴密同有小瘤狀的情況的發展聯繫在一起, 胚胎那些, 情況也許經常顯現出明顯地有他們自己的一個另外身分。這種準備有效和持久deconstructs 負責對所有有小瘤狀和巴拉有小瘤狀的情況的微生物。它成功地被使用在麴黴病的治療, genito-urinary 短文的疾病, 包括癌和囊腫, 並且骨骼疾病和疣。它是有趣注意到, 一個直接鏈接最近建立了在牛(約翰的疾病) 並且Crohn 的疾病之間巴拉結核病在人(參見B.M.J. 1998 2月) 。分枝桿菌屬paratuberculosis 原因地同兩種疾病聯繫在一起, 並且他們可能成功地被對待在isopathic-homoeopathic 療法幫助下。

其它準備被獲得從微生物 毛叢chrysogenum syn. notatum。這種準備不包含青黴素。毛叢chrysogenum 的原始形式達到是具體的不對觸發器亦不對抗原身體的自己的防禦的刺激。在最近科學說法"paramunisation" 和"paramunity 的" 概念(Mayr 1998) 與這連接。在對待的細菌炎症和pyoses 這種準備是選擇補救。這種準備特別被表明在所有staphylococcal 和鏈球菌的傳染。

有一種準備用於皮膚真菌病, 特別那些的治療由Trichophyton 品種造成; 這包含Trichophyton verrucosum 一種特殊萃取物。根據Isopathy 法律, 觸發的有機體由補救deconstructed, 並且這解構產品可能從身體然後被消滅通過自然路線。

在1911 年和1914 年A. Calmette 和G. Guerin 之間描述了分枝桿菌屬結核病var. bovis 的一個基本解法的 生產。從事一個長和相當特殊準備期間, 這顯示了非劇毒, 沒有丟失它的抗原質量。活變稀的分枝桿菌屬這懸浮被使用在接種和挑釁皮膚反應。分枝桿菌屬的一種多孔的萃取物的homoeopathic 準備和規則疫苗一樣擁有卓著的免疫modulatory 物產, 沒有它的infectiousness 任一蹤影。

一個進一步補救在這個小組準備從被開化的Bacillus-subtilis 濾出液, non-pathogenic 桿菌以永久形式。這

準備是一種柔和地行動的興奮劑, 挑釁不看得出的上升在體溫亦不所有一般反應。它並且證明了它的價值在傳染病的治療作為一個未指明的免疫調制器。

在許多疾病, 跟隨觸發的有機體的排除, 他們的毒素也許保留後邊維護病症狀態。此外, 這些毒素也許是病症的單一起因。保護自己免受他們自己的毒素, 觸發有機體形成具體多聚糖(以抗原吸收體著名, 根據CORNELIUS; Cornelius, 1990), 工作它是束縛觸發器的自己的毒素或抗原和因此防止他們變得活躍。此外病毒、細菌、植物和動物會存儲和傳送生物資訊, 以糖類單位協助。因而代碼被編成密碼用這種語言能影響許多管理過程在主人有機體。

另外, 低分子多聚糖導致haptenes, 是能刺激免疫防禦, 多孔和體液: 不是獨自, 而且在與一個更高的分子載體的合作(即蛋白質) 。細菌毒素, 被解放了在早先傳染期間但不能從身體被消滅由於短少產生免疫的物產, 可能由haptenes 一定, 和然後成為抗原。這抗原有能力刺激免疫系統由激活T 淋巴細胞, 最後導致細菌毒素的排除。

沙門氏菌enteritidis 和Trichophyton verrucosum 的 準備 包含多聚糖組成部分(haptenes) 相關的觸發器在一種特別萃取物。強的主要惡化和抗原封鎖被這些準備緩和或去除。所以他們頻繁地被使用作為一種在過程中發生的治療當對應的nosode 被採取。Haptenes 從沙門氏菌enteritidis 運作很好在慢性胰腺炎的治療, 慢性胃腸炎, 和一般在被阻礙的成長。

多聚糖從Trichophyton 被使用在皮膚真菌病洗滌真菌學地形在治療以後以已經被提及的萃取物從同樣真菌(參見上面) 。

整體, isopathic-homoeopathic 療法不僅提供可能性, 在許多情況下, 的處理沒有有一次抗藥性行動, 但此外它果斷地提高治療的範圍可利用對獸醫實習者的醫學。使用這種療法將使它成為可能, 在許多情況下, 繞過瓶頸在動物的治療養殖為食物。

Summary

This contribution provides an introduction to the isopathic-homœopathic treatment of bovine mastitis. The treatment is based on the work of Enderlein, who sees endobionts and disturbances in the acid-base balance as causative of acute and chronic infections. As well as isopathic remedies, haptene preparations, immunomodulators and medicines to improve cell respiration are also presented as features of this regulatory treatment. In cases of mastitis, one pre-condition of successful treatment is that disturbing factors such as faulty milking technique or inadequate care conditions are largely reduced.

••••••••••••••••••

Cases of bovine mastitis may be divided ætiologically into two groups: contagious and constitutional (6). According to the progress of the condition and the clinical appearance, they are further classified into peracute, acute, chronic or sub-clinical mastitis, the first being usually fatal and the last two generally only being recognised when the cell content of the milk is tested.

Sub-clinical cases of bovine mastitis in particular are responsible for immense losses in the order of about DM 2 billion annually (3), about 70% of which is attributable to a loss of milk production. Sub-clinical mastitis may be a consequence of partially cured acute mastitis, or it may occur as a precursor of the acute form. The exciting microbes which are mainly isolated are Staphylococcus aureus and “environmental germs”.

With structural changes in modern milk production, the spectrum of causative agents of bovine mastitis has shifted from the classical causes of contagious mastitis, such as Streptococcus agalactiae, Streptococcus dysgalactiae, Staphylococcus aureus and streptococci of serogroups G and L, towards the causes of constitutional mastitis (the “environmental germs”) such as Streptococcus uberis, Escherichia coli and the coliform bacteria.

Infected lactiferous glands are reservoirs of classic mastitis-exciting organisms. Transmission of bacteria may take place during milking time, with faulty milking technique being a decisive factor. “Environmental germs”, on the other hand, are mainly transmitted between milking times, their transmission being favoured by shortcomings in care conditions, (such as shed climate, straw, injuries to the teats, milking regime).

Conditions of milk production these days mean that mastitis is almost always a problem of stock. Other exciting causes, such as fungi, yeasts or algæ occur only sporadically or within endemic boundaries.

In high-performance cows the occurrence of mastitis may be favoured by errors in feeding, which may result in an interlocking chain reaction leading to metabolic disturbances (3). As a part of these disturbances, changes of milieu take place in the tissues, which may favour the proliferation of pathogenic micro-organisms. Changes of milieu are characterised chiefly by a depression of the pH and the redox potential [rH2]. Amongst others, one consequence of such a change is that Staphylococcus aureus, which is pathogenic in the udders, is phagocytized by the action of neutrophil granulocytes; however for the most part the bacteria are not killed, but remain alive within the phagocytes (2,7). The particular enzymatic provision of Staph. aureus enables it moreover to migrate deep into the tissue of the udder, where medication can only reach it with difficulty. Thus it is extremely important, in cases of chronic Staph. aureus infection, to give an additional isopathic-homœopathic treatment at the end of lactation, or soon after. At this stage, with the involution of the glands, the glandular tissue is largely dismantled, resulting in exposure of the staphylococci and rendering them more susceptible to medication.

In the prevention and treatment of mastitis, “environmental germs” are more difficult to get at than are the classic exciting micro-organisms. Therefore it is necessary to develop procedures which will enable mastitis to be more effectively controlled. Here the use of isopathic-homœopathic remedies has the advantage of employing a treatment principle which is also part of the physiological process for regulating inflammations.

Isopathic-Homœopathic Remedies

The following remedies are available for the tried-and-tested isopathic-homœopathic regulatory treatment of bovine mastitis. In using these remedies no waiting time is required.

Isopathic Remedies

Isopathic treatment goes back to the work of the German, Prof. Dr. Günther Enderlein. Most of his work was already published soon after the first world war.

For millions of years colloids of the strains of fungi Mucor racemosus Fresen and Aspergillus niger van Tieghem have inhabited the bodies of human beings and all mammals. These fungal strains represent the transition to higher forms, and their developmental processes in humans and animals were observed and described by Prof. Enderlein (5). In a healthy organism they occur as primitive forms, having an important regulative role to play in the metabolism. “Endobiont” was the name that Prof. Enderlein gave to these micro-organisms which penetrated the whole mammalian order millions of years ago.

The Endobiont’s course of development has its origin in the most primitive form: the colloidal stage. Colloids are the minutest particles of albumen. Having passed through various intermediate stages as they grow, they may then enter the bacterial stage. Within this cycle of development they pass through numerous further stages, which can lead to an extremely wide variety of chronic diseases. The final stage of this cycle is the fungal stage. However, this can only be observed within the living organism in the terminal stage. Thus the Endobiont passes through three basic developmental stages: colloid - bacterium - fungus. Up to this point, these had always been regarded as independent, immutable organisms. Prof. Enderlein demonstrated this developmental process and explained that, taken together, all these stages make up one single common cycle, whose conclusion depends on the completely identical, inarticulate, colloidal and inert albumen which is contained within the relevant cells. These particles of albumen in the primitive stage are of the same order of size as bacteriophages and viruses (c. 0.01mm). Under certain conditions, shapes separate off from this mass, having come into existence under circumstances conducive to illness, and these continue to circulate in the cycle. They multiply and take on an infinitely large number of shapes and forms.

Various causes - infections, incorrect feeding and keeping conditions, environmental circumstances which are contrary to nature, manifestations of ageing, and so on, may - according to Enderlein - cause these primitive forms of life to evolve to higher stages, so that they become parasitic. On this subject, Enderlein wrote:

“As soon as the blood serum balance between mineral salts (bases, alkalis) and acids is deranged more towards the acid side for some time, as a result of wrong, non-biological nutrition, these endobionts begin an unbridled proliferation, and the elevation of these primitive little blobs to the parasitic stage is underway. Soon they will be a part of the great order of parasites. The higher an endobiont climbs up the evolutionary scale, the greater its potential to do damage becomes, and the greater the disturbance of the acid-alkaline balance; thus this disturbance forms part of a mutually intensifying and alternating relationship.”

What Enderlein wrote (5) applied to numerous different types of bacteria. In a similar way, primitive life forms which are present at the physiological level in the tissue of the udder may, if the surrounding milieu changes, develop into pathogenic forms of bacteria, causing additional damage to the host animal. The effects of these parasites may be determined in the blood, and probably also in the secretion of the udder, by means of dark-field microscopy.

However, such bacterial forms develop not only in the tissue of the udder, but also in other tissues of the body where, by means of various mechanisms, they can often be successfully repulsed. Compared with other tissues, the defensive power of the tissue in the udder is considerably weaker. Purely by reason of the blood-udder barrier, any humoral defense against bacteria is of a very limited nature. Thus, in cases of chronic mastitis, it often appears that a sick udder is found in an otherwise “healthy” organism.

In the course of over 40 years of intensive research, Prof. Enderlein succeeded in observing the changes in and development of parasites in their various guises and in their cycle. It was not until he was in a position to explain the basic principles of parasites from both a biological and a developmental angle that therapeutic measures for their regulation could be evolved. This led to Isotherapy, which states that the various more highly developed, pathogenic forms must be reduced back to their lower, non-pathogenic forms, which then leave the body via the normal eliminative channels.

This means that isopathic remedies are not directed against the illness and its symptoms, but that they support the body’s own regenerative ability, thus facilitating genuine healing processes. Isopathic treatment normalises the symbiotic balance of the endobiontic micro-organisms and their host.

This means that any isopathic-homœopathic treatment of bovine mastitis must be holistic, the remedies being administered by injection. A topical intramammary application is not indicated, nor is it necessary.

Isopathic therapy is a regulatory therapy (4). A healing of the sick cow and its sick udder can therefore only succeed if it is possible for the whole body to be regulated. Modern conditions of high performance make this harder and harder to guarantee; which means that additional disturbing factors must be eliminated as completely as possible. Thus, to ensure a successful treatment outcome it is indispensible in most cases to carry out an isopathic-homœopathic regulatory treatment of mastitis within the context of a constitutional treatment regime.

The following isopathic preparations are available for the treatment of bovine mastitis:

VETOKEHL® Muc 5X solution for injection (Mastavit Co., Hoya; active ingredient Mucor racemosus): for use in diseases of the vascular system, and generally in congestive conditions (e.g. swellings, œdema.)

VETOKEHL® Not 5X solution for injection (Mastavit Co., Hoya; active ingredient Penicillium notatum): this preparation contains no penicillin. It is suitable in all cases of bacterial (specifically staphylococcal and streptococcal) infections. In the isopathic sense, it deconstructs bacteria back to their non-pathogenic forms. N.B.: VETOKEHL Not must not be given at the same time as VETOKEHL Muc.

PEFRAKEHL® 6X solution for injection (Mastavit Co., Hoya; active ingredient Candida parapsilosis): this is used additionally with VETOKEHL Not in cases of bovine mastitis which are pyogenic or yeast-infected.

minibabyqq 2006-12-28 01:50 AM

轉貼自4682

[color=Magenta][size=5][b]飲食建議為狗 Diet Suggestion for DOGS   [/b][/size][/color]


毒物在寵物食品裡!
所有疾病的百分之90% 在動物中必須處理粗劣的飲食。



最宜的狗健康

尾隨飲食建議為最宜的健康和癒合(疾病的預防)

40% 未加工的肉

40% 煮熟的或未加工的被覆蓋樹根的Veggies

沒有五穀   (ie  米, 大麥, 加來飯食不會生產一隻健康寵物)



內容豐富的骨頭:  必須是未加工的!


避免 - 大骨髓類型骨頭- 磨損搪瓷。
雞翼太艱苦同化。

更大的狗唯一- 使用羊羔小腿骨頭飼料未加工的雞脖子, 和雞屍體。

注: 為公牛狗、拳擊手和更小的狗大小
哺養所有未加工的內容豐富的骨頭(省去羊羔小腿內容豐富/骨頭指關節)

未加工的肉
切成小方塊的羊肉、Roo (澳大利亞肉), 小的相當數量魚, 有機雞, 和大量未加工的雞脖子或roo 尾巴為狗。

(沒有牛肉或豬肉)

並且哺養一些桌scraps.(preferably 不剁碎的肉, 如同B 維生素得到毀壞在過程中, 哺養' 煮熟的' 肉毀壞消化酵素使適當的消化非常困難)

* 每月一次哺養器官肉   即未加工的肝臟- 是高度滋補的

在星期過程中, 可能哺養自然酸奶乾酪、自然酸奶(特別是如果寵物是在化工抗生素), 山羊的牛奶, 煮熟的蛋或如果未加工的蛋黃唯一。如果您的貓或狗吃草, 然後加一些新鮮的切好的紫花苜蓿新芽在每日飯食。
這有協助消化的自然酵素。

為協助與更舊的寵物或胰腺炎狗和貓和其它消化混亂。

為狗給1 capful 草本爪子爪子萃取物在每日飯食。為貓加蓋帽的1/4 在每日膳食

避免所有其它果子 如果狗遭受胰腺炎混亂。

Veggies: 如果烹調最好使用-

南瓜並且/或者南瓜很好被搗碎。
如果未煮過被覆蓋樹根在攪拌器唯一夏南瓜, 和化工免費紅蘿蔔。

給自然酸奶或山羊牛奶或酪乳  
(沒有牛奶或被處理的乳酪)







共同的變態反應原使寵物避免

(特別是奪取動物、變態反應原自由飲食和化學製品使和強調自由生活方式服麻醉劑, 將產生在停止上奪取的巨大的變化所有together)   
牛肉、紅蘿蔔(非有機), 玉米、金槍魚、魚、魚油、火雞、pork/ham 、牛奶、接種、辣食物、酵母、麥子, 任何麥子或酵母食物包含。
  所有 貓和狗  - 商業rolls/tin 食物& 餅乾(所有是垃圾食物, 和包含, 糖、鹽、玉米, 麥子等) 。  例子: 釀酒者酵母, 麵團, 所有狗餅乾。





其它較不可能的變態反應原也許包括... 豌豆、豆、米、堅果、貝類、巧克力、被滾動的燕麥、柑桔像... 葡萄, 菠蘿、蕃茄、圓白菜、唐萵苣、硬花甘藍、花椰菜、蘑菇和香料, carrots(if 不有機增長)






營養飲食被建議



能給您的狗各種各樣的營養素通過菜, 結合幾不同的型當 準備他們, 雖然 多數狗 是愉快以 一兩型唯一。





重要:  Veggies 哺養對狗無法劃分纖維素
(細胞壁在菜) 。

如此, 如果哺養狗veggies 沒有juicing, 成漿狀或蒸他們, 您的狗適當地不得到充分的好處和無法使用任何營養素在他們。


菜 - 蘆筍、豆(串), 甜菜, Bok Choy, 布魯塞爾, 新芽, Carrots(organic 唯一), 蒲公英綠色, 茴香, 無頭甘藍, 荷蘭芹, 歐洲防風草, 南瓜, 甜胡椒, 南瓜, 海草, 菠菜,  南瓜, 白蘿蔔, 薯類。



(避免 - 土豆、蔥、米、淡黃葡萄乾、gapes 和所有柑橘食物)



果子 - 蘋果, 藍色莓果, 瓜, 桃子, 李子, 鮞梨避免柑桔。





注: 如果您寵愛有皮膚過敏, 奪取, 檢查食物過敏名單上面避免在飲食。    是高的在乙二酸酯裡菜的結束消耗量也許干涉鈣吸收和十字花科的菜與甲狀腺起作用。適當地菜和果子為您的狗做準備的吸收營養他們必須被投入通過食品加工器或被覆蓋樹根或非常精巧被磨碎在最後一招。





每週食物。

可能給軟的煮熟的蛋, (如果未加工的蛋, 授予卵黃質唯一) 簡單的酸奶乾酪, 山羊擠奶,  自然酸奶, 可能給 多次每星期, 在飯食或早晨飯食之間等。   

                        



維生素和礦物補充   

   

從健康商店- (海藻類型) 小球藻食物補充粉末   

                   或     


Spirulina 粉末和根本脂肪酸的  購買(玫瑰花品牌) Ω上油混合物與Vit E 。   


                      或   



做您自己- EFA'S (根本脂肪酸)  狗油混合使用1 3/4

杯子有機紅花 油. 杯子鱈魚肝臟油 混合了在一個棕色500ml 瓶與螺絲 蓋帽。





然後增加Vit E 100IU oil/cap (與自然保存) - 混合在空氣緊的黑暗的瓶子, 和保留在冰箱。



在  每日劑量之下由Dog 的Weight  油和粉末如果買從健康商店。   


(貓的唯一的需要每少量補充或Vit C 在飯食和. 對被搗碎的南瓜1 tsp 。  





貓的真實的 食肉動物, 不需要更多牛磺酸(肉) 在飲食。)



2   到    8  公斤     =       1/8  茶匙粉末      &    1   茶匙   油混合

8   到   14 公斤    =        1/4  茶匙粉末      &     2 個   茶匙   油混合

15  到   24 公斤    =        1/2  茶匙粉末     &    . 大湯匙油混合

25  到   36 公斤    =        1     茶匙粉末     &    1 把  大湯匙油混合



注:    雙重被推薦的營養藥量- 病或更舊的狗
(經過7 年紀)







飲用水 和牛奶



所有被馴化的動物比牛奶應該 是授予被過濾的水唯一(同一樣什麼   我們喝) 自來水有許多種化學製品在他們, 那影響t 被同化沒有導致寬鬆凳子。  避免商業寵物擠奶。他動物作為毒素。    山羊牛奶是是更好的最佳的自然鈣提供者



' 某一' 狗一些特別需要養殖 德國Shepards, 拉布拉多, 獵犬, 拳擊手, 公牛狗, 新Foundlands 並且許多工作和成群狗要求是更多酸根據的飲食。  如果您有這些養殖的當中一個或橫渡的養殖, 那麼增加氨基酸複雜片劑(被擊碎) 來早晨膳食。  需要的一個徵兆對這調整的是有dark-brown 染黑放電在他的耳朵、膀胱炎或泌尿膀胱傳染、惡劣的染色、頭髮外套和皮膚爆發和他的尿裡鹼性讀書的狗。  


任意建議買從化學家酸鹼度試驗片, 如果您想要測試您的狗的尿。做這件第一件事早晨。它應該讀在6.2 到6.5 之間。如果這是數字大於7, 每日確定地然後增加氨基酸複雜片劑。   


我們有是Metagenics 品牌, 包含 許多補充包括B 複合體的整體範圍並且氨基酸補充所有在一個的巨大成功與階B 片劑。  


Dalmatians, 西部 高地 白色狗 和一些Belington 狗代表一個特別挑戰。  



從這養殖狗無法應付氮氣廢物與相關金額上限動物蛋白質在他們的飲食, 或無法從是存在在罐子食物, 自來水, 藥物裡的他們的系統消滅一些金屬。這些養殖不容忍有高氮氣廢物的牛肉產品: 如此, 您需要轉動有低氮氣廢物譬如雞、魚、酸奶、酸奶乾酪, 和蛋的動物蛋白質(卵黃質唯一) 。   





由增加氨基酸複雜片劑在他們的早晨飯食, 和B 複雜片劑(被擊碎) 上午和pm 飯食, 加上. 茶匙酯類C 粉末  或  鈣Ascorbate 粉末1 tspn, 因此他們可能運用蛋白質。

退化疾病的最宜的預防喜歡癌症, 關節炎, 脊髓myelopathy。   




避免所有化工藥物和食物。  

疫苗嚴厲地將耗盡維生素C 動物, 這就是為什麼許多動物有慢性疾病, 它只採取一疫苗並且這可能然後是decline 下來小山從他們。  

維生素C 作為自然抗組胺並且抗氧劑為維護身體好這就是為什麼它是很重要用Vit C 補充寵物的飲食日報。    更大藥量, 較少被吸收。




所以更小, 更加頻繁的藥量會是有利(. -1/2 Med 大小狗) . 茶匙 酯類C 粉末 每日在飯食(Vit C)








消化植物群 酵素和 恢復 在食道



有過去或現在化工抗生素的病殘或狗, 將需要這個慣例。  恢復 將援助在更好的食道植物群吸收營養他們的食物和營養。  眾多的大學研究表示 , 任一類型退化疾病和巨蟹星座與酵素缺乏  特別是連接了。



消化援助和Probiotics 植物群恢復是需要的。







乾燥片狀' & ' 痒的皮膚"

經常表明飲食缺乏在脂肪酸、Vit E & 卵磷脂裡。

例子  為一條中等大小狗: 向日葵油(1 到2) dessertspoon 對主要飯食每日。
增加自然Vit E 15000IU 在飲食週刊裡。1 把大湯匙卵磷脂五穀每日, 鱈魚肝臟油1 dessertspoon 對主要飯食3 x 倍每週刊  









強的皮膚氣味/氣味



通常被表明的酵母皮膚傳染。  漂洗皮膚日報以一些輕微地被稀釋的膠質銀和這的幾下落以萍果汁醋和Thuja 母親酊被稀釋在耳道裡為酵母耳朵傳染。   如果非常少量變化在皮膚, 我們然後發現了反寄生生物和黴菌草本母親酊的組合被稀釋在一些水中和被使用噴洒在皮膚做把戲。

* 標誌的有過敏反應對防腐劑/chemicals/ 酵母/麥子產品是:  咬住在腳趾, 過份抓, 紅色皮膚, 強的皮膚氣味, 流動的眼睛, lethargic, 愚鈍的看的毛皮, 熱點





蚤問題

最有效的解答我們發現了幾年協助寵物所有者以蚤大批出沒是由洒硼砂 粉末的 (從超級市場) 在地毯, 蓆子, 然後吸塵之後(這趕走蚤蛋週期大批出沒)



洒您的狗或貓  坐  或放置的外部。

做這兩三次在夏天之前當蚤蛋是孵化和跳躍在您的寵物從地毯或沙子外面。   



The Poisons in Pet Food!
90% percent of all disease in animals has to do with a poor diet.



Optimum Dog Health

Dog diet Suggestions for Optimum Health and Healing (prevention of diseases)

40% Raw Meat

40% Cooked or raw mulched Veggies

NO GRAINS   (ie  rice, barley, added to meals will not produce a healthy pet)



MEATY BONES :  Must be Raw!


AVOID - the large marrow type bones – wears enamel down.
Chicken wings too hard to assimilate.

Larger dogs only - Use Lamb Shank bones. feed Raw chicken necks, and chicken carcasses.

NOTE: FOR bull terriers, boxers and smaller DOG size
Feed all raw meaty bones (omitting the lamb shank meaty / bones/ KNUCKLES)

RAW MEAT
Diced mutton, Roo (aussie meat), a little amount of fish, organic chicken, and plenty of raw chicken necks or roo tails for the dogs.

(no beef or pork meat)

Also feed some table scraps.(preferably not minced meat, as B vitamins get destroyed in the process, feeding 'cooked' meat destroy digestive enzymes making proper digestion very difficult)

* Once a month feed organ meat   Eg. Raw Liver - is highly nutritious

Throughout the week, can feed natural cottage cheese, natural yogurt (especially if pet has been on chemical antibiotics), goat's milk, cooked egg OR if raw egg yolk only. If your cat or dog eats grass, then add some fresh chopped Alfalfa sprouts in daily meals.
This has a natural enzyme that assists in digestion.

For assistance with older pets or Pancreatitis dogs and cats and other digestive disorders.

For dogs Give 1 capful of Herbal Paw Paw Extract in daily meals . For cats add 1/4 of the cap in daily meal

Avoid all other fruits if dog suffers from pancreatitis disorders.

Veggies: If Cooked Best to use -

Pumpkin and/or squash well mashed.
If Uncooked mulched in blender only- zucchini, and chemically free Carrots.

Give Natural Yogurt or goats milk or buttermilk  
(no cows milk or processed cheese)







Common ALLERGENS for PETS to AVOID

(especially seizure animals, allergen free diet and chemical drug and stress free lifestyle, will make a huge difference in stopping seizures all together)   
Beef, Carrot (non organic), corn, tuna, fish, fish oils, turkey, pork/ham, cows milk, vaccinations, spicy foods, yeast, wheat, any wheat or yeast food containing.
  ALL cat and dog  - commercial rolls/tin foods & biscuits (all are junk foods, and contain, sugars, salt, corn, wheat etc).  Example: Brewers yeast, pasta, all dog biscuits.





Other less likely Allergens MAY include... peas, beans, rice, nuts, shellfish, chocolate, rolled oats, citrus fruits like … grapes, pineapple, tomatoes, cabbage, chard, broccoli, cauliflower, mushrooms and spices, carrots(if not organically grown)






NUTRITIONAL DIET SUGGESTED



Can give your dog a variety of nutrients through vegetables, combine several different types when preparing them, although most dogs are happy with one or two types only.





IMPORTANT:  Veggies feed to Dogs are unable to break down cellulose
(the cell wall in vegetables).

So, if feeding a dog veggies without juicing, pulping or steaming them, your dog is properly not getting the full benefit and unable to use any of the nutrients in them.


Vegetables - Asparagus, Beans (string), Beets, Bok Choy, Brussels, Sprouts, Carrots(organic ONLY), Dandelion greens, Fennel, Kale, Parsley, Parsnips, Pumpkin, Sweet Peppers, Pumpkin, Seaweed, Spinach,  Squash, Turnip, Yams.



(Avoid – potatoes, onions, rice, sultanas, gapes and any citrus foods)



Fruits – Apples, blue berries, melons, peaches, plums, avocado– avoid citrus fruits.





NOTE: if you pet has skin >><< vegetables that are high in oxalates may interfere with calcium absorption and cruciferous vegetables with thyroid function. To properly prepare vegetables and fruit for your dog's to absorb the nutrition they must be put through a food processor or mulched or very finely grated at last resort.





Weekly foods.

Can give Soft cooked eggs, ( if Raw Egg, give yolk only) plain cottage cheese, goats milk,  natural yogurt, can give several times a week, in between meals or morning meals etc.   

                        



Vitamin and mineral Supplements   

   

From the Health store - (Algae type) Chlorella Food Supplement Powder   

                   OR     


Spirulina Powder and the Essential Fatty Acid’s  buy the (Melrose brand) Omega Oil mixture with Vit E.   


                      OR   



Make your own – EFA’S (Essential Fatty Acids)  DOG OIL MIX Using 1 3/4

cups of Organic Safflower Oil ¼ cup of Cod Liver Oil mixed in a brown 500ml bottle with screw cap.





Then add 100IU of Vit E oil/cap (with a natural preserve) - Mix in an air tight dark jar, and keep in fridge.



Below  DAILY DOSAGE by Dog’s Weight  of oils and powders if bought from health store.   


(Cat’s only need a pinch of supplements or Vit C in meals and ½ to 1 tsp of mashed pumpkin.  





Cat’s a true carnivores and do not need more taurine (meat) in diet.)



2   to    8  kg     =       1/8  teaspoon powder      &    1   teaspoon   Oil Mix

8   to   14 kg    =        1/4  teaspoon powder      &     2   teaspoon   Oil Mix

15  to   24 kg    =        1/2  teaspoons powder     &    ½ Tablespoon Oil Mix

25  to   36 kg    =        1     teaspoons powder     &    1  Tablespoon Oil Mix



NOTE:    DOUBLE the recommended nutritional Dose - SICK or OLDER DOGS
(over 7 yrs of age)







DRINKING WATER AND MILK



All domesticated animals should be give FILTERED WATER ONLY (same as what we drink)   Tap water has too many chemicals in them, that DO effect tassimilated than cows milk without causing loose stools.  Avoid the commercial pet milks.he animals as a toxin.    GOATS milk is the best natural calcium provider that is better



Some special needs of ‘certain’ Dog Breeds German Shepards, Labrador, Retrievers, Boxers, Bull Terriers, New Foundlands and many of the working and herding dogs require a diet that is more acid based.  If you have one of these breeds or crossed breeds, then add Amino Acid Complex tablets (crushed) to the morning meal.  One indication of a need for this adjustment is a dog that has dark-brown to black discharge in his ears, cystitis or urinary bladder infections, poor pigmentation, hair coat and skin eruptions and an alkaline reading of his urine.  


Optional suggestion to buy from chemist pH test strip, If you want to test your dog’s urine. Do this first thing in the morning. It should read between 6.2 to 6.5. If it is a number greater than 7, then definitely add the amino acid complex tablets daily.   


We have had great success with the Meta B tablets which is the Metagenics brand, containing many supplements including the whole range of B complex’s and amino acids supplement all in one.  


Dalmatians, West Highland White terriers and some Belington Terriers represent a special challenge.  



Since these breed dogs are unable to deal with the NITROGEN WASTE associated with high amounts of animal protein in their diets, or cannot eliminate some metals from their systems which are present in tin food, tap water, drugs. These breeds do not tolerate Beef products which have a high nitrogen waste: so, you need to rotate animal proteins that have a low nitrogen waste such as chicken, fish, yoghurt, cottage cheese, and egg (yolks only).   





By adding Amino Acid complex tablets in their morning meals, and B complex tablets (crushed) am and pm meals, plus ¼ teaspoon of Ester C powder  or  1 tspn of Calcium Ascorbate powder, so they can utilize the protein.

Optimum prevention of degenerative disease like cancer, arthritis, spinal myelopathy.   




Avoid all chemical drugs and foods.  

Vaccines will severely deplete animal of Vitamin C, this is why so many animals have chronic disease, it only takes one vaccine and then it can be a decline down hill from their.  

Vitamin C acts as a natural antihistamine and anti-oxidant for maintaining good health this is why it is so important to supplement a pet’s diet daily with Vit C.    The larger the dose, the less is absorbed.




Therefore smaller, more frequent doses would be beneficial. (¼ -1/2 Med size dog) ½ teaspoon of Ester C Powder DAILY in meals ( Vit C )








Digestive enzyme and Restore of Flora in gut



Sick or dogs that had past or present chemical antibiotics, will need this formula.  To restore gut flora which will aid in better absorb nutritional of their food and nutrition.  Numerous University studies has shown that any type of Degenerative Disease and Cancer in particular have been linked to  enzymes deficiencies.



Digestive Aid and Probiotics Flora restore IS needed.







Dry Flaky’ & ‘Itchy Skin”

Often indicates a diet lacking in Fatty Acids, Vit E & Lecithin.

Example  for a Medium Size Dog: Sunflower Oil (1 to 2 ) dessertspoon to main meals daily.
Add 15000IU of Natural Vit E in diet weekly. 1 tablespoon of Lecithin grains daily,1 dessertspoon of Cod Liver Oil to main meals 3 x times per weekly  









Strong skin odour / smell



Usually indicated yeast skin infection.  Rinse skin daily with some slightly diluted Colloidal Silver and several drops of this with cider vinegar and Thuja mother tincture diluted in ear canal for yeast ear infections.   If very little change in skin, we have then found a combination of anti-parasite and fungal herbal mother tinctures diluted in some water and used sprayed over the skin does the trick.

* Signs of having an allergy reaction to the preservatives /chemicals/ yeast / wheat products are:  Biting at toes, Excessive scratching, red skin, strong skin odour, runny eyes, lethargic, dull looking fur, hot spot





Flea Problem

The most effective solution we have found over the several years of assisting pet owners with flea infestations is by sprinkling Borax Powder (from supermarket) on Carpets, mats, then vacuum up afterwards (this rids flea egg cycle infestations)



Sprinkle outside where your dog OR  Cat  sits or lays.

Do this a couple of times just before summer when flea eggs are hatching and jumping on your pets from the carpet or sand outside.

minibabyqq 2006-12-28 01:51 AM

轉貼自4682

[color=Magenta][size=5][b]草本為動物(PAT 1 )   [/b][/size][/color]


我們高度推薦草藥以液體形式- 的或者(萃取物/酊/茶) 為快癒合。草本流體迅速審閱通過血液而不是消化系統/胃如果它是以粉末或片劑形式。

液體萃取物 或酊草本劑量為一般營養支持:

玩具狗貓:  3 - 5 下落混合了在飯食。  3 x 每日
Med 狗:  25 下落混合了在飯食  3 x 日報
Med/Lge 狗: 40 下落混合了在飯食3 x 日報
馬: 10 下落增加了來紅蘿蔔或食物   3 x 日報。

口頭從未給動物草本未稀釋。  必需總稀釋在一些食物和手飼料裡或混合與溜滑榆木粉末混合了在filtere 水和少許口頭然後指定的或在食物裡。

草本茶 不是有強作為草本萃取物或酊。  如此當您組成草本液體茶, 能一樣兩次增加來飯食被比較建議草本萃取物集中慣例。

草本膠囊或片劑 再較不有力, 和長期需要工作由於這樣的事實他們被消化通過胃和被吸收那樣。  為快速的醫治用的結果, 嘗試用液體草本或茶。

購買

100% 質量草本萃取物液體, 和homeopathic 補救, 最好被購買在櫃臺在a (人或動物) Naturopathic 診所或Homeopathic 診所, 全部醫生。


唯一草本

自然風濕甾酮和女性荷爾蒙。
歐亞甘草根, 使用它為調整母狗& 貓- 激素在spaying (明顯的標誌可能是, 掉頭發和皮膚過敏, 女性dribbling/wetting) 為低血糖症, 壞糖尿病, 腎上腺平衡, 便秘和小腸癒合以後, 為心臟和循環系統。歐亞甘草用在咳嗽慣例並且刺激消化酵素狗愛口味。

* 不要使用在一隻寵物以高血壓  (一些心臟病案件)

注: Hormone(deficent 問題) 有時在spaying 以後。

自然草本女性荷爾蒙是:
歐亞甘草根、東quai, 和狂放的薯類。
例如:  開始劑量治療與2/3 草本萃取物或酊下落寵物每日飯食, 逐漸增加在5 天的間隔時間直到無節制停止。保留在那藥量幾個星期, 逐漸然後減少, 如果症狀返回, 再開始。

增加1 個茶匙麥子毒菌油日報來飯食, 並且晚櫻草油是一臺好激素平衡器。切好的荷蘭芹幫助以完全地倒空膀胱。

_ (homeopathic Straphysagria 30C 是還高有用, 為癒合操作和還非常有效當行為問題是顯示還)

1 。植物組成部分傳統上被使用為慢性激動活抗發炎物產。很大數量的補救是有效的為小腸牆壁問題。

下列立刻是明顯的選擇在arthritic 、皮膚和其它慢性激動疾病:


萬壽菊(Calendula) 淋巴和減少炎症在喉頭和胃。
狂放的薯類(Dioscorea Villosa) 治痙攣和抗發炎在更低的食道牆壁上, 可能steroidal 作用系統地。
Meadowsweet (Filipendula ulmaria) 收斂劑在消化短文過程中。
(不是為貓)
巫婆榛樹(Hamamelis Virginiana) 收斂劑, 在消化短文過程中
狂放和羅馬Chamomiles (Matricaria recutita 和Chamaemelum nobile): 冷卻和減少激動損傷在上部消化短文。
月桂果(Myrica cerifera) 溫暖和收斂劑, 傳統上被使用在熱病管理與相關腹瀉和痢疾。
溜滑榆木(Ulmus fulva) 粘和癒合在上部消化短文, 最好被使用作為, 和準備對, 更寬的治療一早期。

2 。植物組成部分傳統上被使用為慢性激動疾病以荷爾蒙物產。
許多草本在豆甾醇和其它潛在地抗發炎phytosterols 上是濃; 一些並且有名譽在激素上平衡, 並且所有下面那些並且有傳統名譽在激動疾病的治療。

藍色cohosh 草本(Caulophyllum thalictroides)
黑cohosh 草本(Cimicifuga racemosa)
巴西人參草本(Pfaffia paniculata)
Sarsarparilla 草本(Smilax spp)

3 。植物組成部分傳統上被使用為慢性激動疾病以一般抗發炎物產。
傳統草本方法包括anti-inflammatories 在現代醫療感覺。這些補救比現代藥物然而較不強有力的和是最有用的作為附屬對治療措施被列出以上。

Feverfew (Tanacetum parthenium)
變成灰燼(fraxinus 細鉋花) 禁止T 細胞和前列腺素生物合成的適度抗發炎包含的coumarins 。
惡魔的爪(Harpagophytum procumbens)
鐵梨木(Guaiacum spp 。)
Bogbean (Menyanthes 三片葉)
普遍的bark(Populus spp)containing 水楊酸以建立的抗發炎物產。
楊柳吠聲(Salix spp) 水楊酸的原始的來源和以強的傳統名譽作為反風濕性。





                                                               草本

禁忌症候為抗發炎補救。
對抗發炎補救的用途是不適當的當有已經強的抗發炎常規療程的處方, 除非意圖將撤出常規療程。

A
Agrimony - 這棵植物是有用的在尿道傳染和活躍或hypermetabolic 肝臟裡和在化療或藥物剩餘。

距骨 - 作為一免疫系統建造者和strengthener, 這個草本是重新補充骨髓的深補劑。Anti-fungal/diuretic/expels toxins/pus/aids 腎上腺。最佳的知道的草本的當中一個用在中醫, 距骨加強消化和刺激免疫系統。它援助腎上腺封墊作用, 作為利尿和並且膨脹血管。用途- 距骨可能被使用促進免疫系統在頻繁地遭受傳染譬如colds 的人。它可能被使用在康復和並且援助在癌症治療和補救從化療。
小心距骨不應該被使用在深刻傳染或熱病案件。

山金車 (山金車蒙大拿) - 至於外在使用唯一(完整的皮膚) 脹大, 痛苦和挫傷, 幫助以neuromuscular 口氣和在關節炎。亦稱山煙草, 山金車是一個知名的草本和homeopathic 補救。它有抗發炎和痛苦殺害物產當外在地使用。用途- 山金車被使用對待挫傷、扭傷和脹大。
小心: 山金車不應該內部被使用, 除非醫學是以商業準備的形式。它不應該被使用在開放創傷

紫花苜蓿 - 。腎臟補劑。紫花苜蓿有強有力的名譽作為醫治草本。它是健康的並且綠葉素、beta 胡蘿蔔素、鈣, 和維生素D 、E 和K. Alfalfa 的滋補來源有瀉藥, 利尿和防腐作用。它並且有名譽作為detoxifier, 能改進肝功能和洗滌血液。用途- 紫花苜蓿也許是有用的在尿道傳染的治療, 和腎臟、膀胱和攝護腺混亂。它經常也被推薦為骨頭和聯合混亂、消化問題、皮膚混亂和潰瘍。

小心任何人與疾病系統lupus erythematosus (SLE) 應該避免紫花苜蓿產品
援助在醫治用的過敏、關節炎、孕婦晨吐、peptic 潰瘍、胃病& 口臭裡: 洗滌腎臟& 從身體取消毒物; 中立化酸; 是一種優秀血液淨化器& 血液稀釋劑; 改進胃口和援助在蛋白質、鈣& 其它營養素的吸收。
我並且喜歡使用紫花苜蓿酊液體, 當動物感到非常不適, 並且不吃- 每日給2/3 下落在寵物裡面嘴2/3 次直到改善, 然後減少數額。
貓: 1/2 茶匙切好的紫花苜蓿新芽& 混合入飯食。- 並且停止他們從要對吃草從後院
狗: 2 茶匙新鮮的切好的紫花苜蓿新芽以每日膳食作為自然酵素為好消化。

蘆薈維拉 - 增長在大多世界的更加溫暖的地區過程中。它醫藥上被使用了為數以萬計幾年和有抗病毒, 抗菌, 抗發炎, moisturising 的和創傷醫治用的作用。它並且刺激免疫。採取內部, 它安慰食道激怒, 助手癒合和是通便的。用途- 當適用於皮膚蘆薈維拉被使用對待燒傷、較小皮膚過敏和創傷。它內部使用治療便秘、peptic 潰瘍、糖尿病、哮喘和病毒傳染。
小心: 防腐劑是毒性的對貓的肝臟。  使用粉末膠囊為CATs. 。

哮喘雜草 (Chamaesyce hirta) 哮喘雜草行動在肺的支氣管, 導致他們放鬆和使它更加容易呼吸。用途- 照原樣命名建議, 哮喘雜草被使用對待哮喘。它可能並且使用對待乾草熱病和上部呼吸道粘膜炎。


B

保祐的薊 (Cnicus Benedictus)
血液淨化器- 一般補劑- 肝臟- 肺- 腎臟- 心臟- 腫瘤。

我使用這草本酊與兩三其他的組合對待癌症。口頭腫瘤在狗和貓收縮了和完全地消失了在4 個到5 個月草本治療以後用這個草本與其他人一道增加來每日飯食。
成功報告  與狗被診斷以收縮了當在保祐的薊加蓋和自然飲食的腦瘤。治療需要了5 個月。例如: small/med 大小狗- 第一月授予1 粒粉末從蓋帽(上午& pm) 在食物裡或更好地在簡單的酸奶裡或山羊擠奶, 那麼第2 和第3 月授予1 蓋帽(pm) 基於第4 個月。第5 個月1 蓋帽每日。

保祐的薊酊說有大國在血液的洗淨和循環。它加強所有身體, 比如腦子, 心臟、胃、肝臟、肺和腎臟的主要成員; 這並且是防腐劑反對疾病。保祐的薊是還有利的為那些遭受肝臟的肝炎、肝臟的炎症, 或肝病, 和並且被推薦為動物暴露於吸煙者在家庭和其它汙染物在workplace/environment. 。

小心: 不被使用與潰瘍在胃裡或懷孕動物或人。

Burdock 根 -(Arctium lappa) 耕種作為食物在日本, burdock 被重視作為血液淨化器和清潔劑。它刺激消化汁液的分泌物, 特別是膽汁。用途- Burdock 使用對待皮膚條件譬如psoriasis 、煮沸、粉刺和eczema 。它並且使用對待關節炎。

Bacopa - 消沉, 故障, 神經,

Baptisia - 有血液洗滌的物產為能使腐敗的情況和退化疾病, 它將刺激廢鑄品產品和多孔的修理新陳代謝。
用途以關心
亦稱: 狂放的靛藍~ 靛藍笤帚~ Baptisia ~ 馬蠅威德~ 靛藍雜草~ Rattlebush ~ 黑色根~ 假的靛藍~ Baptisia tinctoria
抗菌, 抗菌, 退燒藥, 防腐, 收斂性, 淨化, 催吐, emmenagogue, immunostimulant, 通便, cardioactive, 淨化, 補劑

伏牛花- 好為慢吞吞的肝臟、膽結石、herpes 、潰瘍和黃疸, 它將降低熱病、炎症和血壓、行動作為小腸strengthener 和瀉藥。

Buchu - (Barosma betulina) 作為一種泌尿殺菌劑, 它是有用的在慢性膀胱炎或尿道炎在一個酸環境裡, 由於冒號細菌入侵。Buchu 是一個小灌木當地人對它經常被使用作為一個調味的代理和作為醫學的南非。它有防腐和利尿物產, 和作為腎臟補劑。用途Buchu 被用於對待血液在尿、膀胱傳染和其它慢性尿道混亂。它並且說是對腎結石、攝護腺混亂、膀胱炎, 和風濕病的一個有效的補救。
Buchu 應該當心以謹慎地腎臟疾病案件。

蜂花粉 - 從古老希臘, 蜂花粉被使用增加stamina 和耐力在人之中。這整體食物是一個富有的蛋白質來源和碳水化合物, 一位強的免疫系統建造者, 速度癒合和是消化援助。蜂產品並且被使用當止痛藥, 減少過敏和防止癌症。

黑Cohosh - 作為治痙攣, 這在卵巢神經痛甲狀腺平衡器, 雌激素有效。激素平衡的物產。鼓勵雌激素生產。如果寵物疏鬆一些頭髮, 在是以後spayed

黑核桃船身 (毒性對馬)
逐出寄生生物, 柔和的瀉藥, 高在鎂裡。為小腸植物群不平衡狀態, 它口氣GI 短文。作為殺真菌劑, 它也許幫助在酵母傳染。成功地被使用對待HEARTWORM 正面狗, 測試滴定量完成3 個月和提出了陰性對Heartworm 。既使當狩醫說一條狗最壞他看見了。許多動物carers 用這個草本作為自然Heartworm 預防。即。1 支吸管充分每日在飯食。或1 (powder)capsule 每日在飯食。狗以長的外套或睡眠戶內因為夜不會需要保護, 但是好給3 x 週刊如果需要做如此在高季節區域。

越桔萃取物 (Vaccinium myrtillus).Bilberry 萃取物應該幫助防止或對待易碎的血絲。血絲脆弱可能導致流體或血液漏入組織, 導致出血、衝程、心臟病發作, 或盲目性。較不嚴肅的作用包括一個傾向容易地挫傷, varicose 靜脈, 粗劣的夜視, 寒冷, 麻木, 和腿抽瘋。越桔萃取物也許保護血絲和其它小血管由增加紅血球膜的靈活性。
這次行動允許血絲舒展, 增長的血流, 並且紅血球可能扭屈入緩和他們的方式通過狹窄的血絲的形狀。歐洲臨床試驗顯示了越桔萃取物的有效率為更低的肢體的多血脈性的不足18 對75 歲的主題(Corsi 1987 年; Guerrini, 1987) 。它使用對待varicose 靜脈在腿, 它極大改進varicose 綜合症狀症狀譬如抽瘋、沈重、小牛和腳腕膨脹, 並且麻木(Gatta 1982) 。這些試驗沒有顯露重大副作用, 在百分之50 在正常藥量。在二次臨床試驗, 一種規範化的越桔萃取物被給了115 名婦女以多血脈性的不足和hemorrhoids 跟隨懷孕。兩項研究提供了症狀的改善, 包括痛苦, 燒, 和瘙痒, 消失在許多情況下(Baisi 1987 年; Teglio 等, 1987) 。

藍色紫羅蘭 - detox, 腫瘤, 稀少使用得- 能是太進取的在刺激為淋巴瘤在人, 但狗處理它一點更好。
藍色紫羅蘭色葉子- 被使用與紅色三葉草作為Detoxifier 和血液清潔劑。一種草本清潔劑為有毒性反應對每年接種的寵物。
即皮膚問題, 腫瘤, 行為reaction/aggravations, lethargic, 嘔吐, 胃口發抖, 損失和熱病。
* 使用它為巨蟹星座、腫瘤(外在/內部或口頭), 囊腫、煮沸和膿腫、皮膚癌, 和慢性癩。
* 高度推薦為有慢性或深刻皮膚或消化或呼吸問題的任一個動物並且年年被接種了。

如果寵物從未是井從最後疫苗, 或有痒的皮膚- 使用疫苗Detox 下落

藍色旗子 (虹膜versicolor) - 同義詞藍色旗子。毒物旗子。旗子百合。肝臟百合。蛇百合。龍花。匕首花。水旗子。

稱肝臟淋巴, 它得到自然油對皮膚和是好混雜用其它草本為血液毒力; 強有力的肝臟興奮劑; 它將增加複雜食物的新陳代謝和吸收為短少身體類型。它首要被使用為它供選擇的物產, 是一有用的purgative 在肝臟的混亂和十二指腸, 和是許多化合物成份為淨化血液。它作為興奮劑對肝臟和小腸封墊和被使用在便秘和悲觀, 和由一些應該是一種肝興奮劑其次只對它也許惹起可觀的噁心和嚴厲疲勞的podophyllin, 但如果給在充分的藥量。共同地增長作為一棵裝飾庭院植物, 藍色旗子有名譽作為毒素血液淨化器和清潔劑。
用途- 藍色旗子被使用對待皮膚怨言譬如psoriasis 和eczema, 可能通過它的對肝臟的作用。它是還有用的在頭疼和偏頭痛的治療與相關消化問題和低血糖。
警告根能導致噁心和嘔吐。小藥量應該被使用。

Boswella - 收縮被激起的組織, 關節炎炎症, 脊髓關節炎, hip 發育異常(maintance 劑量)

Bladderwack - 巨蟹星座, 腺不足幫助了, 增加腺acitivity 。

越桔 - 越桔(Vaccinium myrtillus) 越桔有用途的一個悠久的歷史, 作為食物和醫學, 但更新的興趣發了火花當第二次世界大戰飛行員注意他們的夜視改善了在他們吃了越桔之後。越桔加強血絲, 穩定膠原, 減少血液凝結, 降低血糖, 放鬆光滑的肌肉和幫助防止和治療潰瘍。它並且有抗氧化行動。
用途- 越桔用對待眼睛條件譬如大瀑布和macular 退化、血管問題譬如varicose 靜脈, 和潰瘍。


Baptisia (Baptissia tinctoria) (能使腐敗, 淋巴)

C

辣椒的果實 - 促進洗滌循環& 消化系統; 減少熱病, 淨化血液; 幫助防止肌肉疼痛、疲倦、皮膚傷疤、頭疼、風濕病、潰瘍& 疼痛喉頭; 幫助在調控您的血壓和脈搏率

Clivers (Galium aparine) 其它名字: Barweed, 蓬子菜, Catchweed, 鵝草, 夾子草, Hayruff, 樹籬burs, Scratchweed, 棍子。
Clivers 有時使用對待尿道傳染和皮膚混亂, 但它的有效率依然是被證明。其它unverified 用途包括潰瘍, 被傳染的封墊, 腎臟並且膀胱石頭、膀胱炎症, 困難的排尿, 脹大由於水保留, 和乳房lumps 。在亞洲醫學它被認為對胃通脹的一個補救, 血液在尿和其它泌尿問題, 和根深蒂固的皮膚傳染(carbuncles

卡宴 (辣椒的果實) 緊急狀態- 心臟病發作興奮劑壅塞- 卡宴胡椒1 個或2 個膠囊搽粉在喉頭下。為循環的改善。天氣非常熱的在口味, 那麼唯一非常少量需要。即。1 到2 下落口頭為寵物或增加下落來水為喝為人。

鵝腸菜 (繁縷屬媒介) 過敏, 胃口, 哮喘, 血液毒化, 煮沸, 支氣管炎, 癌症, 冒號問題, 洗滌, 便秘, 糖尿病, 乾草熱病, hemorrhoids, 炎症, 風濕病, 皮膚問題, 疼痛喉頭, 膨脹, 腫瘤, 潰瘍。
用途在痛苦轉移很多的風濕病; 並且它幫助控制飲食油脂新陳代謝。一堆共同的庭院雜草, 鵝腸菜是維生素和礦物濃草本。它是富有的在B 複雜維生素、鋼、銅、鈣和鋅裡。它可能外在地使用解除發痒, 和有創傷醫治用和鎮痛劑物產。
用途- 鵝腸菜通常被使用對待痒的皮膚問題譬如eczema 、psoriasis 、煮沸、創傷和挫傷

Calendula - (Calendula officinalis) 它有抗發炎, 抗菌, 殺真菌劑和創傷醫治用的物產當外在地使用。它被使用如同皮膚洗滌為快速癒合創傷、燒傷、昆蟲叮咬、皮膚損害、裁減和擦傷處。homeopaths 喜愛, 它被使用在壓縮和salves 如同一個非常有效的急救補救。在創傷和膿腫, 確定開頭完全地被清除和所有pus 被去除在應用salve 或壓縮之前- calendula 迅速地關閉皮膚並且毒素不應該保留在創傷裡面一旦皮膚是閉合的。Calendula 油被使用為耳朵傳染, 被傳染的肛門封墊衝擊(柔和地按摩封墊sacs, 軟化封墊, 和按柔和地發布流體。
稀釋10 下落入一杯水牌子好醫治用的化妝水為裁減和殘破的皮膚。
* Calendula 草本下落整潔的意志中止靈菌在一個開放創傷。- (為汽車傷害和事故- 內部出血, 用途homeopathy 補救, 具體地對haemorrhaging & 震動和挫傷)
注: 它蜇得很多當它是未稀釋的, 那麼唯一用途在緊急狀態。並且首先稀釋它不如此蜇。

Cascara Sagrada - 輕拍自然瀉藥為慢性便秘


Chapparal - 口氣肝臟和增量飲食油脂新陳代謝; 對待風濕病、惡性成長, 和輻射毒化; 拉扯重金屬在身體外面。援助在醫治用的皮膚傷疤、粉刺、關節炎& 過敏; 促進頭髮成長; 作為自然抗生素在身體之內沒有副作用。


玉米絲綢 - 被使用為痛苦的排尿安慰膜, 增加泌尿產品和稀釋固體廢料。

貓的爪 (Uncaria tomentosa) 免疫系統改進物, 它發現了用途在關節炎、癌症、過敏和系統假絲酵母、HIV 和愛滋病, 當減少化療的副作用; 並且增加循環和禁止匾和血塊的形成在腦子。心臟和動脈, 降低血壓和幫助以血栓形成; 抗氧化, 抗病毒和anti-tumor, 它幫助身體與傳染戰鬥更好。糖尿病, 呼吸& 循環。貓的爪由Peruvian Indians 使用對待大範圍衛生問題。它促進免疫和消化系統作用和有抗病毒和抗發炎作用。用途貓的爪被使用對待腸混亂譬如Crohn 的疾病, 和colitis 。它也許並且幫助對待關節炎和滑囊炎, 和支持化療患者。
小心貓的爪不應該被使用在懷孕期間。

雛菊 (Symphytum officinale) 被傷的和破碎的骨頭、扭傷和損壞的腱; 它將刺激呼吸器官和消滅咳出; 有用在關節炎、胃問題、潰瘍的扁桃腺、膿腫, 和創傷; 做優秀漱口為靈菌膠; 好為貧血症和腹瀉。以延長的用途, 它也許激怒肝臟。亦稱knitbone, 雛菊有好名譽作為創傷癒療者。它是安慰性, 醫治用和抗發炎的
用途- 雛菊用對待破裂、創傷、扭傷、psoriasis 和eczema 。它內部使用對待食道問題。這是婦女的所有癒療者為數以萬計幾年。由於這有效, 糧食與藥物管理局取締了它的銷售。您將需要生長您自己。
雛菊是一個美妙的草本, 內部用和加速外在地癒合挫傷、組織和韌帶淚花, 和打破的骨頭非聯合... 。。我們的狗的當中一個吃立刻植物每當他需要這個草本為安慰性的消化難受。
雛菊趕走細菌鏈球菌和葡萄球菌細菌, 癒合尿道傳染以血液在尿, 癒合肺和呼吸問題, 和並且癒合皮膚創傷, 叮咬和發痒(外在地) 。它是營養的, detoxifier, 血液清潔劑, infection/inflammation 戰鬥機。
* 能砍新鮮的葉子並且根作為一poultice, 為扭傷, 藤條, 走路疼痛, 骨頭破裂與馬。
雛菊並且是富有在維生素B12 裡因此哺養小極少數切好的葉子對需要採摘我的馬。

小心雛菊包含造成了肝臟損傷只如果給在巨大的 數額每日和長期的化合物。否則是非常安全和非常有效的為醫治用的動物和人。我們經常用雛菊在Homeopathic 公式化為小動物(Symphytum 30C) 為easer 應用作為無味的下落在頭或口頭。


Co 酵素10 - 心臟循環,  似貓的愛滋病。

卡宴胡椒 (辣椒的果實annuum) 一種基本成分在烹調, 卡宴是亦稱辣椒或辣椒。它包含有強有力的抗氧化作用的胡蘿蔔素分子。卡宴可能並且幫助消化, 改進循環和降低膽固醇和血液油脂水平。當申請典型地, 它作為止痛藥。
用途- 典型卡宴胡椒準備被使用解除痛苦在關節炎、頭疼和糖尿病神經病案件。
小心大劑量在一個空的胃可能導致食道激怒和最終潰瘍在易受影響的人民。

芹菜種子 (Apium graveolens) 知名的菜, 芹菜的狂放的版本有利尿和防腐作用。它解除光滑的肌肉痙孿和並且可以低血壓。
用途- 它使用治療關節炎和尿道傳染。
小心芹菜不應該由任何人使用在懷孕期間或以腎臟疾病。

Chamomile (Matricaria recutita) - 一般噁心、clingy 寵物、nervine (第10 根crania 神經) 並且所有分支。普遍的草本茶, chamomile 有許多有利作用。它是抗發炎的, 反過敏, 援助消化, 解除肌肉痙孿, 是弛緩劑和有創傷醫治用的作用。用途Chamomile 被用於對待許多條件包括哮喘、乾草熱病、竇炎、食道干擾、月經和menopausal 問題、緊張的緊張、失眠和緊張和消化頭疼。消化短文的一種優秀清潔劑& 調色劑; 援助在鎮定神經; 逐出蠕蟲& 寄生生物; 改進胃口& 幫助消滅頭屑。外在地它可能使用對待皮膚問題和結膜炎。
小心在罕見的案件, 那裡也許是過敏反應對chamomile

砍肉刀 (Galium aparine) 亦稱goosegrass 和catchweed 由於它稠黏的葉子, 砍肉刀長期被重視了作為補劑為淋巴系統。用途砍肉刀被使用對待皮膚混亂譬如psoriasis 、eczema 和粉刺。它是還有用的在對待脹大的封墊和泌尿石頭。

蔓越桔 (Vaccinium macrocarpon) A 普遍和可口汁液飲料, 蔓越桔並且有可貴的作用在泌尿系統。
用途- 蔓越桔用治療尿道傳染和作為一種長期預防措施為腎結石。

D

蒲公英 (Taraxacum officinale) 新鮮的全植物作為電解質平衡器, 這是我們最佳利尿的因為它不耗盡鉀在貓或狗, 它是好的為腎臟炎症。有血液洗滌的作用。  腎臟和肝臟補劑。一堆知名的庭院雜草, 蒲公英被重視作為一個草本補救。這是維生素和礦物的一個富有的來源, 包括鉀。根被使用改進消化當它刺激消化汁液流程, 包括膽汁從肝臟和膽囊。這可能有有利作用在許多情況。葉子有一個利尿作用。
用途- 蒲公英根被使用對待肝臟情況和改進肝功能。兩葉子和根可能被使用對待關節炎和皮膚情況。
優秀為貧血症因為它是高的在鋼裡、鈣和其它維生素和礦物。一非常好利尿。- 有用在腎臟和膀胱問題。
為一匹馬以膀胱傳染, 給至少五棵(三為小馬) 杯子切好的植物每天四到五天。

惡魔的爪 (Harpagophytum procumbens) - 一種好第一種方法為類風濕病和骨關節炎作為抗發炎和行動減少血液油脂、膽固醇和尿酸水平; 還好為痛風和腎上腺表皮問題。它有強的抗發炎和鎮痛藥物產。
用途- 惡魔的爪被使用對待關節炎、肝臟和膽囊怨言。非常有效為關節炎症狀並且肝臟和腎臟問題。

東Quai (當歸sinensis) - 再生激素平衡器。
東quai 有名譽因為對婦女的一個非常可貴的補救當它包含可能調控女性激素行動的化合物。東quai 降低血壓, 增加血流對腦子和其它身體部位, 和並且並且被顯示有溫和安靜和使解除作用痛苦。

minibabyqq 2006-12-28 01:52 AM

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[color=Magenta][size=5][b]草本為動物(PAT 2)   [/b][/size][/color]


Echinacea - (Echinacea angustifolia 、E. purpurea, E. pallida) 是草本抗生素在青黴素上的水平。這是傳染戰鬥機活躍反對strep 細菌(膿腫和煮沸), 血液清潔劑(血液毒化、蛇叮咬, 毒昆蟲), 和一種腺和淋巴系統清潔劑。使用它特別為呼吸作用傳染和任一種疾病在腰部之上。
使用它只當真正地需要, 和保留寵物或人對此為最大二個星期防止症狀返回。
貓: 增加3 下落來飯食2 x 日報。血液淨化器刺激白細胞計數在傳染範圍; 它的抗病毒, 抗菌, 和抗藥性物產刺激快的組織修理。好為colds 、流感、傳染和熱病抗藥性免疫strengthener 。由美洲印第安人高度重視, echinacea 現在被使用全世界。它刺激免疫系統, 幫助在組織癒合和有抗發炎, 抗病毒, 抗菌和抗癌作用。用途Echinacea 長期被使用治療傳染譬如colds 和流感。它是還有用的在援助創傷醫治用, 對待關節炎和緩和化療的副作用。



更舊的 (Sambucus nigra) Elderflowers 有利尿, 抗發炎和反catarrhal 行動。他們提高體溫, 導致冒汗是有用的在刺激免疫系統。吠聲和莓果有瀉藥, 利尿和抗發炎行動。用途長輩主要用途對待colds 、流感、乾燥咳嗽、竇炎和粘膜炎。

土木香 (Inula helenium) 土木香的拉丁名字來自Troy Helen 如同草本說反彈從她的淚花。它有抗菌, 抗病毒和殺真菌劑的作用。這是消化補劑, 袪痰劑, 和並且減少咳嗽由放鬆支氣管肌肉。用途土木香被使用對待慢性咳嗽、支氣管炎和哮喘。它可能並且被使用為食道問題。

小米草 (Euphrasia rostokoviana) - 有反catarrhal, 抗發炎和收斂性行動。這是主要草本為保護和維護眼睛的健康。作為內科為憲法傾向對眼睛弱點。
- 將去除由慢性結膜炎造成的囊腫。

F

茴香 (Foeniculum vulgare) - 鎮靜劑逐出逐出氣體, 胃抽瘋和小腸絞痛。它溫和地並且鎮定對咳嗽和colds 導致amenorrhea 。它將增加哺乳期在護理母親。當根被吃作為菜, 這是醫藥上被使用得的種子。茴香有抗發炎和利尿作用。它作為消化援助和並且增加牛奶流程在breastfeeding 婦女。
用途- 茴香可能用對待呼吸傳染和消化問題這樣作為氣體和通脹。它可能外在地使用作為gargle 和作為eyewash 治療眼睛傳染。

葫蘆巴 (Trigonella foenum-graecum) 抗發炎胃混亂。過敏, 貧血症, 支氣管炎, 挫傷, colitis, 冒號, 咳嗽, 糖尿病, 消化混亂, 熱病, 流感, 乾草熱病, 頭疼, 肺問題, 偏頭痛頭疼, 黏膜, 肺炎, 靜脈竇壅塞, 疼痛喉頭, 潰瘍, 水保留。它有袪痰劑, 潤藥, vulnerary, 抗發炎, 治痙攣, 和血液壓力降低的行動。
用途- 葫蘆巴被使用對待疼痛喉頭, 支氣管炎和改進消化。

migranes , 作為的Feverfew (Tanacetum parthenium) 治療一抗發炎和治痙攣由反對前列腺素行動。它也許並且幫助關節炎在深刻激動階段Feverfew, 向日葵家庭的成員, 被使用了醫藥上幾個世紀。它禁止促進炎症物質的製造。
用途- Feverfew 主要用途對待和防止偏頭痛攻擊。它並且使用對待頭疼和類風濕病的關節炎。
Feverfew 不應該當心在懷孕期間。

Figwort (Scrophularia nodosa)Figwort 被使用洗滌和淨化血液。用途Figwort 被使用對待癩譬如eczema 、粉刺和psoriasis 。

胡麻 (Linum usitatissimum) 高度重視了為它的纖維並且油, 胡麻耕種了為數以萬計幾年。亞麻籽是有利Ω3 脂肪酸的一個好來源和被證明將抑制腫瘤成長的油。

G

大蒜 -(Allium sativum) 行動在細菌、病毒和小腸寄生生物。醫藥上使用5000 年, 大蒜有許多很好被研究的作用。這是抗菌, 殺真菌劑, 抗病毒和抗發炎。它促進免疫作用, 幫助消化和並且被顯示有抗癌作用。大蒜並且減少膽固醇, 血壓, 血液凝結, 和極限對血液油脂的自由基損傷。用途除烹飪用途, 大蒜之外經常使用對待高的膽固醇和血壓。它並且使用對待傳染和消化和呼吸問題。是極端有效的在溶化的和洗滌的膽固醇裡從血液; 它刺激消化短文; 它殺害蠕蟲、寄生生物和有害的細菌; 它正常化血壓和減少熱病、氣體& 抽瘋; 它由運動員使用了為增加體力& 能量。我們發現了年邁的Kyolic 液體非常有效。
劑量: 擊碎新鮮的大蒜(1 個丁香唯一) 入(大對med 大小狗) 狗的每日飯食。

植物 (Gentiana lutea) A 知名的' 苦澀' 補劑, 植物被使用得幾個世紀改進消化。它刺激消化汁液流程包括唾液和膽汁, 並且幫助刺激食道運動。植物改進胃口。
用途- 植物被使用刺激消化活動每當這是必要的。它並且使用對待消化怨言譬如消化不良、胃炎、腹瀉、噁心和胃灼熱。

薑 (Zingiber officinale) 為小腸抽瘋和氣體, 消化不良; 將導致冒汗在乾燥熱病以冷顫。援助在戰鬥的colds 、colitis 、消化混亂、流感& 氣體裡。它幫助增量唾液的分泌物; 是優秀為循環系統和幫助增量stamina 。薑作為抗氧劑和有  抗菌, 抗發炎, 反凝結和痛苦殺害物產。對心臟的有利作用。薑有反潰瘍活動和改進肌肉的作用在食道當幫助解除痙孿。薑並且被重視為它溫暖的物產。
用途- 薑用對待暈動病, 噁心和嘔吐; 激動條件譬如關節炎; 並且改進消化。
小心大藥量在一個空的胃也許導致激怒並且以長期用途可以導致潰瘍。

銀杏Biloba - 抗氧劑, 腦子補劑, 循環。銀杏樹樹是世界的最舊的生存樹種類的唯一的倖存者。它有許多可貴的作用包括穩定的細胞膜, 減少自由基損傷, 改進血液循環和提高氧氣和葡萄糖用途。銀杏樹是特別有利的為腦子、神經和血管。
用途- 銀杏樹被使用對待老態龍鍾的條件, 包括Alzheimer 的疾病; 硬化動脈; 血栓形成、消沉, 和過敏。它並且被使用作為治療為氧氣剝奪。在年長人民, 銀杏樹改進了pain-free 步行距離由百分之30 到百分之100
(孵育1990) 。德國研究提供了好處長期銀杏樹用途
在減少心血管風險, 包括那些與冠狀交往
心臟病、高血壓、hypercholesterolemia, 和糖尿病mellitus
(Witte 等1992) 。由維護血流對視網膜, 銀杏樹
萃取物被禁止的惡化的視覺在年長的人。充分數額
萃取物可以扭轉損傷從視網膜的長的氧氣剝奪。


薑萃取物 防止腫瘤形成- 人和動物。
小心非常非常大藥量也許導致腹瀉和嘔吐。
人參(Panax 人參和Eleutherococcus senticosus)There 是幾類型人參, 最佳的已知的品種是韓國或中國人參(Panax 人參) 並且西伯利亞人參(Eleutherococcus senticosus) 。韓國人參認為是刺激比西伯利亞人參。兩類型人參有用途的一個悠久的歷史在中醫作為補劑。他們提高身體的能力應付重音, 改進能量新陳代謝, 更低的血糖, 助力免疫, 提高肝功能, 和調控細胞成長。
用途- anti-fatigue 和反注重兩類型物產人參被使用增加物理和精神表現在是debilitated 和遭受重音的人。韓國人參並且被使用對待糖尿病, 降低膽固醇, 提高再生系統作用, 對待menopausal 症狀, 改進免疫和防止癌症。西伯利亞人參經常被使用對待慢性疲勞綜合症狀, 與癌症化療和放射療法交戰的副作用, 和對待風濕性痛苦在年長的人。
小心人參應該由有深刻傳染、高血壓或憂慮的人避免。某些人民體驗副作用與人參。這些包括高血壓、神經質、失眠、皮膚問題和腹瀉。

金黃標尺 (Solidago virgaurea) 亦稱woundwort 和Aaron 的標尺, 金黃標尺有利尿, 抗發炎, 抗菌和收斂性行動。
用途- 金黃標尺被使用對待腎臟和泌尿傳染和石頭。它可能並且使用對待呼吸粘膜炎和關節炎.... 我們像採摘一片新鮮的葉子和擊碎加煮沸的水來它, 讓它浸泡5 分鐘那麼讓它冷卻種植大多這些草本在庭院裡, 一樣容易。給一個貓1/2 茶匙口頭或在食物2 x 日報。雙重數額為狗。

Goldenseal - Antibiotic/penicillin 。強有力的補劑對這些組織, 它也許緩和胃炎、潰瘍、colitis 和一些hayfever 症狀。Goldenseal 防止細菌附有細胞, 刺激免疫系統, 降低熱病, 和有抗癌作用。
用途- Goldenseal 使用對待激動消化條件譬如胃炎、peptic 潰瘍和colitis 。它是肝臟清潔劑和防腐的, 和被使用為內部出血和腸疾病(colitis 等) 。它降低血糖和是自然胰島素。它癒合黏膜和外在地被使用為皮膚癌。
* 使用goldenseal 作為不老長壽藥為寵物以癌症、似貓的白血病、似貓的感染腹膜炎, 和腫瘤。不要使用goldenseal 與hypoglycemic 動物或不要增加歐亞甘草根來goldenseal 為他們。嚴密監測糖尿病寵物。使用特別為所有傳染在腰部- 胃, 腸之下, 消化。* 並且用水稀釋和使用作為防腐劑為wounds/infections 激怒等。

Gotu 可拉樹 (Centella asiatica) - 作為一種大腦興奮劑, 它運載營養素為運輸對腦子和使神經系統的突觸充滿活力幫助以粗劣的記憶和慢吞吞的腦子活動, 與skullcap 和Oregan 葡萄結合因為它將改進皮膚質量和將鎮定中央神經系統。關節炎、在腎臟的神經系統、工作(yin) 並且年長的人。Gotu 可拉樹用了作為醫學為數以萬計幾年和有名譽作為一個anti-ageing 草本。它有創傷醫治用和鎮靜物產, 和並且改進精神作用。用途Gotu  可拉樹用對待創傷, 燒傷, cellulite,  
小心- Gotu 可拉樹是毒性的在休藥量。

石渣根 (Eupatorium purpureum) 亦稱kidneyweed, 石渣根有有利作用在腎臟和泌尿系統。
用途- 它使用對待腎臟和泌尿傳染和石頭、攝護腺炎症和痛風。

Grapeseed - 抗氧劑。葡萄種子萃取物PCO 並且被發現減少咳嗽, 喘息, 弱點, 黏液和復發的呼吸傳染。減慢癌細胞成長, 強有力的抗氧劑。其它抗氧化, 給一健康心血管。是Vit C 和50 次強比Vit E 在中立化的' 自由基"的20 時間更強。自由基損傷連接對60 種主要疾病。這是我們用的主要癌症草本的當中一個, 成功地!
逸事報告從人使用葡萄種子提取credit 它以幫助以下條件: 過敏; 關節炎; 哮喘; 封鎖的冠狀動脈; 粗劣的循環; 高的膽固醇; 糖尿病(胰島素依賴性); 腫鼓; 青光眼; 頭疼; hemorrhoids; 聯合炎症; 腿急拉在晚上; 擴大的攝護腺; 皮膚: 褐斑病, cellulite, eczema, 發痒, psoriasis, 下垂, 老外科傷痕, 蜘蛛靜脈。

Grindelia - 對肺和腎臟的補劑作用, 它刺激的行動使它有用作為袪痰劑提供賭氣粘膜炎。為尿道, 它是溫和地利尿的。
用途作為皮膚奶油作為它形成亮漆塗層在皮膚, 冷卻和防止傳播發痒。




H

山楂樹莓果- 心臟補劑肌肉口氣對心臟病行動, 作為心臟補劑好為心肌炎。這個草本可能加來每日飯食在長期。
當地人向歐洲, 山楂樹有名譽作為心臟補劑。山楂樹行動加強血液血絲和結締組織。山楂樹改進供血對心臟, 改進心肌收縮力量, 降低血壓和膽固醇, 和減少咽喉痛攻擊。
用途- 山楂樹被使用對待動脈粥樣硬化、高血壓、充血的心力衰竭, 和心率失常。

歐洲七葉樹 (Aesculus hippocastanum) 收斂性和補劑對循環系統, 它加強和口氣靜脈。
歐洲七葉樹是對加強靜脈的一個可貴的補救。它可能外在地和內部被使用。用途歐洲七葉樹用對待靜脈問題譬如varicose 靜脈、haemorrhoids 和thrombophlebitis 。
小心歐洲七葉樹不應該由那些使用以腎臟疾病。

蛇麻草 - (Humulus lupulus) 鎮靜劑, 奪取, 促進睡眠、控制神經質和緊張的胃問題。蛇麻草用釀造啤酒從羅馬時期。高度重視為他們的醫藥物產, 蛇麻草有鎮靜劑, 催眠劑, 利尿和抗菌作用。蛇麻草解除肌肉痙孿和並且行動改進消化。用途蛇麻草用對待失眠、不安定性和緊張的緊張。草本可能並且用對待急燥的腸綜合症狀、激動腸疾病和消化不良。
小心蛇麻草不應該用在消沉案件。

Horsetail (木賊屬植物arvense) - 利尿, 硅土, 哮喘和腎臟混亂, 加強組織。Horsetail 是a 衝像植物與空心被聯接的詞根。它是富有的在硅土和其它礦物裡和有利尿和醫治用的物產。它並且停止流血和口氣膀胱。Horsetail 也許並且促進癒合殘破的骨頭和結締組織。用途Horsetail 主要用途對待尿道和攝護腺混亂譬如膀胱炎、尿道炎、腎結石、前列腺炎和無節制。它也許並且是有用的在關節炎和骨頭疾病的治療。它可能外在地使用停止流血和癒合創傷。
Horsetail 建立免疫, 腺, 和神經系統, 加上皮膚、外套、牙, 和釘子。它幫助在逐出的parasites/worms 和是利尿的。

海索草 - 呼吸抗病毒和治痙攣為croupy 咳嗽、支氣管炎和哮喘; 將帶來在冒汗以乾性皮膚和熱病; 一放鬆的nervine 為petit mal 奪取和憂慮狀態。

J

杜松莓果 - 利尿, 和用為膀胱炎& 尿道炎。
杜松莓果*** 溫暖的茶每2 個小時, 在短時間內迅速趕走' 流感' 。

K

海帶 - 碘, 自然甲狀腺協助礦物為甲狀腺機能不足的寵物。1 個茶匙med 家每日飯食準備一的大小狗。

L

檸檬香脂 (蜜蜂花officinalis)This 根本富有油的草本有用途的一個悠久的歷史作為對神經質和消沉的一個補救。它有鎮靜劑, nervine, 治痙攣, anti-depressive, 發汗和抗菌作用。用途: 它使用治療憂慮、消沉、失眠、flatulence 、過敏、偏頭痛和病毒傳染譬如herpes 。

甘草精根 (廣泛被應用的草本的Glycyrrhiza glabra)One, 甘草精有一個重要地方在西部和東部草藥。它有荷爾蒙, 抗發炎, anti-allergic, 抗菌和抗病毒作用。甘草精並且被顯示刺激免疫系統。用途: 甘草精用對待激動和過敏情況、colds 、病毒傳染、肝炎、premenstrual 綜合症狀、Addison 的疾病、peptic 潰瘍和皮膚情況。
對甘草精的小心長期用途可能提高血壓。它不應該由任何人使用在懷孕期間或以高血壓、肝臟病或腎臟失敗。

甘草精根- detox 為liver/kidney, 刺激腎上腺封墊, 呼吸, 支氣管炎, 咳嗽, 皮膚情況。

卵磷脂五穀 - 神經, 神經保護, 好為心臟狗, 奪取狗。1 個茶匙在每日飯食。並且為心臟或奪取情況, 請尋求動物治療師為自然醫學和過敏自由飲食癒合情況和修理損傷。

山梗菜 - 在適度藥量它將放鬆肺和治痙攣為奪取

M

蛋白軟糖 (Althea officinalis) 蛋白軟糖有名譽有安慰, 醫治用的植物。它有潤藥, 鎮痛劑, 利尿, 抗發炎和expectorant 行動。用途: 蛋白軟糖用對待胃和十二指腸的潰瘍、粘膜炎、咳嗽、colds 和尿道傳染。

Meadowsweet (Filipendula ulmaria) (不是為貓) 長期對流感、熱病, 和關節炎的一個補救, meadowsweet 包含一種阿斯匹靈類型化合物叫做水楊基酸。它有防腐劑, 反潰瘍, 抗發炎和利尿物產。用途: Meadowsweet 使用對待風濕病、潰瘍、腹瀉、腎臟問題和胃酸度。

Motherwort (Leonurus cardiaca) 照原樣共同的名字建議, motherwort 是有用的為婦女的混亂並且當拉丁名字建議, 它是還有利的在對待的心臟問題。
用途: Motherwort 被使用對款待被延遲的, 缺席或痛苦的期間, menopausal 變動, 在分娩和為心悸。

牛奶薊 (Silybum marianum) St.Milk 薊, 是當地的對歐洲和一些美國的部分, 有強有力的肝臟保護的物產。它防止損傷和改進作用。用途: 牛奶薊被使用對待肝臟病, 包括肝病和肝炎。
它並且使用對待膽結石和psoriasis 。這個肝臟草本是當務之急為是在Cortisones 的任一個動物(任何時侯) 疫苗或指定的heartworm 藥物或所有其它含毒物藥物毀壞寵物的肝臟。

牛奶薊 (Silybum marianum 種子) & 蒲公英 一起做一位好& 柔和的肝臟清潔劑, detoxifier, 和修理匠。
* 使用它為肝臟或腎臟損傷、肝炎(包括Echinacea), 黃疸、細螺旋體病, 和parvovirus 補救。它也許是有用的在慢性皮膚混亂、腫瘤, 和癌症。這是主要抗氧劑。
是在很多獸醫藥物- ie Heartworm 預防藥物、接種、除蟲的藥物, 或化療需要這洗滌/修理和保護者上述草本的寵物。
DOSADE: 狗- 增加3ml 草本萃取物日報在飯食。

Mullein (Verbascum thapsus) 高度被重視有呼吸補救, mullein 有袪痰劑, 潤藥, 利尿, 抗發炎, nervine, 治痙攣和收斂性行動。用途: Mullein 使用對待呼吸混亂, 特殊bronchitis.A 骨頭、骨肉和軟骨建造者; 援助在癒合呼吸疾病, 哮喘, 支氣管炎, 腹瀉, 靜脈竇壅塞; 安慰對任一炎症和解除痛苦; 行動解除痙孿& 明白肺。
日語5 個蘑菇5 採蘑菇萃取物25ml (Shiitaki16.6%, Maitaki 16.6%, Reiishi 16.6%, Hakumokuji 25%, Tochukaso 25%)
免疫建造者(似貓的愛滋病) 巨蟹星座/腫瘤- 為- 狗/貓/馬

注: 癒合有cancer/tumors 的您的寵物, 您將需要用5 蘑菇與其它抗癌草本一起& Homeopathic 慣例, 適合與各各自的動物需要!
請尋找一個合格的全部或Homeopathic 動物實習者為推薦和劑量。總之治療給9 下落2 x 日報在飯食為小狗或貓。雙重劑量為med 大小狗。
- 似貓的愛滋病, 使用5 個蘑菇萃取物與肝臟修理匠一起, 自然被補充的飲食, 是一個優秀開始對柔和地和有效地與癌細胞戰鬥。並且改變您的寵物到所有防腐自由飲食以維生素和礦物補充, 羅斯臀部和Vit E 作為添加劑等。這些蘑菇能是半新新鮮的並且萃取物是還可利用的以膠囊形式。用途: 這些蘑菇可能用對待和防止各種各樣的混亂, 包括cancer/tumor 、糖尿病、慢性疲勞綜合症狀、病毒傳染、高血壓、心臟病和疲勞。



沒藥(Commiphora molmol) 沒藥有古老名譽因為洗滌的代理和它有防腐, 殺真菌劑和收斂性作用。它經常被使用在漱口裡。用途: 沒藥被使用對待疼痛喉頭和被傳染的膠。它可能並且是有用的在鵝口瘡(假絲酵母albicans 傳染的) 治療防腐, 收斂性, stomach 病毒, 咳嗽, 哮喘。

Maitake 抗癌與胃, 肝臟, 白血病, 援助高血壓(糖尿病, 由降低血液葡萄糖)

Morin 萃取物 - (Noni 汁液) 所有情況- 腎臟, 關節炎, 能量, 癌症) 這個慣例製造在澳洲唯一的diabetes.(Noni 植物, 這果子是唯一一個有物產可能再生組織細胞。即。腎臟疾病, 還偉大的補劑為sick/cancer 並且/或者年長寵物。  如果您食用Noni 汁液, 這運作為動物。
- 用這個集中慣例或Noni 汁液- 充分增加一支吸管在每個每日膳食。貓和狗。

Mullein - 呼吸, 便秘, 喉頭, 哮喘, 支氣管炎, 神經系統

蛋白軟糖 - 安慰性的代理為嘴、胃、肚腑、腎臟和膀胱的炎症; 相似的免疫興奮劑物產發現了在Echinacea 。安慰性的食道混亂, 未加工的喉頭。

Mistletoe - 心臟, 循環, 心臟失敗, 充血的心力衰竭, 腫鼓, 微弱的心臟, 心肌病, 便秘, dysmenorrhea, 風濕性痛苦, 癌症, 肝臟壅塞。行動: 興奮劑, 利尿, 消化, 反激動, 血管擴張劑。

N

Nettles - 它的利尿行動沖洗積累廢物尿道和幫助替換失去的電解質, 是高的在吸收鋼, 鈣& 綠葉素高內容, 富有在鋼& Vit 上C 、貧血症、熱病、colds 、hayfever, 和過敏, 皮膚混亂, 關節炎, 泌尿傳染。

Neem - 壁虱, 小蜘蛛, 蚤洗滌外部。並且內部好為免疫系統。

O

Oatstraw (Avena.sativa) 並且種子, 燕麥植物的葉子醫藥上被使用得。燕麥有nervine 補劑、抗抑鬱劑, nutritive, demulcent 和醫治用的物產。用途: Oatstraw 使用對待衰弱、精疲力盡、消沉和重音。這是一個有用的補救在那些康復。

俄勒岡葡萄根(Mahonia aquifolium) 亦稱山葡萄, 這個草本有有利作用在肝臟和膽囊和有好名譽作為血液淨化器。用途: 它使用對待皮膚混亂譬如eczema 、psoriasis 和粉刺。因為它有通便作用它並且被使用在便秘。
小心俄勒岡葡萄根不應該被使用在懷孕期間。

橄欖色的葉子- 幫助循環、細菌、病毒、真菌、colds 、流感, 和寄生生物, 慢性竇炎

燕麥種子 - 抗發炎和補劑, 養育神經系統。

P

荷蘭芹 (Petroselinum crispum) 最常用的烹飪草本的當中一個, 荷蘭芹並且有醫藥用途由於它的利尿行動。用途: 荷蘭芹用對待泌尿傳染和石頭。它並且使用改進消化和對待flatulence 。
小心荷蘭芹不應該用在醫藥藥量在懷孕期間。
荷蘭芹- 是一營養, 消化短文補劑和利尿的。它是高的在鉀、礦物, 和維生素裡。使用它為膀胱和腎臟傳染, 無節制, 和為胃和肝臟。荷蘭芹是血液清潔劑、癌症預防措施、免疫建造者, 和補劑為血管。它幫助一個母親尾隨或貓中止分泌乳汁和援助在胞胎痛苦中。不要使用它當動物護理。
為從病症、手術或毒性腎臟問題恢復的任何動物。

馬: 新鮮荷蘭芹植物, 根和所有- 一天一次幾天。
貓: 加開水  來新鮮的荷蘭芹堆和讓陡峭20 分鐘, 涼快, 每日然後給  one/two 茶匙(在食物裡或以口) 一個星期。
狗: 用巨額荷蘭芹茶- 1 2 把大湯匙3/4 次每日。
罐頭加精巧切好的荷蘭芹入他們的每日飯食一星期一兩次來幫助保留腎臟被洗滌和並且免於疾病。

牆草屬植物這牆壁 (Parietaria officinalis) 經常發現了在老廢墟並且牆壁, 牆草屬植物這牆壁有安慰的, 利尿和收斂性物產。用途: 它使用對待膀胱炎、攝護腺炎症和泌尿石頭。

波城d'arco (Tabebuia avellanedae) 巴西當地印地安人使用這棵樹吠聲為許多疾病。它有抗菌, 抗病毒, anti-parasitic, 抗發炎和抗癌作用。用途: 波城d'arco 使用治療陰道和小腸酵母傳染。它使用治療cancer/tumors, 免疫建造者, 對待系統和酵母傳染, 禁止假絲酵母酵素從生產, 和並且將增加紅血球計數。

抗生素, 腫瘤禁止, 病毒殺害、殺真菌劑和antimalarial 物產、貧血症、哮喘、psoriasis 、colitis & 各種各樣的傳染由建立免疫系統。

捅根 - 過敏, 關節炎, 乳腺癌, 支氣管炎, 粘膜炎, 慢性風濕病, 便秘, 腫鼓, 熱病, 肥胖病。
用途外在: 為膿腫, 煮沸, 裂痕, 乳房abscess(poultice), 疼痛喉頭, 聲音, 腫瘤。捅根淋巴drainer/stimulant 。在保守的藥量, 意志detox 身體。
行動: 過敏, 關節炎, 血液淨化器, 利尿, 淋巴, 興奮劑, 抗發炎。用途在小藥量或以前咨詢您的全部治療師使用如果缺乏信心劑量要求。

大蕉- 高在綠葉素, 優秀創傷癒療者裡- 擦傷處、疹和昆蟲叮咬。內部胃潰瘍對痢疾和血液的septicemic 條件。

Pleurisy - 好為乾燥咳嗽和壅塞因為它將重新濕潤肺使咳出更加容易, 增量冒汗為寒冷, 流感症狀。將解除困難在呼吸, 支氣管炎和pleurisy 。

Passionflower- 弛緩劑, 奪取, 鎮靜劑, 被使用在哮喘組合和奪取。

Paeonia - 冷卻的草本  ie 紅色和熱的皮膚

薄荷 - 暈動病, 恢復胃口在狗。

Psyllium 五穀 - 小腸清潔劑。並且幫助與被衝擊的肛門封墊與對修理的homeopathic 補救一起和癒合和detox 。

R

紅色三葉草 (車軸草pratense) - detox, 腫瘤, 高在礦物裡, 叫' 營養草本', 對孩子的溫和的鎮靜作用, 好為任一個慢性疾病狀態。富有在化合物以phytoestrogens 著名, 紅色三葉草被使用了在癌症的治療。用途: 紅色三葉草用對待皮膚條件譬如psoriasis 和eczema 。它是還有用的在百日咳和支氣管炎的治療因為它有expectorant 和治痙攣的行動。

Rehmannia - 腎上腺封墊, 皮膚情況。Rehmannia glutinosa [ 省di 黃] 中國毛地黃屬植物根。
這草本和根值glycyrrhiza uralensis 的準備(gan cao) 被使用對待肝炎50 個病例以各種各樣的階段。在10 天之內, 41 個案件顯示了改善的症狀、被減少的肝臟和脾臟大小, 和改善的肝功能測試。實驗從30 年代似乎顯示那省di 黃, 被給鼠通過胃lavage 或射入, 降低的清液葡萄糖水平。這個問題的最新研究顯示了易變的結果。

羅斯臀部 - □去□常與傳染& 遏制重音戰鬥。一個有用的草本為癌症患者, 這是最高的草本在維生素C 內容和包含整個C 複雜。... 購買新鮮和易碎種子和增加來飯食或使用藥草浸劑或萃取物和增加來飯食。好為癌症患者, 作為高的維生素C 。

羅斯瑪麗 - 奪取, 弛緩劑, 改進循環對頭, 正常化血壓和加強血絲在腦子, 解除衰弱和消沉與相關緊張的混亂。

S

番瀉樹 (桂皮acutifolia 和C. angustifolia) 番瀉樹是知名的為它的通便行動。用途: 番瀉樹被使用對待要求軟的凳子的便秘和haemorrhoids/fissures 。
小心番瀉樹不應該被使用超過10 天一次和不應該被使用根本在懷孕期間; 哺乳期; 或由那些有小腸阻礙、激動腸疾病或胃腸痛苦由於未知的起因。

St.John's 麥芽酒 (Hypericum perforatum) - 消沉, 神經, 抗病毒和抗菌物產, 好在耳朵傳染, 幫助外在地神經損壞和炎症沿脊髓。St 約翰的麥芽酒有用途的一個悠久的歷史和有幾次行動包括反抑制劑, 抗病毒和抗菌作用。用途: St 約翰的麥芽酒變得越來越普遍作為一種治療使溫和減輕消沉, 包括menopausal 消沉。它可能並且使用治療病毒傳染。
小心大劑量也許導致光敏和食道翻倒。
不要使用- 如果患者是在心臟病藥療程從狩醫或醫生。

鋸矮棕櫚條 (Serenoa repens) - 用途: 鋸矮棕櫚條主要被使用對待良性prostatic 肥大, 攝護腺封墊成為擴大的混亂。它可能並且使用治療尿道傳染。

石根 (Collinsonia canadensis) 當地人向加拿大, 石根有利尿和靜脈加強作用。用途: 石根被使用對待腎結石、gall 石頭、varicose 靜脈、hemorrhoids 和腹瀉。

Siberain 人參 - 補劑、增量表現、stamina, 和耐力, 增加精神警報

賢哲 (Salvia officinalis) - 冷卻的草本為皮膚。能增加冒汗在熱病和流感。一個常用的烹飪草本, 賢哲並且有醫藥用途。它有鎮靜, 治痙攣, 抗菌, 收斂性和抗發炎行動。用途: 賢哲用對待colds 、疼痛喉頭、熱的閃光、痛苦的期間和消化不良。
賢哲不應該當心在懷孕期間

St.John's 麥芽酒或Hypericum 是一個主要止痛藥為關節炎、風濕病、創傷、燒傷, 和身體傷害。使用它為神經痛苦和神經損傷從精神創傷, 和使用它為脊髓問題和滑倒的圓盤。最通認作為homeopathic, hypericum 是治痙攣,   反出血, 和癒合肺、尿道, 和再生器官。它的主要用途是為痛苦在皮膚是完整的處。

minibabyqq 2006-12-28 01:53 AM

轉貼自4682

[color=Magenta][size=5][b]自然變質藥對疫苗There is a Natural Alterative to Vaccine  [/b][/size][/color]


nosodes 結束疫苗最大的好處是事實他們是完全地安全的。沒有風險或副作用什麼。並且他們比疫苗能可能安全地被給小狗和小貓及早。實際上, 母親可能被對待在她誕生之前, 給他們是出生的小狗或小貓保護免受片刻。

Nosodes, 像所有homeopathic 補救, 非常容易執行: 他們被給得以口, 和甚而不需要被吞下。他們並且是非常經濟的- 較不昂貴, 實際上, 比接種。

Nosodes 的局限

有一些局限對對nosodes 的用途。在美國狂犬病接種為狗由法律必需在多數縣, (雖然不是在澳洲) 並且狂犬病nosode, 稱Lyssin, 不會滿足那個要求由法律。  但是使用這nosode 是一個有效的選擇。

您應該知道, 然而, 為您的動物健康, 所有疫苗, 包括狂犬病法律上和醫療上被批准用於唯一非常健康動物! 有惡習, 重音, 年長的人的歷史的許多狗和貓, 慢性病症, 並且是在巨大的風險能應付病毒接種, 由於他們損壞的或被減弱的免疫系統。

如果您的狗顯示任何深刻或慢性疾病的標誌, 他或她是豁免從那個要求, 不應該被接種。

儘管nosodes 明顯的好處, 多數boarding 狗窩和獸醫醫院不會接納他們代替接種。如果您需要上您的狗或貓在boarding 狗窩或獸醫醫院, 您可以被迫使有him/her 被接種。這是有希望地將改善以時間的問題如同更多狗窩所有者和獸醫熟悉nosodes 。

如果您安排您的寵物被接種與活病毒的.......Your 狩醫應該要求您報告任一異常的發展或有害反應跟隨接種。獸醫請求仿效工作小組的疫苗管理做法和有害反應向疫苗報告援助這個小組的調查。它難得出結論關於關係在疫苗站點和型之間當有這樣的差距在實習者之中多頻繁和在哪裡他們給射擊。如果大家使用相似的技術和時間表, 工作小組更好能跟蹤有害反應和得出結論關於他們。

終於, 您的狩醫應該鼓勵您做您的貓的身體的徹底的檢查□星期, 特別是在疫苗站點附近。小團或爆沸應該儘快被檢查因為早期的診斷通常與一種更好的預測有關為完全治療。注: 參見您的全部醫生為' 口頭寵物免役的

從未接種一個動物以深刻或慢性衛生問題症狀, 或在手術或其他物理或情感重音之時。

接種為一種疾病那是一次避免多值性(組合) 疫苗。為貓, 接種為似貓的panleukopenia 單獨。疫苗為二上部呼吸病毒(calicivirus 和rhinotracheitis) 可能一起被給。

我強烈推薦反對接種為似貓的白血病或似貓的感染腹膜炎病毒。疫苗是無效的, 和以我所見, 極端危害。為狗, 分開地給parvo 與慍怒。不要接種為細螺旋體病、肝炎, 或parainfluenza 。

從未給狂犬病疫苗在其他疫苗的同時。

避免修改過的活病毒疫苗每當可能。得到被殺死的病毒疫苗, 特別是為狂犬病(如果您居住在美國), 似犬parvo 病毒, 和似貓的panleukopenia 。(似犬distemper/.hepatitis 疫苗不是可利用的以被殺死的病毒形式) 。

一疫苗射擊將持續抗體終身在您的寵物的身體。  如果您是帶領相信否則, 您能要求安排您的狗或貓被測試為免疫抗體哪些稱滴定量測試。  如果您的狩醫做不做驗血的任何原因, 那麼要求他提到您對能合作的狩醫。   

某些人民開始在測試他們的寵物的每3 到5 年, 這個測試叫做a (滴定量身體免疫test)until 他們最終反看見他們充分地被蓋無論許多歲月在軌道下從他們首先一個疫苗當一隻幼小寵物。



治療用途

除幫助之外防止具體病毒疾病以預防疾病的用途, nosodes 能被使用在對病毒的暴露發生了以後。如果給在曝光之後, 在症狀顯現出之前, 這些nosodes 可能防止臨床疾病的發展。

病毒疾病這樣似貓的白血病、似貓的感染腹膜炎、似犬慍怒和似犬parvo 病毒通常是無可救藥的以常規藥物治療(抗生素、類固醇, 等。)

但是, 他們非常迅速和有利地頻繁地反應homeopathic 治療和維生素C (純淨的鈣ascorbate 酸粉末或可注射的vit c) 。

如果您的寵物顯示病症, 具體所有症狀, 被賦予個性的homeopathic 治療將是需要的並且可注射的Vit C 3 x 每日當在診所。  

由於這些情況的潛在的重要性, 您應該立刻尋找全部專業幫助。

The biggest advantage of nosodes over vaccines is the fact that they are completely safe. There are no risks or side-effects whatever. And they can be safely given to puppies and kittens much earlier than vaccines can. In fact, the mother can be treated before she gives birth, giving the puppies or kittens protection from the moment they are born.

Nosodes, like all homeopathic remedies, are very easy to administer: they are given by mouth, and don't even need to be swallowed. They are also very economical - far less expensive, in fact, than vaccination.

Limitations of Nosodes

There are some limitations to the use of nosodes. In the USA Rabies vaccination for dogs is required by law in most counties, (although not in Australia) and the rabies nosode, called Lyssin, will not satisfy that requirement by law.  However using this nosode is an effective alternative.

You should know, however, for the health of your animal, that all vaccines, including rabies are legally and medically approved for use in ONLY very healthy animals ! Many dogs and cats who have had a history of abuse, stress, elderly, chronic illness, are also at huge risk of not being able to cope with virus vaccinations, due to their damaged or weakened immune system.

If your dog is showing any signs of acute or chronic disease, he/she is exempt from that requirement and should not be vaccinated.

Despite the obvious advantages of nosodes, most boarding kennels and veterinary hospitals will not accept them in lieu of vaccination. If you need to board your dog or cat in a boarding kennel or veterinary hospital, you may be forced to have him/her vaccinated. This is a problem that will hopefully improve with time as more kennel owners and veterinarians become familiar with nosodes.

If you have had your pets vaccinated with the live virus’s .......Your vet should ask you to report any unusual development or adverse reaction following vaccination. Veterin>><<s and to report adverse reactions to vaccines to aid this group's investigations. It’s difficult to draw conclusions about the relationship between vaccine sites and types when there's such disparity among practitioners in how often and where they give shots. If everyone uses similar techniques and timetables, the task force will be better able to track adverse reactions and draw conclusions about them.

Finally, your vet should encourage you to make a thorough inspection of your cat's body each week, especially around vaccine sites. Small lumps or bumps should be checked out as soon as possible because early diagnosis is usually related to a better prognosis for a complete cure. Note: Please refer to your Holistic Doctor for the 'Oral Pet Immunizations'

Never vaccinate an animal with symptoms of acute or chronic health problems, or at the time of surgery or any other physical or emotional stress.

Vaccinate for one disease at a time that is, avoid multivalent (combination) vaccines. For cats, vaccinate for feline panleukopenia alone. The vaccines for the two upper respiratory viruses (calicivirus and rhinotracheitis) can be given together.

I strongly recommend against vaccination for feline leukemia or feline infectious peritonitis virus. The vaccine is ineffective, and in my opinion, extremely hazardous. For dogs, give parvo separately from distemper. Do not vaccinate for leptospirosis, hepatitis, or parainfluenza.

Never give the rabies vaccine at the same time as any other vaccine.

Avoid modified live virus vaccines whenever possible. Get killed virus vaccines, especially for rabies ( if you live in the USA ), canine. parvo virus, and the feline panleukopenia. (The canine distemper/.hepatitis vaccine is not available in a killed virus form).

One vaccine shot will last a lifetime of antibodies in your pet’s body.  If you have been lead to believe otherwise, you can ask to have your dog or cat tested for immune antibodies which is called a Titre test.  If your vet make any reasons for not doing a blood test, then ask him to refer you to a Vet who can co-operate.   

Some people start off in testing their pet’s every 3 to 5 years, this test is called a (Titre anti- bodies immunity test)until eventually they see that they are fully covered no matter how many years down the track since their very first one off vaccine when a young pet.



Therapeutic Uses

In addition to helping prevent specific viral diseases with prophylactic use, nosodes can be used even after exposure to a virus has taken place. If given immediately after exposure, before symptoms develop, these nosodes can prevent the development of clinical disease.

Viral diseases such a feline leukemia, feline infectious peritonitis, canine distemper and canine parvo virus are usually incurable with conventional medical treatment (antibiotics, steroids, etc.)

However, they frequently respond very quickly and favorably to homeopathic treatment and Vitamin C ( pure calcium ascorbate acid powder or injectable vit c).

If your pet shows any symptoms of illness, specific, individualized homeopathic treatment will be needed as well as injectable Vit C 3 x daily while in clinic.  

Due to the potential seriousness of these conditions, you should seek holistic professional help immediately.

minibabyqq 2006-12-28 01:54 AM

轉貼自4682

[color=Magenta][size=5][b]手術和自然療法 Surgery and Natural Therapies   [/b][/size][/color]


協助寵物通過任一類型重音和震動手術您能提供維生素補充對於他們的飯食導致對手術。

Med 大小狗:

增加來每日飯食, 酯類C 粉末 1/2 茶匙

小狗或貓增加:

1/8 茶匙 酯類C 為膠原生產

好  probiotics 為維生素K 的生產

維生素50mg B complex(crushed) 為皮膚修理。


二天預先, 給homeopathic Ferrum phos 30C, 每星期三次二天, 為了防止傳染和heamorrhaging 。

使它unecessary 採取家庭處方治療抗生素片劑。

檢查所有可能的大道對癒合。手術不是唯一的選擇。如果您未嘗試草本和homeopathy, 然後喜歡考慮這第一, 99% 時間手術是unecessary 如果自然醫學被使用了。  除非當然他們是事故。

我們增加一些有用的建議援助您的寵物通過任一類型手術。這些homeopathic 補救和飲食補充將幫助一個動物迅速恢復與複雜化/靈菌/痛苦/挫傷。

為普通外科, 夜在手術、 山金車1M 或  手術慣例一個藥量之前。

手術的早晨, 山金車其他藥量在手術之前, 和其他藥量立刻之後, 每2 個小時(要求狩醫護士執行)

為手術介入軟骨和骨膜, Ruta Grav 200C 晚上在, 操作的早晨, 和立刻之後之前為2 藥量, 一個小時單獨。

如果動物是慢的從麻醉出來, (可能嘔吐) 給磷一藥量 200C。如果寵物顯示恐懼, 特別是如果指定的止痛藥, 和看起來幻滅並且混淆, 給藥量 附子200C 。


寵愛絕育

以下補救如下- 那次比賽特殊手術- 應該由Homeopath 給一個小時在最後藥量山金車以後1m, 二到三天除非另外說明:

寵物鎮靜下落和震動1M 補救應該一樣經常並且被給在天期間像需要幫助寵愛感受放鬆了。


Spay/中性:    Staphysagria 200C, 每星期三次。

剖腹產或外陰切開術: Staphysagria 200C 或Bellis perennis 200C, 每星期三次。

墮胎或流產:  Ignatia 1M, 每 2 個小時

胃腸手術: Staphysagria 200C 或Bellis perennis 200C, 四次每天

Gastrectomy: Raphanus 200C, 每星期三次

膽囊手術: Lycopodium 200C, 每星期三次

眼睛手術: Ledum 200C, 每  半小時, 重覆4 次然後減少在改善。

軟骨或骨膜: Ruta 嚴重1M 15 分鐘或如果嚴重損壞的用途 10M, 每四個小時

介入脊椎: Hypericum 1M, 每個小時。
(如果深刻神經損傷, 使用homeopathic Hypericum 10M 藥量 每個小時- 4 x 每日)

手術為槍傷並且/或者刺傷: Staphysagria 200C 、Ledum 200C 作為破傷風預防和Hypericum 10M (神經損傷和痛苦) 四次每天。
並且搶救補救規則防止震動(震動殺害) ie 每5 分鐘為3 到4 重覆將做它。

截肢術: Hypericum 10M, 每個小時,  4 重覆然後每3 個小時。

Haemorrhoids: Staphysagria 200C 或Aesculus 30, 每四個小時二或三天。

Dental/tooth 手術: Hypericum 1M 和Ruta Grav 1M, Calc Phos 1M, 交替或被結合, 藥量每二個小時。



----- 減少深刻劑量頻率- 作為痛苦和癒合改善。

麻醉的危險

知道投入一條更舊或病的貓或狗在麻醉之下是危險的- 為幼小或中間年齡寵物, 在手術授予 山金車1M 3 天前後之前。

總給您的寵物肝臟Detox homeopathic 下落並且burdock 根和蒲公英草本茶洗滌肝臟和腎臟並且增加牛奶薊如果肝臟毒力/損傷發生。

Homeopathic 胃口硅土 200C (detox) 如果lethargic 和損失在sugery 或麻醉劑以後。
每日藥量4 下落為一個星期或二。

重要: 堅持, 狩醫投入您的寵物在流體before/during 和在手術以後- 這將幫助從身體發布麻醉的毒素/chemicals 因此它不關閉和不殺害您的寵物。

山金車200C: 如果被給一旦每七天顯著減速了的貓。他們是疲乏& 無動於衷, 可以時常下落。山金車保證, 循環依然是強。

Mercurius 200C: 被給每七天為喝很多的貓。更多流體進水閘比通常表明腎臟損傷。

Calc Carb 200C: 一藥量每日幾個星期裝於罐中幫助變得肥胖和慢在老年齡的貓並且顯示顯現出的大瀑布的標誌。

Calc 流體200C: 一藥量為開發了一束在他們的毛皮裡, 開始丟失重量, 和有大瀑布的貓。執行三個星期每處所(13 個星期)

氧化鋇汽車200C: 被給每日兩次為忘記的貓何處他們的垃圾箱時常是並且因此變得髒。這些貓頻繁地有皮膚問題。


具體疾病在手術以後

靈菌: 山金車1M 幫助減慢或停止流血在手術以後。
如果山金車不運作足夠有效地, 使用磷200C 。
如果您的狗是一條非常敏感狗, 總使用磷200C 而不是山金車

為明亮的紅色血液靈菌:   Ipecacuanha 200C 。
Secale 30C 是有效的在對待的 子宮靈菌。
辛可寧30C 是為靈菌和流體一般 損失帶領的動物
他們感到微弱和微弱。

您可以必須使用這個補救幾星期、月, 或年在流體丟失了之後, 在或病症或操作以後。

Arsenicum 200C 是有用的當大方靈菌導致巨大弱點、灼燒的痛苦、不安定性、憂慮, 和恐懼, 與典型地大乾渴一起為唯一飲者一次。

藥量: 需要補救每個小時直到流血中止, 不超過四藥量。

如果靈菌顯著未減慢, 考慮其它補救。次日, 採取一更多藥量工作減少失血的可能的複雜化。


精神創傷對組織:

山金車奶油: 典型地
嚮殘破的皮膚不要應用山金車奶油。它將導致皮膚過敏。

Homeopathic 山金車200C 是有用的當肌肉感覺挫傷或脹大並且當有所有合併血液在皮膚之下。

Hamamelis 典型和homeopathic Hamamelis 30C 口頭 是有效的為微弱的靜脈, 被動出血, 流血hemorrhoids 。

Calendula 草本 在外在應用(膠凝體、軟膏、酊, 浪花) 被表明癒合創傷或切開。

Bellis perennis 200C 是一個補救至於使用在胃腸手術以後和當深內部組織受了損傷

藥量: 運用外在補救至少一天一次。通常, 內部補救的只二到八藥量在2 天的期間將是必要完成恢復過程。



創傷傳染外在應用:

Calendula 和Hypericum, 或單獨或更好地一起, 幫助對防止和治療外科創傷的傳染。如果pus 開發了和導致創傷的過敏症, Hepar 硫磺30C 或我們的 圖畫慣例6X 被推薦。

不要使用Hepar 硫磺當有針因為它將幫助推出裂片, 玻璃片斷, 並且得到陷進在皮膚之下的各種各樣的外國對象, 它並且有一個傾向推出外科針。

如果創傷變得紫色: 使用 Lachesis 30C 。
如果那裡燒在創傷或創傷區域, 硫磺30C 是有用的。
藥量: 運用外在補救至少一天一次。

給內部補救每二個到四個小時在第一24 小時期間和四次每天二到五另外天。



便秘:

Raphanus 30C 被表明當有便秘沒有urgings 為凳子並且/或者當有痛苦的氣體。其它便秘補救可利用在我的電存儲器。
藥量: 每星期三次給這個補救四天。

噁心和嘔吐

Nux 膿洞30C:   是好的為猛烈retching, 特別是當有一般無效果retching 不導致嘔吐。

磷30C: 幫助防止或對待nausea/vomiting 和grogginess 在手術以後。1 藥量通常是所有是需要的。

Ipecac 200C - 30C: 是有效的為堅持噁心以嘔吐, 當嘔吐不提供安心。

Arsenicum 200C 對待猛烈和持續不斷嘔吐由飲用水, 特別是冷水, 或吃使更壞。

藥量: 給補救每二個小時在強烈的症狀期間和每四個小時在較少強烈的難受期間。

如果改善不是顯然的在24 小時以後, 考慮其它補救。


氣體 或通脹

Carbo veg 30C: 幫助遭受偉大的膨脹和進攻氣體的動物。

辛可寧6C 或30C: 不是有用當有頻繁隆隆響在腹部, 並且安心從發布氣體。

Raphanus 30C: 是對擴張的腹部的一個共同的補救但無法逐出氣體。

Colocynthis 30C: 是由彎曲解除的有效當有比膨脹更多痛苦, 並且並且抽瘋。藥量: 給補救每二個小時在強烈的痛苦期間和每四個小時在溫和的難受期間

如果改善不是顯然的在24 小時以後, 考慮其它補救。



在手術以後, 繼續probiotics, 酯類C, B 複雜。
您能增加晚櫻草油為皮膚癒合, CoQ10 為組織修理, Gotu 可拉樹為神經損傷和減少麻木和膠原綜合, Bromelain 為減少膨脹。

To assist the pet through stress >><<up to surgery.

Med size dog:

Add to daily meals, Ester C Powder 1/2 teaspoon

Small dog or cat Add:

1/8 teaspoon of Ester C for collagen production

good  probiotics for production of vitamin K

vitamin 50mg B complex(crushed) for skin repair.


TWO DAYS PRIOR, give homeopathic Ferrum phos 30C, three times a day for two days, in order to prevent infection and heamorrhaging.

Making it unecessary to take home prescription Vet antibiotics TABLETS.

Check out all possible avenues to healing. Surgery is not the only option. If you have not yet tried herbs and homeopathy, then please consider this first, 99% of the time surgery is unecessary if natural medicines have been used.  Unless of course their has been an accident.

We have added some helpful suggestions to aid your pet through any type of surgery. These homeopathic remedies and dietary supplements will help an animal to recover quickly with less complication / bleeding / pain / bruising.

For General Surgery, night before surgery, Arnica 1M or  SURGERY FORMULA one dose.

The morning of the surgery, another dose of Arnica just prior to the surgery, and another dose immediately afterwards, every 2 hours (ask Vet nurse to administer)

For surgery involving cartilage and periosteum, Ruta Grav 200C the evening before, the morning of the operation, and immediately afterward for 2 dose, one hour apart.

If animal is slow coming out of anesthesia, (maybe vomiting) give one dose of Phosphorus 200C. If pet is showing fear, especially if given pain killers, and looks disillusioned and confused, give a dose Aconite 200C.


Pet Sterilization

The following remedies below - that match the particular surgery - should be given one hour after the last dose of Arnica 1m, for two to three days unless otherwise stated by Homeopath:

Pet CALM drops and SHOCK 1M REMEDIES SHOULD ALSO BE GIVEN AS OFTEN DURING DAY AS NEEDED TO HELP PET FEEL RELAXED.


Spay / Neuter:    Staphysagria 200C, three times a day.

Caesarian section or episiotomy: Staphysagria 200C or Bellis perennis 200C, three times a day.

Abortion or miscarriage:  Ignatia 1M, every 2 hours

Abdominal surgery: Staphysagria 200C or Bellis perennis 200C, four times a day

Gastrectomy: Raphanus 200C, three times a day

Gall bladder surgery: Lycopodium 200C, three times a day

Eye surgery: Ledum 200C, every half an hour, repeating 4 times then reduce on improvement.

Cartilage or periosteum: Ruta Grave 1M 15 mins or if badly damaged use 10M, every four hours

Involving the spine: Hypericum 1M, every hour.
(if acute nerve damage, use homeopathic Hypericum 10M dosing every hour - 4 x daily)

Surgery for bullet wounds and/or stab wounds: Staphysagria 200C, Ledum 200C as a tetanus prevention and Hypericum 10M (nerve damage and pain) four times a day .
And Rescue Remedy regularly to prevent shock ( shock kills) ie every 5 minutes for 3 to 4 repeats will do it.

Amputation: Hypericum 10M, every hour,  4 repeats then every 3 hours.

Haemorrhoids: Staphysagria 200C or Aesculus 30, every four hours for two or three days.

Dental/tooth surgery : Hypericum 1M and Ruta Grav 1M, Calc Phos 1M, alternating or combined, dosing every two hours.



----- Reducing acute dosage frequency - as pain and healing improves.-----

Dangers of Anesthesia

Be aware putting an older or sick cat or dog under anesthesia IS dangerous - for young or middle age pets, before surgery give Arnica 1M 3 day before and after.

Always give your pet a Liver Detox homeopathic drops and herbal teas of burdock root and dandelion to cleanse Liver and Kidney also Add Milk Thistle if Liver toxicity / damage occurs.

Homeopathic Silica 200C (detox) if lethargic and loss of appetite after sugery or anesthetic.
Dose 4 drops daily for a week or two.

IMPORTANT: Insist that the Vet puts your pet on fluids before/during and after surgery - this will help release the anesthetic toxins /chemicals from the body so it does not shut down and kill your pet.

Arnica 200C: should be given once every seven days to cats that have slowed down significantly. They are tired & apathetic, may fall over from time to time. Arnica ensures that circulation remains strong.

Mercurius 200C: given every seven days is for cats that drink a lot. The intake of more fluids than usual indicates kidney damage.

Calc Carb 200C: one dose daily for several weeks can help cats that have become fat and slow in old age and show signs of developing cataracts.

Calc Fluor 200C: one dose for cats that have developed tufts in their fur, have begun to lose weight, and have cataracts. Administer for three weeks a quarter (13 weeks)

Baryta Car 200C: is given twice a day for cats that forget where their litter box is from time to time and therefore become unclean. These cats frequently have skin problems.


Specific Ailments After Surgery

Bleeding: Arnica 1M helps to slow or stop bleeding after surgery.
If Arnica doesn't work effectively enough, use Phosphorus 200C.
If your dog is a very sensitive dog, always use Phosphorus 200C rather than Arnica

For bleeding of bright red blood:   Ipecacuanha 200C.
Secale 30C is effective in treating uterine bleeding.
Cinchona 30C is for an animal whose bleeding and general loss of fluids lead
them to feel weak and faint.

You may have to use this remedy for several weeks, months, or years after much fluid has been lost, after either an illness or an operation.

Arsenicum 200C is useful when profuse bleeding leads to great weakness, burning pains, restlessness, anxiety, and fear, along with a characteristically large thirst for only sips at a time.

Dose: Take the remedy every hour until bleeding stops, not more than four doses.

If bleeding has not significantly slowed, consider another remedy. The next day, take one more dose of whichever works to reduce the possible complications of blood loss.


Trauma to Tissue:

Arnica cream: topically
DO NOT apply Arnica cream to the broken skin. It will cause skin irritation.

Homeopathic Arnica 200C is useful when the muscle feels bruised or swollen and when there is any pooling of blood under the skin.

Hamamelis topically and orally homeopathic Hamamelis 30C are effective for weak veins, passive hemorrhage, bleeding hemorrhoids.

Calendula herb in external application (gel, ointment, tincture, spray) is indicated to heal wounds or incisions.

Bellis perennis 200C is a remedy for use after abdominal surgery and when deep internal tissue has been traumatized

Dose: Apply external remedies at least once a day. Generally, only two to eight doses of the internal remedy over a two day period will be necessary to complete the healing process.



Wound Infection External Applications:

Calendula and Hypericum, either alone or preferably together, help to both prevent and treat infection of surgical wounds. If pus has developed and causes hypersensitivity of the wound, Hepar Sulphur 30C or our DRAWING formula 6X is recommended.

DO NOT use Hepar sulphur when there are stitches because it will help to push out splinters, pieces of glass, and various foreign objects that get stuck under the skin, it also has a tendency to push out surgical stitches.

If the wound becomes purplish: use Lachesis 30C.
If there is much burning in the wound or wound area, Sulphur 30C is helpful.
Dose: Apply external remedies at least once a day.

Give internal remedies every two to four hours during the first 24 hours and four times a day for two to five more days.



Constipation:

Raphanus 30C is indicated when there is constipation with no urgings for a stool and / or when there is painful gas. Other constipation remedies available on my electronic store.
Dose: Give this remedy three times a day for up to four days.

Nausea and Vomiting

Nux vomica 30C:   is good for violent retching, especially when there is generally ineffectual retching that does not lead to vomiting.

Phosphorus 30C: helps to prevent or treat nausea/vomiting and grogginess after surgery. 1 Dose is usually all that is needed.

Ipecac 200C - 30C: is effective for persistent nausea with vomiting, when vomiting does not provide relief.

Arsenicum 200C treats violent and incessant vomiting which is made worse by drinking water, especially cold water, or eating.

Dose: Give a remedy every two hours during intense symptoms and every four hours during less intense discomfort.

If improvement is not obvious after 24 hours, consider another remedy.


Gas or bloating

Carbo veg 30C: helps animals who suffer from great distention and offensive gas.

Cinchona 6C or 30C: is useful when there is frequent rumbling in the abdomen, and no relief from releasing gas.

Raphanus 30C: is a common remedy for a distended abdomen but are unable to expel gas.

Colocynthis 30C: is effective when there is more pain than distention, and also cramps that are relieved by bending over. Dose: Give a remedy every two hours during intense pain and every four hours during mild discomfort

If improvement is not obvious after 24 hours, consider another remedy.



After surgery, continue probiotics, Ester C, B-complex.
You can add Evening Primrose oil for skin healing, CoQ10 for tissue repair, Gotu Kola for nerve damage and reduce numbness and collagen synthesis, Bromelain for reducing swelling.

minibabyqq 2006-12-28 01:55 AM

轉貼自4682

[color=Magenta][size=5][b]類固醇 | Heartworm | 接種 | 抗生素   [/b][/size][/color]


類固醇/Cortisones!

被使用許多次為許多另外illness/disease, 原因至於使用他們是減少炎症並且只脹大, 他們不癒合動物。他們運作在壓制身體的免疫系統旁邊不癒合疾病或病症的身體! 炎症和膨脹是一個正常身體部位免疫反應... 。。類固醇不治療什麼, 他們只壓制症狀和駕駛他們深在系統之內。

最單薄藥物

約翰磨房, 前醫學教授在加州大學、傳染病的舊金山和院長在舊金山綜合醫院。
......."說醫生告訴您, 類固醇只導致副作用在許多歲月以後。
但新研究表示, 永久損傷是直接和摧殘"。

類固醇快速地跟上抗生素作為藥物被濫用的組在您的醫生的黑袋子。沒有疑義, 在類固醇的發現上一半個世紀前是飛躍在醫學- 一life-saver 為那些像已故的總統約翰・F 甘乃迪, 遭受Addison 的疾病, 腎上腺封墊的疾病導致不足的激素生產。

類固醇仿造腎上腺封墊的行動, 一般新陳代謝身體的最強有力的管理者。約翰・Stirling, 維生素公司Biocare, credits 的主任一個非常短訓班(三射入) 類固醇以jump-starting 他的failing 腎上腺系統在過敏反應震動和挽救以後他的生活。問題是, 像抗生素, 類固醇看來是奇蹟' 治療' 。

有致殘的關節炎或哮喘病人似乎立即是更好在類固醇。喘息, 膨脹, 痛苦走開。如此醫生轉向類固醇作為攻擊一, 而不是前, 線為他們的抗發炎和anti-allergic 作用。

但我們知道, 類固醇知道損壞腎臟。我們並且知道, 從藥物製造商的自己的資料表, 類固醇可能造成肝臟損傷、易碎的骨頭、糖尿病、腎上腺不足、對免疫系統的無能應付重音, 和損傷。

和與抗生素, 什麼曾經是後備的為極端緊急狀態現在被使用在最瑣細情況。類固醇一樣欣然現在被實施像抗生素, 對嬰孩, 在任一個排序的炎症的第一標誌。最新的藥物集合用croup 替換牢騷水為嬰孩是類固醇(budesonide); □化可體松包括在最新的不用處方的療程為堆。類固醇組成許多OTC 皮膚藥物, 和被認為選擇藥物為哮喘, eczema, 關節炎, 背部毛病, 腸問題像ulcerative colitis 的確, 為了任何和所有炎症或過敏反應和新用途仍然被發明。單一例外是Addison 的疾病, 類固醇作為風濕甾酮替換療法, 因為胰島素被給糖尿病患者。

離是很遠的地方靈丹妙藥' 治療所有', 類固醇不能治療一個唯一情況。所有他們是壓制您的身體的能力表達一個正常反應。在幾個事例, 這類型鎮壓將給身體一次機會自癒。但經常, 作用是直接, 毀滅和永久損傷。並且我們現在只意識到多損傷可能快發生。儘管什麼醫生說, 那類固醇只有副作用在許多使用年限以後, 那裡是沒有如此事像安全藥量。
研究表示, 類固醇導致永久, 致衰弱的作用在一種唯一劑量以後。類固醇大概是最單薄的現代天療程。


Heartworm 藥物- 它危害我的狗嗎?

您應該總記得, Heartworm 療程, 不管種類您使用, 是一種藥物以可能的副作用。我們將談論藥物在Heartguard, Intercepter, 稍兵, 並且什麼您能做使副作用減到最小。
類型藥物Milbemycin 是有效成分在Intercepter, 由Novartis 動物健康銷售。  Novartis 產生了節目為蚤問題。節目使用Lufenuron 作為有效成分。以後, 同樣公司介紹了稍兵, 一起結合Milbemycin 和Lufenyron 。Heartguard-30 是一種基於Ivermectin 的藥物。

副作用

檢查以USDA 的資料, 有許多可能的副作用被列出為這些藥物。主要副作用是消沉, 慵倦, 嘔吐, 抽風, 厭食, 不整齊, elu 種類(在貓), 活動過度, 甚而死亡。有較小(發生) 副作用長的名單。這些包括震動, 眼睛問題, 緩慢的心臟行動, 掀動頭。

Heartworm 醫學可選擇方法, 那裡是一定數量的自然補救, 許多使用Homeopathic Heartworm Nosode 作為預防措施和並且使用作為一種治療沒有任何有害的作用。您能給您的寵物草本叫做牛奶薊作為肝臟補劑為對肝臟的修理的損傷如果您使用化工藥物, 並且由許多寵物所有者使用以成功。一些寵物所有者用一個草本像黑核桃液體在heartworm 藥物位置, 這並且是非常有效和低廉的。草本總加來每日飯食每週一次。





接種

您能並且給Homeopath 補救告訴的Thuja 30C 在射入以後。它使用在歐洲, 澳洲, 減輕接種的毒性作用。強的免疫系統的重要性無法被忘記了, 並且所有藥物用於顯著減弱免疫系統。強的免疫系統無法被建立在少量天。這是自然飲食和避免毒性藥物每天好關心的結果。


抗生素是做您的狗病的嗎?

腹瀉, 胃腸痛苦, 冒號(colitis 的) 嚴厲炎症, 急燥的腸綜合症狀, 皮膚問題, 熱病, 舉起了白細胞計數, 微弱的免疫系統, 嘔吐, 失水, 鉀缺乏, 過敏, 冒號穿孔, 口臭, 剩餘胃氣體, 酵母問題, 營養缺乏和便秘是正義的一些許多副作用和問題與抗生素連接。

1928 年, 當亞歷山大・Glemming 發現了抗生素, 大家叫嚷在在醫學的這難以置信的突破。但是, 多年來, 被宣佈以治療的疾病的這突破現在製造它自己的疾病和問題。細菌現在建立了對許多抗生素的抵抗。因此, 越□越強的抗生素需要做工作和如果更加微弱的抗生素製造問題, 可以您是想像什麼更加強有力的抗生素將做? 這是惡性循環因為細菌最後將建立對新和更加強有力的抗生素的抵抗也是! 細菌的新形式和疾病被創造。

這些新問題是非常危險的並且骨肉吃疾病是抗藥性抗性細菌最佳的例子。抗生素逐字手段反對生活(反= 反對和生物= 生活) 。在一個健康身體, 有好和壞細菌在小腸短文。那裡應該是大約80% 好細菌和大約20% 壞細菌。當抗生素被使用, 好和壞細菌被毀壞在小腸短文。一旦抗生素被停止, 壞細菌生長第一和快速地。結果是一非常不健康的和減弱身體沒有友好的細菌。

平均需要1 年從抗生素恢復如果您哺養好食物和用友好的細菌補充。如果您哺養的飲食是壞, 那麼您的寵物長期將需要恢復和可以從未充分地恢復。滑稽的事是, 抗生素解除根據症狀的問題。但在抗生素被停止之後, 症狀回來。如此什麼現在發生? 他們給更多抗生素。什麼是反語的是, 抗生素然後被給幫助作戰抗生素製造在身體的問題。

抗生素確定地是被規定和被使用。抗生素做□什麼為病毒仍然經常例如被執行無論如何。有希望地很快, 常識將戰勝並且開業醫生將體會  什麼發生。但, 它是由您, 人民決定施加壓力在狩醫變得仔細關於執行抗生素他們的實踐。實際上, 鼓勵您的狩醫學會選擇。使他們知道, 有可能不再被忽略的副作用。

在抗生素之前, 人們做了什麼? 在第一次世界大戰, 軍醫投入了大蒜丁香, 長期被讚譽了為他們的自然抗藥性物產, 在戰士創傷。一些使用蜂propolis 有自然phagocystosis 物產。Phagocystosis 是能力鼓勵白細胞毀壞細菌。有一定沒有副作用的許多其它自然抗生素(除了口臭在大蒜的盒) 。總之, 自然抗生素只攻擊壞細菌和把友好的細菌留在單獨。發現雖然抗生素幫助了之外許多生活, 他們不是治療通過任何手段。

結論- 身體應該有80% 友好的細菌和大約20% 壞細菌在小腸短文裡面。在對抗生素的用途, 身體將有沒有比20% 友好的細菌和80% 壞細菌如果不是更多之後。多數病症、疾病和問題開始在小腸短文。因而, 抗生素創造在病魔的潛力開始。您不也許給您的寵物抗生素, 但是如果它曾經吃了食物與防腐劑, 您給您的寵物什麼我稱' 暗藏的抗生素的。防腐劑工作將控制細菌並且一旦您的寵物吃食物與防腐劑, 它最後將有一個作用在小腸短文裡面太和殺害友好的細菌。- 您應該期望將需要1 年至少recolonize 小腸短文與友好的細菌在對抗生素的用途以後。- Recolonze 小腸短文與友好的細菌由使用補充和哺養自然食物。由Jesse 達拉斯寫。

注: 哺養您的動物未加工的食物(肉、魚、堅果、水果、五穀和蔬菜) 飲食將提供友好的細菌寬裕的供應。我注意, 狗喜歡腐爛的食物項目從天然肥料堆。原因大概是因為腐爛的食物在友好的細菌上是濃。最壞它嗅到, 更好她似乎喜歡吃它。對動物, 被損壞的vegies 也許是相似與什麼酸奶是對人。



Steroids / Cortisones!

Are used many times for many different illness/disease, the reason for using them is to reduce inflammation and swelling only, they do not heal the animal. They work by suppressing the body's immune system not healing the body of the disease or illness! Inflammation and swelling are a normal part of the body's immune response. ..... Steroids do not cure anything, they only suppress the symptoms and drive them deeper within the system.

The sleaziest of drugs

John Mills, former professor of medicine at the University of California, San Francisco and chief of infectious diseases at San Francisco General Hospital.
Says .......” Doctors tell you that steroids only cause side effects after many years.
But new research shows that permanent damage is immediate and devastating”.

Steroids are fast catching up with antibiotics as the most abused class of drugs in your doctor's black bag. There's no doubt that the discovery of steroids a half century ago was a major advance in medicine - a life-saver for those like the late President John F Kennedy, who suffered from Addison's disease, a disease of the adrenal glands causing insufficient hormone production.

Steroids mimic the action of the adrenal glands, the body's most powerful regulator of general metabolism. John Stirling, director of the vitamin company Biocare, credits a very short course (three injections) of steroids with jump-starting his failing adrenal system after anaphylactic shock and saving his life. The problem is, like antibiotics, steroids appear to be a miracle 'cure'.

Patients with crippling arthritis or asthma seem to be instantly better on steroids. The wheeze, the swelling, the pain go away. So doctors turn to steroids as the first, rather than last, line of attack for their anti-inflammatory and anti-allergic effects.

But we do know that steroids are known to damage kidneys. We also know, from the drug manufacturers' own data sheets, that steroids can cause liver damage, brittle bones, diabetes, adrenal insufficiency, an inability to deal with stress, and damage to the immune system.

As with antibiotics, what was once reserved for the extreme emergency is now being used on the most trivial of conditions. Steroids are now handed out as readily as antibiotics, even to babies, at the first sign of inflammation of any sort. The latest drug set to replace gripe water for babies with croup is a steroid (budesonide); hydrocortisone is included in the latest over-the-counter medication for piles. Steroids make up many OTC skin drugs, and are considered the drug of choice for asthma, eczema, arthritis, back problems, bowel problems like ulcerative colitis-indeed, for any and all inflammations or allergic reactions-and new uses are still being invented. The sole exception is Addison's Disease, where steroids act as a replacement therapy of cortisone, much as insulin is given to diabetics.

Far from being a wonder drug 'cure all', steroids cannot cure one single condition. All they do is suppress your body's ability to express a normal response. In a few instances, this type of suppression will give the body a chance to heal itself. But more often, the effect is immediate, devastating and permanent damage. And we are only now realizing just how quickly damage can occur. Despite what doctors say, that steroids only have side effects after many years of use, there is no such thing as a safe dose.
Studies show that steroids cause permanent, debilitating effects after a single dosage. Steroids are probably the most sleazy of modern day medications.


Heartworm Drug - Does it harm my Dog ?

You should always remember that Heartworm Medications, no matter what kind you use, are a drug with possible side effect. We will discuss the drugs in Heartguard, Intercepter, Sentinel, and what you can do to minimize the side effect.
Type of Drugs Milbemycin is the active ingredient in Intercepter, which is marketed by Novartis Animal Health.  Novartis came up with Program for flea problem. Program uses Lufenuron as active ingredients. Later, the same company introduced Sentinel, which combine the Milbemycin and Lufenyron together. Heartguard-30 is an Ivermectin-based drug.

Sides Effect

Checked with USDA's data, there are many possible side effects listed for these drugs. The major side effects are depression, lethargy, vomiting, convulsions, anorexia, ataxia, elu-species (in cat), hyperactivity, even death. There are long list of minor (less occurring) side effects. These include shaking, eye problem, slow heart action, tilting of head.

Alternative Approach of Heartworm Medicine, there are a number of natural remedies, many use Homeopathic Heartworm Nosode as a preventive and used as a treatment also without any harmful effects. You can give your pet a herb called Milk Thistle as a liver tonic for repairing damage to liver if you have been using the chemical drug, and has been used by many pet owners with success. Some pet owners use a herb like Black Walnut liquid in place of heartworm drug, this is also very effective and inexpensive. Herbs are always added to daily meals once a week.





Vaccinations

You can also give Homeopath remedy called Thuja 30C after an injection. It has been used in Europe, Australia, to lessen the toxic effect of vaccination. The importance of strong immune system cannot be forgotten, and all drugs serve to weaken the immune system dramatically. Strong immune system cannot be built in few days. It is a result of everyday good care of natural diet and avoiding toxic drugs.


Are Antibiotics making your dog sick?

Diarrhoea, abdominal pain, severe inflammation of the colon (colitis), irritable bowel syndrome, skin problems, fever, elevated white blood cell count, weak immune system, vomiting, dehydration, potassium deficiencies, allergies, colon perforation, bad breath, excess stomach gas, yeast problems, nutritional deficiencies and constipation are just some of the many side effects and problems linked to antibiotics.

In 1928, when Alexander Glemming discovered antibiotics, everyone was raving at this incredible breakthrough in medicine. However, over the years, this breakthrough which was heralded with curing disease is now creating disease and problems of its own. Bacteria now has built resistance to many antibiotics. Hence, stronger and stronger antibiotics are needed to do the job and if weaker antibiotics create problems, can you imagine what more powerful antibiotics will do? It's a vicious circle because ultimately bacteria will build resistance to the new and more powerful antibiotics too! New forms of bacteria and disease are being created.

These new problems are very dangerous and the flesh eating disease is the best example of antibiotic resistant bacteria. Antibiotics literally means against life (anti = against and biotic = life). In a healthy body, there is both good and bad bacteria in the intestinal tract. There should be about 80% good bacteria and about 20% bad bacteria. When antibiotics are used, both good and bad bacteria are destroyed in the intestinal tract. Once the antibiotics are stopped, the bad bacteria grows back first and faster. The result is a very unhealthy and weakens the body with no friendly bacteria.

It takes on average 1 year to recover from antibiotics if you are feeding good food and supplementing with friendly bacteria. If the diet you are feeding is bad, then your pet will take even longer to recover and may never fully recover. The funny thing is that antibiotics relieve symptomatic problems. But after the antibiotics are stopped, the symptoms come back. So what happens now? They give more antibiotics. What's ironic is that antibiotics are then given to help combat the problems that the antibiotics created in the body.

Antibiotics are definitely over prescribed and over used. Antibiotics for example do nothing for a virus and yet are often administered anyway. Hopefully soon, common sense will prevail and medical practitioners will realize  what is happening. But, it is up to you, the people to put pressures on vets to become more careful about their practice of administering antibiotics. In fact, encourage your vets to learn the alternatives. Make them aware that there are side effects that can no longer be ignored.

Before antibiotics, what did people do? In World War 1, medics put garlic cloves, which have long been acclaimed for their natural antibiotic properties, in the wounds of soldiers. Some use bee propolis which has natural phagocystosis properties. Phagocystosis is the ability to encourage white blood cells to destroy bacteria. There are certainly many other natural antibiotics which have no side effects (except bad breath in garlic's case). In general, natural antibiotics only attack bad bacteria and leave the friendly bacteria alone. Become aware that although antibiotics have helped save many lives, they are not a cure by any means.

Conclusion - The body should have 80% friendly bacteria and about 20% bad bacteria inside the intestinal tract. After the use of antibiotics, the body will have no more than 20% friendly bacteria and 80% bad bacteria if not more. Most illness, disease and problems begin in the intestinal tract. Thus, antibiotics create the potential for serious illness to begin. You may not be giving your pet antibiotics, but if it has ever eaten foods with preservatives, you have been giving your pet what I call 'hidden antibiotics'. The job of preservatives is to control bacteria and once your pet eats food with preservatives, it will ultimately have an effect inside the intestinal tract too and kill the friendly bacteria. - You should expect it will take at the very least 1 year to recolonize the intestinal tract with friendly bacteria after the use of antibiotics. - Recolonze the intestinal tract with friendly bacteria by using supplements and feeding natural foods. Written by Jesse Dallas.

Note: Feeding your animal a diet of raw food (meat, fish, nuts, fruits, grains and vegetables) will provide ample supply of friendly bacteria. I noticed that dogs are fond of rotten food items from compost piles. The reason is probably because rotten foods are rich in friendly bacteria. The worst it smells, the better she seems to enjoy eating it. To an animal, spoiled vegies may be similar to what yogurt is to humans.

minibabyqq 2006-12-28 01:56 AM

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癒合以homeopathy, 我們使用為人的維生素和草本是還安全 和有效的 為所有種類

Homeopathy 是一個全部方式對待綜合症狀病症由身體的自己醫治用的反應的刺激。他們準備從自然物質; 植物、礦物和動物對微藥量(高度被稀釋的物質的) 用途保證缺乏毒力、副作用和偵查在藥物測試期間。

癒合以Homeopathy 運作更加高級比到達non-physical 身體的物理振動, 癒合圖紙能量振動被打亂的疾病, 並且物理平實癒合隨後而來從振動變動和重新平衡。

可利用的是似犬& 似貓的免役證明包括。
(被推薦的Boarding 狗窩名單如果您住在澳洲)

嚼膏藥

吃或嚼膏藥有缺乏在' 鈣& 鎂裡' 的狗- 這些礦物的一個自然形式是有這兩礦物在他們的白雲岩粉末, 並且是在' 最宜的粉末補充混合物補充。您能組成它和補充說來每日飯食。


毛皮球

哺養好自然飲食, 將阻止這個問題因為他們將流洒較少毛皮並且他們的消化系統將有酸為潤滑。幫助一隻貓立刻為第一星期增加1/2 茶匙額外維京橄欖油來他們的每日飯食, 潤滑系統幫助消滅通過消化短文等。對毛皮球的Homeopathic 補救。

牙匾預防& 撤除。

再次餵養您的寵物以防腐免費和未加工的肉飲食, 是匾的預防。加來商業食物的糖實際上導致匾細菌。當糖被結合這將形成堅硬匾, 形成酸和這是最終導致朽爛的酸。  


耳朵小蜘蛛/傳染

混合過氧化+ 的5% 或3% 容量與1/2 茶匙麥子毒菌油和加大約水3 mls 。
(溫暖混合物, 由安置小碗一個更大的碗溫暖的水)

如果貓或狗有您可能需要使用一種homeopathic 治療下落的耳朵傳染, 如果傳染是慢性的。
為耳朵小蜘蛛使用或一個棉花球或眼睛吸管, 填裝眼睛吸管和柔和地滴下混合物入耳道(大約一半茶匙) 讓它運行下來入耳朵幾秒鐘從耳朵的基地柔和地然後按摩它(聽見壓碎聲音) 按摩為2/3 分鐘那麼讓貓或狗震動他們的頭, 做這個做法每天3 天那麼重覆同樣以下星期。

為耳朵傳染做同樣, 除了款待耳朵每天直到沒有其他棕色流體不是存在或蠟被清除了。它重要投入您的寵物在自然未加工的meat/veg 飲食並且食物維生素補充, 許多耳朵傳染導致從質量差food/food allergy/low 免疫系統。

中耳傳染

可利用的是草本下落為(耳道應用)
並且Homeopathic 下落(口頭被給)

* 傳染用途附子的第一個標誌30C homeopathic 下落在寵物頭頂部是優良, 用途直到急性的標誌消失。

• 如果傳染是以後參見homeopathic 進一步下來。


給組合打蠟

橄欖油- 25 機器語言, 維生素E 400IU, 杏仁油- 10ml (溫暖的油) 混合和用途每日直到放電是- 浸泡棉花球或使用眼睛吸管和柔和地浸泡入貓或狗的耳朵耳道。柔和按摩, 然後讓寵物搖他們的頭。

• 為有土, 蠟狀和痒的罐頭用途組合homeopathic 下落烏賊屬30C 每日藥量的更舊的貓直到症狀是。


為了完全地癒合耳道和停留從re 動物需要被投入在好營養飲食的傳染或小蜘蛛解脫, 因為動物不會就該易受影響再對缺乏根本vitamins/minerals 維護頂面健康。

自然- 蚊子/蚤/壁虱令人退避的狗& 貓

蚤狗洗滌- 增加玉樹油40 到60 下落來肥皂的洗滌液和洗滌狗- 馳名趕走蚤。

蚤狗洗滌- 用途5ml 對草本稱Neem 菜籽油對您自然香波從健康商店。

停止蛋的週期(通常在地毯)... 。。洒 硼砂粉末 在地毯區域在房子和狗和貓床, 震動, 和真空地毯在幾塗層地毯分鐘內。並且投入一些硼砂在真空袋子。像必要一樣經常重覆停止eggs/fleas 。

每日保護為狗- 增加Neem 油5ml 被稀釋入水500mls, TICKS/FLEAS/MOSQUITOS 的用途在一個浪花瓶為每日治療或保護。



乾性皮膚情況- (狗)

增加一個茶匙橄欖油來食物直到皮膚情況被解除, 然後一天一次使用最宜的油混合物補充。(鱈魚肝臟油& 紅花油- 混合物)



Eczema 癒合& 蚤放水劑- (狗洗滌)

稀薄地切一個整體檸檬, 包括果皮。增加它來1 品脫近煮沸的水和讓陡峭隔夜。次日, 擦解答動物的皮膚& 讓它烘乾。並且蚤和蚊子令人退避的Avon 的SSS 油被使用在最後的水漂洗。Neem 油液體(增加5ml 來浪花瓶或來您寵物的香波) 是癒合的一個優秀形式eczema 和mange 在狗。

剝皮過敏

實際上是缺鋅的標誌。買被結為螯合物的鋅10mg 片劑和擊碎片劑& 混合入每日飯食。年長貓狗有益於這礦物在他們的每日規則飯食, 與消化酵素tablet(crushed) 一起。變動任意節食對所有自然防腐劑一個。那不意味沒有其他商業狗餅乾或罐子食物。較不毒性化學製品和藥物更加健康您的寵物將停留。許多狗對食物是過敏的(商業) 並且避免麵團, 米, 紅蘿蔔, 酵母, 玉米, 麥子, 牛肉, 燕麥。這些是一些更加共同的食物allergerns.(all 商業食物有麥子、玉米和蜜餞、質量差人為肉和flavorings)


外套調節劑為狗(只)

(羅斯瑪麗草本幫助排斥蚤& 情況外套)
1 個茶匙烘乾了葉子的羅斯瑪麗(或1 把大湯匙新鮮的草本) 帶來給煮沸1 品脫水。結合& 浸泡10 分鐘, 蓋。張力& 冷卻對體溫。傾吐它在您的狗作為最後的沖洗。摩擦和毛巾乾燥沒有進一步漂洗。
Healing with homeopathy, vitamins and herbs that we use for humans are also safe and effective for All Species

Homeopathy is a holistic way to treat syndromes illnesses by the stimulation of the body's own healing responses. They are prepared from natural substances; plant, mineral and animal. the use of micro-doses ( highly diluted substances) guarantees the absence of toxicity, side effects and detection during drug tests.

Healing with Homeopathy works higher than physical vibration that reaches the non-physical bodies, heals the disease where the blueprint energy vibration is disrupted, and the physical level healing follows from the vibrational change and rebalancing.

Available are Canine & Feline Immunization Certificate Included.
(Recommended Boarding Kennel list if you live in Australia)

Chewing Plaster

Dogs that eat or chew plaster have a deficiency in 'Calcium & magnesium' - a natural form of these minerals is Dolomite Powder which has both these minerals in them, and is in the 'Optimum Powder supplement mixture supplement. You can make it up and add to daily meals.


Fur Balls

Feeding a good natural diet, will deter this problem as they will shed less fur and their digestive system will have acids for lubricating. To help a cat straight away for the first week add 1/2 teaspoon of Extra Virgin Olive Oil to their daily meals, which lubricates the system to help eliminate through the digestive tract etc. Homeopathic Remedy for Fur Balls.

Tooth Plaque prevention & removal.

Once again feeding your pets with a preservative free and RAW meat diet, is a prevention of plaque. The sugars that are added to the commercial foods actually cause the plaque bacteria. When sugar is combined this will form the hard plaque, which forms an acid and it is the acid that eventually causes the decay.  


Ear Mites / Infections

Mix 5% or 3% volume of hydrogen Peroxide with 1/2 teaspoon of wheat germ Oil and add about 3 mls of water.
(Warming the mixture, by placing small bowl onto a larger bowl of warm water)

If cat or dog has an ear infection you may need to use a homeopathic treatment drops as well, if the infection is chronic.
For Ear Mites use either a cotton ball or eye dropper, fill eye dropper and gently trickle mixture into the ear canal (approx. half a teaspoon) let it run down into the ear for a few seconds then from the base of the ear gently massage it (hear the squishing sound) massage for 2/3 minutes then let the cat or dog shake their head, do this procedure each day for 3 days then repeat same the following week.

For Ear Infections do the same, except treat the ear every day until no more brown fluid is present or the wax has been cleared. It is important to put your pet on a natural raw meat/veg diet and food vitamin supplements, many ear infections are caused from poor quality food/food allergy/low immune system.

Middle Ear Infections

Available are Herbal Drops for (Ear Canal application)
and Homeopathic Drops ( given orally)

* First sign of infection use Aconite 30C a homeopathic drops on top of pets head is fine, use until signs of acuteness disappear.

• If infection is at a later stage see homeopathic further down.


Wax Build up

Olive Oil - 25 ml, Vitamin E 400IU, Almond Oil - 10ml (warm Oil) Mix and use daily until discharge goes - Soak cotton ball or use eye dropper and gently soak into ear canal of cat or dog's ear. Gently massage, then let pet shake their head.

• For older cats that have a build up of dirt, waxy and itchy can use the homeopathic drops Sepia 30C Daily dose until symptoms go.


In order to completely heal the ear canal and stay free from re infections or mites the animal needs to be put on a good nutritional diet, as the animal will not be susceptible anymore due to lack of the essential vitamins/minerals to maintain top health.

Natural - Mosquito / Flea / Tick Repellant Dog & Cats

FLEA Dog WASH - Add 40 to 60 drops of Eucalyptus Oil to soapy washing water and wash dog - reputedly rids fleas.

FLEA Dog WASH - Use 5ml of Herb called Neem Seed Oil to you natural shampoo from the health store.

To stop the cycle of eggs (usually in carpets) ..... Sprinkling Borax Powder over carpet area in house and dog and cat beds, shake out, and vacuum carpets within a few minutes of coating carpet. Put some Borax in the Vacuum bag also. Repeat as often as needed to stop eggs/fleas.

DAILY PROTECTION FOR DOGS - Add 5ml of Neem Oil diluted into 500mls of water, use in a spray bottle for daily treatment or protection of TICKS/FLEAS/MOSQUITOS.



Dry Skin Condition - (Dog)

Add a teaspoon of Olive Oil to food once a day until the skin condition is relieved, then use the Optimum Oil mixture supplement. (Cod Liver Oil & Safflower Oil - Mixture )



Eczema healing & Flea Repellent - (Dog Wash)

Thinly slice a whole lemon, including the peel. Add it to 1 pint of near-boiling water and let steep overnight. The next day, sponge the solution onto the animal's skin & let it dry. Also a FLEA and mosquito repellent Avon's SSS Oil used in a final water rinse. Neem Oil liquid (add 5ml to spray bottle or to you pet's shampoo) is a excellent form of healing of eczema and mange in dogs.

Skin Allergies

Are actually signs of zinc deficiencies. Buy the Chelated Zinc 10mg Tablets and crush the tablet & mix into daily meals. Elderly cats an dogs benefit this mineral in their daily regular meals, along with digestive enzyme tablet(crushed). Change diets to a all natural preservative free one. That means no more commercial dog biscuits or tin foods. The less toxic chemicals and drugs the healthier your pet will stay. Many Dogs are allergic to the foods (commercial) Also avoid pasta, rice, carrots, yeast, corn, wheat, beef, oats. These are some of the more common food allergerns.(all commercial foods have wheat, corn and preserves, poor quality artificial meat and flavorings )


Coat Conditioner for Dogs (only)

( Rosemary herbs helps repel fleas & Conditions coat )
1 teaspoon dried Rosemary leaves (or 1 tablespoon of fresh herb) Bring to the boil 1 pint of water. Combine & steep for 10 minutes, covered. Strain & cool to body temperature. Pour it over your dog as a final rinse. Rub in and towel dry without further rinsing.

minibabyqq 2006-12-28 01:57 AM

轉貼自4682

[color=Magenta][b][size=5]Euthansia 和正確的時間!   [/size][/b][/color]


動物和正確的時期為無痛苦的死亡?

以下文章摘抄在它的全部從書, "動物的觀點在死, 死亡和無痛苦的死亡", 由伊麗莎白・F. Severino 博士寫。

Severino 博士是一種高度老練的動物通信裝置以幾乎20 年的經驗並且誰處理所有動物和所有問題以愛和慈心。  她書是可利用的或通過她的網站或通過amazon.com 。

"毀壞動物, 把動物放下, 或euthanizing 它, 有非常不同的涵義, 在和在物理身體的死亡以後期間, 根據動物是死亡的階段並且意圖能量在死亡附近。

在dying/illness 第1 個階段, , 雖然動物稱它"第1 個階段死", 動物是能恢復, 動物實際上知道它的物理身體是能癒合, 和可能經常自癒, 但仍然要求一些合作從它的直接環境。這合作會包括適當的食物、創傷或擦傷處的休息、潔淨, 和或許一些獸醫干預。動物euthanized 在第1 個階段將是迷茫的從任何地方6 個到12 個月, 人的時間。

在dying/illness 第2 個階段, 動物的物理身體也許或不能恢復。一個動物在這個階段知道它要求某一排序的干預為了它的物理身體癒合。它不再能完全地單獨自癒。動物euthanized 在第2 個階段將是迷茫的在任何地方從6 個星期到6 個月, 人的時間。

在第3 個階段死, 動物知道它的物理身體可能不再被癒合沒有神的干預。它開始soul/spirit 的分離從形式。動物的spirit/soul euthanized 在第3 個階段可能是充足地清楚被接觸在24 小時之內, 和通常是完全地清楚在4 個到6 個星期, 人的時間。他們說它是真實的人的知覺。


動物euthanized 在第3 個階段非常相似地起反應非常, 與自然地死了的動物。這像自然地死幾乎是一樣為他們, 並且他們是優良與它。一些相當明顯他們的主要經驗, 從詞條入第3 個階段, 將是痛苦和身體的進步失敗。

人的詞無法申張正義對非凡範圍, 區別, 分別, 連續流從精妙的和平並且動物的清晰euthanized 在第3 個階段, 對動物離開的形式的痛苦, 易爆的混亂在第1 個階段以前。亦不適當地能人的詞重音多麼非凡它是並且多麼重要它將知道第3 個階段是很相似在它的精神衝擊, 對自然死亡。

一個遭受的伴侶動物的詞條入第3 個階段由一個非常突然的變化在行為上, 變動標記足夠劇烈和足夠不同以便它的人通知。請注意我們談論遭受, 害病, 或老和不牢固的動物。從未咬住了的動物將咬住。

"過份地從未聽起來" 的動物(咆哮, screeched) 過份地將聽起來。動物, 總是熟悉, 將成為distant/withdrawal 和掩藏或許, (例外: 一隻年長貓, 做什麼我稱vocalizing, 做□非常不同事。..這不是第3 個階段顯示) 。但請求幫忙。(如果這是您的貓, 尋找血液或尿檢為腎臟問題或慢性膀胱炎, 診斷, 一次對待您的貓以是安全和柔和的。) 的homeopathic 補救

動物或進入或已經在第3 個階段, 突然將開始起反應好像它(用人的術語) 幻想, 與相關和或反應對, 計算, 對肉眼"不是有。" 什麼這時發生, 是, 動物的知覺開始對分別於形式, 並且它實際上開始對更加清楚看能量, 有時非物質人或動物, 和經常天使, 多數肉眼不能欣然看。

如果您是一位保管財物者為一個遭受的動物, 並且您為一會兒提供了自然醫學和關心和認識您感受您的動物是在第3 個階段, 要求問題...  (But 深深地首先呼吸的her/him 並且集中自己如同您最好能)

清除您的頭腦如同您最好能; 記住首要您的對您的動物和最高好的愛; 專心地轉動您的能量對您的動物, 和要求, "是您準備好現在留下形式?"
深深地再呼吸。您的動物將回答在那呼吸裡。

如果您不是肯定的答復, 不重覆做法, 和這時候, 要求, "您請將給我標誌, 行為變動, 如果和當您變得準備好, 如果和當您進入第3 個階段?"

動物總將反應, "是," 這個問題。

然後您等待和觀看。並且如果您仍然不是肯定的, 不重覆做法, 和不補充說, "您請將使它非常明顯如果您是或當您進入了第3 個階段?"

當寵物準備好, 安排一位狩醫來到您的家協助。您能並且幫助協助它的精神的分離形式, 由給您的寵物一種尊敬的儀式由燒一個白色蠟燭為24hrs 。

動物得到的清除器, 快它能移動它的精華能量向它的再生。

在許多情況下在過去幾年, 我發現了是很清楚在分離從形式以後的動物, 他們能和告訴了他們的人是否有機會他們再一起會是在這一生; 如果那樣, 告訴人近似地理位置、近似時間, 和形式, 他們會轉世。

數的確是現在一起再。如此, 如果這與您的生活關係, 與動物在您的關心, 請知道, 動物是好以是euthanized 。

並且請知道, 他們將愛您什麼您做並且什麼您決定。它最後是容易在他們, 然而, 如果euthanizing 做在正確時間。尋找標誌的是在第3 個階段。
它事關。
Animals and the right time for Euthanasia?

The following article is excerpted in its entirety from the book, "The Animals' Viewpoint on Dying, Death and Euthanasia", written by Dr. Elizabeth F. Severino.

Dr. Severino is a highly experienced animal communicator with almost 20 years' experience and who handles all animals and all issues with love and compassion.  Her books are available either through her web-site or through amazon.com.

"Destroying an animal, putting an animal down, or euthanizing it, has very different implications, during and after the death of the physical body, depending on the stage of death that the animal is in and the energy of intention around the death.

In the 1st stage of dying/illness, in which, although the animals call it the "1st stage of dying", an animal is still capable of recovering, the animal actually knows its physical body is capable of healing, and often can heal itself, but still requires some cooperation from its immediate environment. This cooperation would include proper food, rest, cleanliness of wounds or abrasions, and perhaps some veterinary intervention. An animal euthanized in the 1st stage will be confused for anywhere from 6 to 12 months, human time.

In the 2nd stage of dying/illness, an animal's physical body may or may not recover. An animal in this stage knows it requires intervention of some sort in order for its physical body to heal. It is no longer able to heal itself completely by itself. An animal euthanized in the 2nd stage will be confused for anywhere from 6 weeks to 6 months, human time.

In the 3rd stage of dying, an animal knows its physical body can no longer be healed without a Divine intervention. It begins the separation of soul/spirit from form. The spirit/soul of an animal euthanized in the 3rd stage can be sufficiently clear to be contacted within 24 hours, and is usually completely clear in 4 to 6 weeks, human time. They say it is true of human consciousness.


Animals euthanized in the 3rd stage react very, very similarly to animals that have died naturally. It is almost the same for them as dying naturally, and they are fine with it. Some are quite clear that their primary experience, from entry into the 3rd stage on, will be pain and progressive failure of the body.

Human words cannot do justice to the extraordinary range, the difference, the distinctions, the continuum from the exquisite peace and clarity of an animal euthanized in the 3rd stage, to the painful, explosive confusion of an animal leaving form even before the 1st stage. Nor can human words appropriately stress how extraordinary it is and how important it is to know that the 3rd stage is so similar in its spiritual impact, to natural death.

A suffering companion animal's entry into the 3rd stage is marked by a very sudden change in behaviour, a change dramatic enough and different enough so that its humans notice. Please note we are talking about suffering, diseased, or old and infirm animals. An animal that has never bitten will bite.

An animal which has never "sounded" excessively (barked, screeched) will sound excessively. An animal, which has always been familiar, will become distant/withdrawal and hid perhaps, (Exception: an elderly cat, doing what I call vocalizing, is doing something very different . . . it is NOT an indicator of 3rd stage). But is asking for help. (If this is your cat, seek a blood or urine test for kidney issues or chronic cystitis, once diagnose, treat your cat with homeopathic remedies that are safe and gentle.)

An animal either entering into or already in the 3rd stage, will suddenly start to react as if it were (in human terms) delusional, relating to and or responding to, figures that to human eyes "aren't there." What's happening at this point, is that the animal's consciousness is starting to separate from form, and it is actually starting to more clearly see energies, sometimes incorporeal human or animal, and often angelic, which most human eyes can't readily see.

If you're a caretaker for a suffering animal, and you have provided natural medicines and care for awhile and know you feel your animal is in the 3rd stage, ask her/him a question  ...(But first breathe deeply and centre yourself as best you can)

Clear your mind as best you can; remember foremost your love for your animal and the highest good; turn your energy intently to your animal, and ask, "Are you ready to leave form now?"
Breathe deeply again. Your animal will answer in that breath.

If you're not sure of the answer, repeat the procedure, and this time, ask, "Will you please give me a sign, a behaviour change, if and when you become ready, if and when you enter the 3rd stage?"

The animals will always respond, "Yes," to this question.

Then you wait and watch. And if you're still not sure, repeat the procedure, and add, "Will you please make it very obvious if you're in or when you've entered the 3rd stage?"

When the pet is ready, arrange a Vet to come to your home to assist. You can also help assist its' spirit's separation form, by giving your pet an honoring ritual by burning a white candle for 24hrs.

The clearer an animal gets, the sooner it can move its essence energy on to its reincarnation.

In many cases over the past few years, I've found animals that were so clear after separating from form, they could and did tell their humans whether or not there was a chance that they would be together again in this lifetime; and if so, have told the humans the approximate geographical location, the approximate timing, and the form, into which they would reincarnate.

Several are indeed now together again. So, if this relates to your life, to the animals in your care, please know that the animals are OK with being euthanized.

Please also know that they will love you whatever you do and whatever you decide. It's easier on them ultimately, however, if euthanizing is done in the correct time. Look for the signs of being in the 3rd stage.
It matters.

minibabyqq 2006-12-28 01:58 AM

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[color=Magenta][b][size=5]Cancer and Auto-Immune  [/size][/b][/color]


一總裝載過多身體, 個體的頭腦(情感) 並且精神由是致癌物質的罐頭的有毒能量領域導致巨蟹星座和自動免疫的綜合症狀。

有毒能量領域包括:

1 。 飲食:

商業寵物食品用汙染化學製品被填裝: 殺蟲劑、除草藥、石油、食物著色和毒性致癌物質的防腐劑譬如ethoxyquin (多數製造商不投入這在標籤而是所有用途它保存脂肪), 和重金屬(特別是主角、水銀和鋁) 。動物肉由產品運載藥物de- wormers 、疫苗, 和藥物有毒能量被給動物在它的一生期間。

"新鮮食品材料" 買了在市場上譬如菜, 穀物, 肉, 禽畜並且魚是裝載與重金屬由於汙染的地下水源、小河、海洋和土壤在這個國家。這些來自工業和消費者來源燒礦物燃料, 導致空氣的汙染, 健康危害殺蟲藥不正當的處置, 石油產品、電池、食物和氯的重金屬汙穢和氟化物毒力在自來水裡。

你必須停止哺養任一個品牌商業寵物食品。開關對detoxed, 新鮮, 家做的自然飲食。


2 。免疫破壞:

從頻繁, 多接種並且/或者長遠時期類固醇藥物管理。長的期限抗生素、抗組胺、non-steroidal 抗發炎藥物、鎮定藥, 和致癌物質的蚤和heartworm 殺蟲劑預防藥方。這是一個已知事實有導致臨床似貓的白血病的一種高交互作用與似貓的白血病疫苗。有並且腫瘤形成的一種高交互作用在其它重覆的疫苗接種站點。


3 。 曝光:

對致癌物質, 環境和其他有毒能量輻射: Biofeedback 能量掃瞄測試在QCXI 設備與動物fur/photo 通常顯示寵物由電場影響導致在電子接線裡和所有電氣用品、辦工用電腦、電腦、影印機、掃描器、印表機、手機、熱水配管管子、汙水管子、電話和電話接線。輻射被傳送從微波爐, 並且醫療X-射線和貓掃瞄。輻射對身體可能被取消以nosodes 。


戴安娜・海斯, DIHom, 承擔了8 年最宜的醫治用的研究, 發現了一個增加的malignatizing 的影響對家庭成員- 人和動物, 當家/辦公室/狗窩/catteries/槽櫪被安置了在這些geopathic 區域。

這些是真實的"巨蟹星座" 房子。在歐洲和亞洲, 這被認可了為上百年。中國電話這些區域龍的"爪" 。這些能量領域必須由一熟練的dowser 查出和中立化。家庭寵物是一注意在被改變的環境能源系統上的區別。

例如, 當有房間或區域寵物拒絕睡覺。

毒力的起因需要由具體homeopathic nosodes 洗滌: 即我的Homeopathic Detox 為可能是增加的具體藥物、殺蟲劑、heartworm 和蚤/壁虱預防藥物、抗生素、類固醇, 等被給動物的重金屬。我有咨詢服務為動物所有者。

請看這個網站的網上咨詢部分。

所有接種和(狂犬病nosodes - 美國) 必須被給洗滌這些有毒能量系統。



6 。毒性情感、重音和否定論 罐頭正比任一種致癌物質肯定毀壞免疫系統的能力對作用。




巨蟹星座的治療以能量醫學

1 。執行具體巨蟹星座Nosodes 制止癌症的傳播和有希望地減少實際成長的大小。淋巴drainers 和特別"幫手" homeopathy 補救是包括的。
癌症營養飲食板料和教導並且被提供。
homeopathic detox 治療系列包括連續地洗滌這些nosodes 越□越高有力: 30C, 100C, 200C, 然後複評反應。許多次在更舊的動物我們必須更高向反應求助。

2 。加強免疫系統與遲鈍的Colostrums cap/powder 在食物, 3x 裡日報, 有具體有利免疫系統斡旋人加強和平衡免疫系統。colostrums 的抗病毒, 抗菌和殺真菌劑的物產幫助保護被減弱的癌症患者免受次要傳染。

3 。支持以Homeopathy: 肝臟Spleen/Pancreas, 內分泌平衡為馬律或女性, 和總身體支持對於馬律或女性補救是非常有用的。

5 。每天執行抗氧劑譬如維生素E 、Beta 胡蘿蔔素(維生素A 為貓) 並且酯類維生素C, 以多個礦物補充。

6 。停止哺養所有商業寵物食品和款待和替換用detoxed, 新鮮, (更好地未加工的) 家做的飲食。

7 。避免對觸犯的有毒致癌物質的進一步暴露。使用homeopathic vaccines/wormers 唯一, 中立化環境輻射在home/barn/kennels/catteries 和detox 一切被投入入或您的寵物。如果治療開始及早在疾病, 它是可能扭轉情況。


證詞

甲狀腺腫瘤

"... 狩醫預測非常是貧寒2 年前
因為我們去您為幫助, Kepa 現在做□很好- 愉快和很好愛。
他的腫瘤是存在, 但它未增長在大小因為他的飲食的自然醫學和變動大約18 個月前。
感謝再! 戴安娜, 沒有您的幫助和知識' Kepa ' 更不會在這裡- 您是難以置信的。"
Koa 約翰遜・夏威夷。美國。


奪取

"... 我斷絕了' Rudi ' 所有他的早先藥物療程1月29 日自。
他美妙地做□, 他迄今沒有奪取並且變化在他的行為& 態度上是卓越的。

他意識到他的周圍和想要參加什麼繼續。他的PU/PD 正常化了。他睡覺通過夜多半時間。如果我偶然地未找到您, 我不會想像有別的我能做為Rudi, 並且我到達了一個轉折點在指向無痛苦的死亡的他的生活中。
非常謝謝。" Judi 美國。



膀胱癌

"... 在什麼以後您做了對Porscha 我們的狗, 我認為, 您能幫助我和我家離開這憔悴以您的homeopathy 補救。我們所有試驗過的射擊和常規醫學但他們工作了在開始唯一, 他們不再一會後是高效率的。"
Khanh Bui Pho. 美國

A total overburdening of Body, Mind (Emotion) and Spirit of the individual by noxious energy fields that are carcinogenic can lead to Cancer and Auto-Immune Syndrome.

Noxious energy fields consist of:

1. DIET:

Commercial pet food is filled with polluting chemicals: pesticides, herbicides, petroleum, food coloring and toxic carcinogenic preservatives such as ethoxyquin (most manufacturers don’t put this on the label but all use it to preserve animal fat), and heavy metals (especially lead, mercury and aluminum). Animal meat by- products carry the noxious energies of drug de- wormers, vaccines, and drugs given to the animal during its lifetime.

Even “fresh food stuffs” bought in the market such as vegetables, cereals, meat, poultry and fish are laden with heavy metals due to contaminated underground water sources, streams, ocean and soils in this country. These come from industrial and consumer sources burning fossil fuels, causing pollution of the air, improper disposal of health hazard insecticides, petroleum products, batteries, heavy metal contamination of the food and chlorine and fluoride toxicities in tap water.

One must stop feeding commercial pet food of any brand. Switch to detoxed, fresh, home made natural diets.


2. IMMUNE DESTRUCTION:

from frequent, multiple vaccinations and/or long- term steroid drug administration. Long- term antibiotics, antihistamines, non-steroidal anti-inflammatory drugs, tranquilizers, and carcinogenic flea and heartworm pesticide preventative drug therapy. It is a known fact that there is a high correlation of producing clinical Feline Leukemia with the Feline Leukemia vaccine. There is also a high correlation of tumor formation at sites of other repeated vaccine inoculations.


3. EXPOSURE:

to carcinogenic, environmental and other noxious energy radiations: Biofeedback energy scan testing on the QCXI device with animal fur/photo regularly shows the pet is being affected by electrical fields produced in electrical wiring and all electrical appliances, office machines, computers, copiers, scanners, printers, cellular telephones, hot water plumbing pipes, sewerage pipes, telephones and telephone wiring. Radiation is transmitted from microwave ovens, as well as medical x-rays and cat scans. Radiation to the body can be removed with the nosodes.


Diana Hayes, DIHom, who has undertaken 8 years of optimum healing research, has found an increased malignatizing affect to household members – human and animal, when homes / offices / kennels / catteries / stables have been placed over these geopathic areas.

These are true “Cancer” houses. In Europe and Asia, this has been recognized for hundreds of years. The Chinese call these areas the “Claw of the Dragon”. These energy fields have to be detected and neutralized by a skilled dowser. The household pets are the first to notice the difference in changed environmental energy systems.

For example, when there are rooms or areas pets have refused to sleep in.

The causes of toxicities need to be cleansed by specific homeopathic nosodes: e.g. My Homeopathic Detox for heavy metals to which can be added specific drugs, pesticides, heartworm and flea / tick preventative drugs, antibiotics, steroids, etc. given to the animal. I have a consultation service for the animal owner.

Please see the On-Line consultation section of this website.

All vaccinations and (Rabies nosodes - USA) must be given to cleanse the system of these noxious energies.



6. Toxic Emotions, Stress and Negativism can just as surely destroy the ability of the immune system to function than any carcinogen.




TREATMENT OF CANCER WITH ENERGY MEDICINE

1. Administer specific Cancer Nosodes to halt the spread of the cancer and hopefully reduce the size of actual growths. Lymph drainers and special “helper” homeopathy remedies are included.
A cancer nutritional diet sheet and guidance is also provided.
The homeopathic detox treatment series consist of sequentially cleansing by higher and higher potencies of these nosodes: 30C, 100C, 200C, then re-evaluating response. Many times in older animals we have to go higher for response.

2. Reinforce the immune system with Bovine Colostrums cap/powder in food, 3x daily, which has specific beneficial immune system mediators to strengthen and balance the immune system. The antiviral, antibacterial and antifungal properties of the colostrums help to protect the weakened cancer victim from secondary infections.

3. Support with Homeopathy: Liver/ Spleen/Pancreas, Endocrine Balance for Male or Female, and Total Body Support for Male or Female remedies are very helpful.

5. Administer antioxidants such as Vitamin E, Beta Carotene (Vitamin A for cats) and Ester Vitamin C, with multiple mineral supplementations on a daily basis.

6. Stop feeding all commercial pet foods and treats and replace with detoxed, fresh, (preferably raw) home made diets.

7. Avoid further exposure to the offending noxious carcinogens. Use homeopathic vaccines/wormers only, neutralize environmental radiations in the home/barn/kennels/catteries and detox everything put into or onto your pet. If treatment is started early in the disease, it is possible to reverse the condition.


Testimonies

Thyroid tumor

"... Vet prognosis was very poor 2 yrs ago
Since we had gone to you for help, Kepa is now doing well – happy and well loved.
His tumor is still present, but it has not grown in size since his natural medicines and change of diet about 18 months ago.
Thanks again! Diana, without your help and knowledge 'Kepa' would not still be here - you are incredible."
Koa Johnson Hawaii. USA.


Seizures

"... I have weaned 'Rudi' off all his previous drug medications as of January 29th.
He is doing wonderfully, he has had no seizures to date and the change in his behavior & attitude is remarkable.

He is more aware of his surroundings and wants to participate in whatever is going on. His PU/PD has normalized. He sleeps through the night most of the time. If I hadn't accidentally found you, I would not have imagined there was anything else I could do for Rudi, and I had reached a turning point in his life that was pointing to euthanasia.
Thank you so much." Judi USA.



Bladder Cancer

"... After what you have done to Porscha our dog, I think that you will be able to help me and my family get out of this sickness with your homeopathy remedies. We all tried shots and conventional medicines but they worked at the beginning only, after a while they are not efficient any more."
Khanh Bui Pho. USA

minibabyqq 2006-12-28 01:59 AM

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[color=Magenta][b][size=5]TTouch 療法[/size][/b][/color]   


我們的伴侶動物, 是否工作或房子寵物, 吸收房子和他們的工作環境的人民的情感氣候。

伴侶並且寵愛犧牲為他們結合與人的福利。

動物採取消極能量或情況入他們自己(像海綿) 並且因此保護他們的房子的人民。如果動物是被注重或不適, 調查您的生活方式, 和嘗試做變動為所有關心!

貓和狗作為緩衝在他們的人民和世界的危險和陰性之間。

人意識到這在一個神志清楚的水平上當狗運行回到一個灼燒的房子保存孩子或投入自己在她的人和攻擊者之間和死。同樣情節每日發生在能級上雖然介入的人也許從未意識到它。貓在一個混亂的家庭也許體現她的監護人的癌症, 清除人的氣氛和採取疾病入她自己的身體。

情感平實癒合包括幫助寵物發布她吸收了從她的家庭的消極能量和情感, 和安排她自己的需要適應在那個家庭。

這清潔由第一理解完成怎麼回事和然後解決它。一定數量的全部方法運作從引起情感身體發布疾病。

動物通信是最重要的方法的當中一個(metaphysical 癒合) 我們經常跟隨這癒合並且瞭解以一些Homeopathic 下落, 如果我們親自看見動物我們能並且顯示寵物的監護人怎麼對做柔和的身體連接Ttouches, 所有或一個療法幫助緩和起因和激活癒合立刻。

動物與的人必須結合並且癒合!! ... 發布他們的情感失望的和注重為快速成功癒合。

重音是百分之八十五(或更多的) 直接緣由人的疾病, 和狗和貓份額和反映人生。



顯示消極動物行為!

有狗顯示的四(4) 本能行為類別-
當  感覺的...... Stressed!... Fearful!... 非常關心!

結冰              戰鬥                             飛行                       無所事事







什麼是Ttouch?

這是Ttouch 療法進來的地方, 這個獨特的接觸技術可能被使用在  狗、貓, 和馬解決這種日常天性反應, 使用一種柔和和自然連接的接觸療法(很容易做) 。我們使用了這種療法在所有類型動物, 一樣小像鳥   和兔子。它是非不可捉摸的, 柔和並且動物愛!!

注 : 寵物的這個醫治用的技術不是相同像寵物按摩或醫治用的reiki 能量。您能申請T 接觸每天或唯一兩三時間每星期是優良- 沒有比5 分鐘必需(最大。5 分鐘只如果動物是不適即在手術或非常被注重的) - 用途T 接觸之後在觀察之後什麼您的動物當時需要, 觀看為變動和新反應, 然後工作能被停止在動物, 或您可能需要研究其它問題!



怎麼Ttouch 技術運作。

手和胳膊應該依然是軟。意識到您呼吸。

Ttouch 移動皮膚而不是摩擦如同按摩會。意圖將激活神經系統的路對腦子& 改進細胞的作用。當您影響神經系統它並且影響肌肉。與light/firm /slow/steady 迫使想法將影響神經系統和細胞, 不是肌肉。當接觸適當地完成(圈子被關閉) 它引起所有四(4) 腦子- 波浪樣式在動物接受它, 阿爾法, beta, 希臘字母的第八字, 和三角洲。

即法線每日活動使用beta 樣式, 阿爾法與人的集中或凝思是等效的, 希臘字母的第八字是深刻的trance, 並且三角洲是水平在知覺之下通常與相關睡眠。使用接觸刺激身體細胞和對應的腦細胞激活腦子和改變老習性和樣式。

例如 它使動物認為通過而不是自動地起反應由天性。

....So 代替日常戰鬥或結冰, 無所事事或飛行反應, 動物評估情況- 和鎮定下來。

更加快速的起點圈子喚醒狗的或貓的身體, 並且慢慢地隨後而來允許深刻的放鬆, 發布肌肉緊張, 加深和提高呼吸作用, 援助物理和情感癒合。

Our Companion animals, whether working or house pets, absorb the emotional climate of the people of the house and their working environment.

Companion Pets also sacrifice themselves for the well-being of the humans they have bonded with.

Animals take negative energy or situations into themselves (like sponges) and thereby protect their people of the house. If the animal is stressed or ill, look into your lifestyle as well, and try to make changes for all concerned!

Both cats and dogs act as buffers between their people and the dangers and negatives of the world.

Humans are aware of this on a conscious level when a dog runs back into a burning house to save a child or puts herself between her person and an attacker and dies. The same scenario happens on an energy level daily although the humans involved may never be aware of it. The cat in a troubled family may manifest her guardian's cancer, clearing the human's aura and taking the disease into her own body.

Emotional level healing includes helping the pet to release the negative energy and emotions she has absorbed from her household, and having her own needs met in that household.

This clearing is done by first understanding what's going on and then resolving it. A number of holistic methods work to release disease from the causative emotional body.

Animal Communications is one of the most important methods (metaphysical healing) we most often follow this healing and understanding with some Homeopathic drops, also if we see the animal in person we can show the pet's guardian how to do the gentle body connecting Ttouches, all or one of the therapies help to alleviate the cause and activate healing straight away.

The human that the animal has bonded to must also heal!! ... Release their emotional frustration's and stress for fast successful healing.

Stress is the direct cause of eighty-five percent (or more) of human disease, and dogs and cats share and mirror human lives.



Displaying of Negative Animal Behavior!

There are FOUR (4) Instinctive behavior Categories that Dogs display -
when  feeling......Stressed!,...Fearful!...Very concerned!

Freeze              Fight                             Flight                       Fooling around







What is Ttouch?

This is where Ttouch Therapy comes in, this unique touch technique can be used on  dogs, cats, and horses to resolve this habitual instinct responses, using a gentle and natural connecting touch therapy (so easy to do). We have used this therapy on all types of animals, as small as birds   and rabbits. It is non evasive, gentle and animals love it!!

NOTE : This healing technique for pets is not the same as a pet massage or the healing reiki energy. You can apply the T touches everyday or only a couple of times a week is fine - no more than 5 minutes required ( max. of 5 minutes ONLY if animal is ill e.g. after surgery or very stressed ) – Use T touches only after observing what your animals needs at the time, watch for changes and new responses, then work can be stopped on the animal, or you may need to work on another problem!



How Ttouch technique works.

The hand and arm should remain soft. Be aware of your breathing.

The Ttouch moves the skin rather than rubbing as a massage would . The intention is to activate neural pathways to the brain & to improve the function of the cells. When you affect the nervous system it also affects the muscle. With light/firm /slow/steady pressures the idea is to affect the nervous system and cells, not the muscles. When the touch is done properly (circles closed) it generates all four (4) brain - wave patterns in the animals receiving it, alpha, beta, theta, and delta.

E.g. Normal daily activity uses the beta pattern, alpha is equivalent to human concentration or meditation, theta is deep trance, and delta is the Level below consciousness usually associated with sleep. Using the touch to stimulate the body cells and corresponding brain cells activates the brain and changes old habits and patterns.

For Example it enables the animal to think through rather than automatically reacting by instinct.

....So instead of the habitual fight or freeze, fooling around or flight response, the animal evaluates the situation - and calms down.

The faster beginning circles awaken the dog’s or cat’s body, and the slower that follow on allow deep relaxation, release muscle tension, deepen and enhance respiration, aid physical and emotional healing.

minibabyqq 2006-12-28 02:01 AM

轉貼自4682

[color=Magenta][size=5][b]咳嗽的評估在狗以心臟Evaluation of Cough in Dogs with Heart Murmurs [/b][/size][/color]

[size=12px]咳嗽狗共同地提出一種診斷和治療困境對實踐的獸醫。這是特別真實的在中年對年邁的小養殖狗, 經常被折磨以慢性呼吸疾病和僧帽形的不足, 每個也許導致咳嗽。問題然後成為一個區別呼吸並且/或者心血管疾病對咳嗽貢獻的程度對。這重要因為療法是相當不同的, 並且適當的療法為一個, 例如, 惡化其他。
咳嗽反射, 被咽的激怒, 喉, 氣管, 和更大的支氣管通常創始, 導致強有力的失效反對閉合的嗓門, 被突然的發行和被強迫的開除跟隨。這個防護機制是有用的在逐出雜質、滲出液, 和有機體從呼吸道。它是疲勞和並且激怒對患者和所有者。但是, 鎮壓咳嗽不被表明在所有事例。最好緩和根本原因, 和使用咳嗽suppressants 只在事例的一個有限的數字。因此, 以及允許具體治療和對更加準確地prognosticate, 一個明確的診斷是必須的。
咳嗽的起因是許多, 但在狗的人口在討論中, 咳嗽最共同地起因於上部導氣管疾病、tracheobronchial 崩潰、變化的原因論慢性支氣管炎, 肺纖維變性、bronchiectsis 、肺瘤形成、肺炎, 和僧帽形的反流(後者, 通常但不總以心力衰竭) 。在僧帽形的反流, 咳嗽的起因不是整個地清楚的, 但是左atrial 呼吸mucosa 的侵入在左主要支氣管並且/或者週期性laryngeal 神經, 腫鼓, 細胞間的可變的壓力在導氣管, 和過份支氣管黏液生產所有被建議了作為捐助。
慢性, 無答復的咳嗽診斷是富挑戰性, 特別當一致心臟病疾病被辨認。經常, 提及的這樣案件像fluoroscopy 被擔保, 提供如此診斷機會, electrocardiography 、echocardiography 、oximetry, bronchoscopy, bronchoalveolar lavage 、文化和敏感性、細胞學評估、肺切片檢查法或美好的針志向、血清學(即, 黴菌, 弓形體、heartworm, 等), 專業糞便考試(沉積作用和Baerman 考試為呼吸寄生生物), 和動脈和多血脈性的血液氣體分析。在許多情況下然而, 提及中心是不便的, 所有者decline 提及, 或提及是多餘的通過仔細歷史, 物理, 並且特別程式考試, 實際上所有小動物實踐可能為狗供給一優秀診斷workup 咳嗽和僧帽形的反流。
特別規程典型地可利用對私有實習者包括吸入並且呼氣胸部和子宮頸射線照相評估為導氣管崩潰或滲入, 心臟病心力衰竭的大小、證據, 和肺柔膜組織; electrocardiography 確定心率和左並且/或者正確的atrial 並且/或者心室擴大出現; transtracheal 洗滌作為bronchoscopy 的一個替補, 以文化和細胞學評估; 並且試驗利尿。期望的結果的這樣規程在慢性呼吸疾病和為僧帽形的反流被投入在表1 。對這個診斷協議的用途應該援助在咳嗽的起因的診斷在有心臟私語病人, 因此改進治療干預和患者反應。
歷史和物理研究結果(表1), 也許表明呼吸起因為慢性咳嗽, 包括肥胖病, 苛刻的咳嗽, mucopurulent 鼻放電, 苛刻, honking. 並且/或者有生產力的咳嗽, 和呼吸喘息。相反地, 情況損失; 軟, 非生產性的咳嗽, 經常壞在晚上; 伴隨呼吸困難(可以發生以嚴厲呼吸疾病); 並且心動過速以微弱的脈衝是表示的心臟病起因為咳嗽。
極小的資料庫為咳嗽workup 被描述在表2, 以另外的測試, 也許是有用的在一些, 但不必要總計, 案件。完全血液計數也許是有用的在表明嗜酸性白血球過多和可能basophilia, 是與過敏或寄生混亂兼容, 譬如寄生或嗜伊紅的肺炎或heartworm 疾病。以細菌肺炎, 那裡也許是sepsis 顯示, 譬如neutrophilia 、含毒物變化在嗜中性上, 和monocytosis 。它被強調, 血液學變動不一致最好。在heartworm 地方性區域, 適當測試是必要的(抗原Elisa 為狗在月度預防物; 抗原Elisa 並且/或者Knott 測試如果在沒有或每日預防物) 。狗以好預防歷史, heartworm 測試也許被延期直到在胸部造影之後。
總之, 最有用的工具是胸部射線照相。它是在範圍這個原稿之外回顧胸部造影。是有用的在分化心臟病從咳嗽的呼吸起因的具體變動會包括左對右胸擴大, 表示各自地心臟病和呼吸起因。肺、導氣管, 和肺vasculature 的狀態, 同樣, 經常闡明。支氣管變厚, 肺滲入(除肺腫鼓之外), 肺動脈擴大(頂端肺動脈大比伴隨的靜脈或他們相交) 第四塊肋骨的接近三分之一建議呼吸疾病以後者發現最一致與肺高血壓(典型地heartworm 疾病) 。相反地, 肺靜脈的擴大(頂端肺靜脈大於伴隨的動脈或大於他們相交) 第四塊肋骨的接近三分之一建議肺多血脈性的壅塞(左心力衰竭) 。導氣管的評估為動態作用最好執行與fluoroscopy 但可能由最大化接近資訊被搜集從常規造影。這可能由補充的定期充分的吸入的側向和ventrodorsal 射線照相完成以側向曝光在充分的失效, 和理想地, 充分的吸入的曝光被聚焦在子宮頸氣管。前意志展示intrathoracic 和後者, extrathoracic 導氣管崩潰。它應該被強調, 一項消極動態研究譬如這明確地不排除導氣管崩潰。
心電描記的研究結果與呼吸疾病(和實際上是respiratory.or 肺arterial.disease) 的heartworm 疾病兼容包括緩慢的率, 靜脈竇心率失常, P-pulmonale (P 揮動> 0.4 mv, 表明正確的atrial 擴大), 和偶爾地, 一個正確的心室擴大樣式(S 揮動在主角1, 2 裡並且3, 正確的軸偏差, 和深刻的S 揮動在V3) 。供選擇地, 狗以僧帽形的valvular 不足典型地有法線卑鄙電子軸, 心動過速如果在心力衰竭, P mitrale (被加寬和有時被刻凹痕的P 波浪), 和可能, 被留下心室擴大樣式(高R 揮動並且/或者延長了QRS 複合體) 。
關於呼吸疾病的本質的具體資訊可能定期地被獲得以transtracheal 志向(洗滌) 。這是成功在溫和的鎮靜之下(或無在debilitated 動物) 以便咳嗽反射不blunted 。標準外科準備進行在喉。cricothyroid 韌帶由感覺palpated 凹進; 這由屈曲和延伸強調脖子。Lidocaine 皮膚下地被滲入在這個站點。狗被安置在sternal recumbency 或在一個坐的位置。它重要保持狗對稱地被安置允許對解剖地標的準確評估。脖子是延長和小刺切開被做在cricothyroid 膜。一12 到18 英寸14- 16 測量靜脈內導尿管被使用用氣管刺膜, 數字式地被穩定。導尿管被指揮下來入導氣管和導尿管被推進。
咳嗽表明成功的詞條入導氣管。一旦導尿管充分地被推進了, 針支持從氣管和針衛兵被應用。金屬stylet 被去除並且nonbacterostatic 鹽(大約0.4 ml/kg) 被灌輸和迅速地reaspirated 。唯一infusate 的一個小分數被檢索。這個洗滌物做法也許被重覆一兩次。黏液或pus 的證據在被檢索的材料建議一次成功的洗滌。材料被安置在適當的運輸媒介和遞交為細菌(和可能黴菌) 文化和為細胞學評估。壓力應該嚮詞條站點施加為充分五分鐘在導尿管被去除之後。我喜歡不執行這個做法在狗較不比大約10.15 公斤; 在更小的狗, 做法執行通過一支不育的氣管內管使用一份紅色橡膠哺養的管和摘要一般麻醉。複雜化對這個做法是不凡的但住院治療或接近的觀察在家被勸告。鎮靜第一12 個小時是有用在可激發的狗或那些以難處理, 猛烈咳嗽。
Bronchoscopy 提供允許具體站點導氣管和有選擇性的採樣的直接形象化好處。不利包括費用、對特別專門技術和設備的需要, 和麻醉必要。優越細胞學樣品可能被獲得使用bronchoalveolar lavage, 並且要求一般麻醉和最好執行使用bronchoscopy 的技術。這個技術, 也許妥協動物以嚴厲呼吸疾病, 抽樣具體肺耳垂由填裝小窩在這個區域用不育鹽和吐氣內容。很大數量的細胞恢復和因為樣品被稀釋, 聚集細胞與黏液減到最小。Bronchoalveolar lavage 一般是後備的為較不蔓延性方法是不成功的案件。像技術以上提到, bronchoalveolar lavage 最有利地被使用在案件以除純淨的細胞間的疾病之外, 因為樣品代表主要導氣管和小窩。
最後, 一種卸貨的藥物的一次治療試驗, 譬如furosemide, 可能是有用的在統治在或在心臟病疾病之外作為起因為咳嗽。這樣的療法將清除腫鼓和將收縮左心房, 免除起因心臟病咳嗽。如果咳嗽是純淨地呼吸在起源, 這回旋不太可能是好處。幾個概念重要如果這種方法被使用。首先, furosemide 劑量必須是充分和療法的期間太久(0.5.1 mg/kg q8h 2-4 天) 允許堅定結論至於它的效力在控制咳嗽。其次, 這種方法不應該介入任何其它藥物, 以便一個有利反應的確切的起因是顯然的。最後, 所有者需要被教育對事實這是反應他們的評估是重要的一次診斷測試, 並且如果成功, 劑量將被降下並且其它藥物, 譬如血管緊縮素轉換的酵素抗化劑, 將增加來養生之道。
使用這種方法, 咳嗽的起因可能經常是堅定的。它應該被強調, 在某些情況下, 呼吸和心臟病疾病也許共存和運作在音樂會引起咳嗽。另外, 不呼吸亦不慢性僧帽形的valvular 疾病是靜態的, 因此結論得出關於咳嗽的起因今天正確地被畫也許不再是合法的隨時間。
表1: 區分咳嗽由於心臟病和呼吸疾病 [table][tr][td=1,1,306][/td][td=1,1,306][b]呼吸疾病[/b]
[/td][td=1,1,306][b]心臟病疾病[/b]
[/td][/tr][tr][td=1,1,306][b]體重[/b]
[/td][td=1,1,306]正常或肥胖
[/td][td=1,1,306]變薄或減重
[/td][/tr][tr][td=1,1,306][b]咳嗽[/b]
[/td][td=1,1,306]經常以鍛煉,
[/td][td=1,1,306]壞在晚上,
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]+/- mucopurulent 唾沫,
[/td][td=1,1,306]+/- 桃紅色唾沫(罕見),
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]苛刻, 致衰弱
[/td][td=1,1,306]軟的咳嗽
[/td][/tr][tr][td=1,1,306][b]呼吸困難[/b]
[/td][td=1,1,306]+/- 呼吸困難
[/td][td=1,1,306]+/- dyspnea/orthopnea
[/td][/tr][tr][td=1,1,306][b]私語[/b]
[/td][td=1,1,306]有或沒有
[/td][td=1,1,306]總私語與先生
[/td][/tr][tr][td=1,1,306][b]肺聲音[/b]
[/td][td=1,1,306]無, 喘息, 嗶拍作響;
[/td][td=1,1,306]無, 嗶拍作響, 喘息;
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]喘息最共同
[/td][td=1,1,306]爆裂聲最共同
[/td][/tr][tr][td=1,1,306][b]心臟Rate/Rhythm[/b]
[/td][td=1,1,306]通常正常減慢,
[/td][td=1,1,306]通常迅速, 靜脈竇
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]靜脈竇心率失常
[/td][td=1,1,306]rhythm/tachycardia
[/td][/tr][tr][td=1,1,306][b]ECG[/b]
[/td][td=1,1,306]NSR 或NSA +/- p-pulmonale,
[/td][td=1,1,306]NSR 或靜脈竇心動過速,
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]正確的心室擴大
[/td][td=1,1,306]p-mitrale, 留給心室
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]擴大
[/td][td=1,1,306][/td][/tr][tr][td=1,1,306][b]射線照相[/b]
[/td][td=1,1,306]沒有肺腫鼓+/-
[/td][td=1,1,306]肺腫鼓, 左心臟
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]右胸擴大(鐳, RV),
[/td][td=1,1,306]擴大(LA, LV), 沒有
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]+/- 導氣管崩潰和parenchymal
[/td][td=1,1,306]導氣管崩潰或導氣管
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]並且/或者支氣管滲入
[/td][td=1,1,306]滲入
[/td][/tr][tr][td=1,1,306][b]Echocardiogram[/b]
[/td][td=1,1,306]易變的右胸擴大,
[/td][td=1,1,306]左心臟擴大, 先生,
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]易變的高速度TR 或PI (PHT)
[/td][td=1,1,306]擴大的肺靜脈
[/td][/tr][tr][td=1,1,306][b]導氣管細胞學[/b]
[/td][td=1,1,306]激動或造形術
[/td][td=1,1,306]正常
[/td][/tr][tr][td=1,1,306][b]Hemogram[/b]
[/td][td=1,1,306]易變的炎症,
[/td][td=1,1,306]法線或重音leukogram
[/td][/tr][tr][td=1,1,306][/td][td=1,1,306]+/- 紅血球增多症
[/td][td=1,1,306][/td][/tr][tr][td=1,1,306][b]利尿[/b]
[/td][td=1,1,306]無答復
[/td][td=1,1,306]敏感
[/td][/tr][/table][i]注意研究結果變化並且沒有所有反常性看在指定的案件並且疾病和標誌交疊也許發生。NSR = 正常靜脈竇節奏, NSA = 正常靜脈竇心率失常, 先生= 僧帽形的反流, 鐳= 正確的心房, RV = 右心室, LA = 左心房, LV = 左心室, TR = tricuspid 反流, PI = 肺不足, PHT = 肺高血壓。 [/i]
表2: 極小的資料庫和另外的測試為狗以慢性咳嗽和心臟私語 [table][tr][td=1,1,191][b]極小的資料庫[/b]
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 完全血液計數
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Heartworm 測試
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 胸部射線照相
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 心電圖
[/td][td=1,1,328][b]另外的測試[/b]
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 動脈血液氣體(評估oxygenation 和透氣)
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 多血脈性的血液氣體(評估透氣和組織灌注)
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 氣管洗滌*
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Bronchoscopy*
[/td][td=1,1,353][img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Bronchoalveolar lavage *
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 肺切片檢查法
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 血清學
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 特別糞便考試
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Echocardiography
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 對卸貨的療法的反應
[/td][/tr][/table]The coughing dog commonly presents both a diagnostic and therapeutic dilemma to the practicing veterinarian. This is particularly true in middle-aged to aged small breed dogs, which are often afflicted with chronic respiratory disease and mitral insufficiency, each of which may result in coughing. The problem then becomes one of distinguishing the degree to which respiratory and/or cardiovascular disease are contributing to the cough. This is important because the therapies are quite different, and, in some instances, appropriate therapy for one worsens the other.
The cough reflex, usually initiated by irritation of the pharynx, larynx, trachea, and larger bronchi, produces forceful expiration against a closed glottis, followed by sudden release and forced expulsion. This protective mechanism is useful in expelling foreign material, exudates, and organisms from the respiratory tract. It is also fatiguing and irritating to the patient and owner alike. However, suppression of coughing is not indicated in all instances. It is better to alleviate the underlying cause, and using cough suppressants only in a limited number of instances. For this reason, as well as to allow specific treatment and to more accurately prognosticate, a definitive diagnosis is mandatory.
Causes of coughing are many, but in the population of dogs under discussion, cough most commonly results from upper airway disease, tracheobronchial collapse, chronic bronchitis of varying etiologies, pulmonary fibrosis, bronchiectsis, pulmonary neoplasia, pneumonia, and mitral regurgitation (the latter, usually but not always with heart failure). In mitral regurgitation, the cause of cough is not entirely clear, but left atrial impingement on the left main bronchus and/or recurrent laryngeal nerve, edema of the respiratory mucosa, interstitial fluid pressure on airways, and excessive bronchial mucous production have all been suggested as being contributory.
The diagnosis of chronic, unresponsive cough is challenging, particularly when concurrent cardiac disease is identified. Often, referral of such cases is warranted, providing such diagnostic opportunities as fluoroscopy, electrocardiography, echocardiography, oximetry, bronchoscopy, bronchoalveolar lavage, culture and sensitivity, cytological evaluation, lung biopsy or fine needle aspiration, serology (e.g., fungal, toxoplasma, heartworm, etc), specialized fecal examinations (sedimentation and Baerman examination for respiratory parasites), and arterial and venous blood gas analysis. In many instances however, referral centers are inconvenient, owners decline referral, or referral is unnecessary. through careful historical, physical, and special procedural examination, virtually all small animal practices can provide an excellent diagnostic workup for dogs with cough and mitral regurgitation.
Special procedures typically available to private practitioners include inspiratory and expiratory thoracic and cervical radiographs to evaluate for airway collapse or infiltrate, cardiac size, evidence of heart failure, and the pulmonary parenchyma; electrocardiography to determine heart rate and the presence of left and/or right atrial and/or ventricular enlargement; transtracheal wash as a substitute for bronchoscopy, with culture and cytological evaluation; and trial diuresis. The expected results of such procedures in chronic respiratory disease and for mitral regurgitation are put forth in Table 1. The use of this diagnostic protocol should aid in the diagnosis of the cause of cough in patients with heart murmurs, hence improving therapeutic intervention and patient response.
Historical and physical findings (Table 1), which may indicate a respiratory cause for chronic cough, include obesity, harsh cough, mucopurulent nasal discharge, harsh, 蘔onking?and/or productive cough, and respiratory wheezes. Contrarily, loss of condition; soft, non-productive cough, often worse at night; accompanying dyspnea (may occur with severe respiratory disease as well); and tachycardia with weak pulses are more indicative of a cardiac cause for the cough.
The minimum database for the workup of cough is depicted in Table 2, with additional tests, which may be useful in some, but not necessary in all, cases. The complete blood count may be useful in indicating eosinophilia and possibly basophilia, which are most compatible with allergic or parasitic disorders, such as parasitic or eosinophilic pneumonias or heartworm disease. With bacterial pneumonia, there may be indicators of sepsis, such as neutrophilia, toxic changes in neutrophils, and monocytosis. It is emphasized that hematological changes are inconsistent at best. In heartworm-endemic areas, appropriate testing is necessary (antigen Elisa for dogs on monthly preventative; >><< preventative histories, heartworm testing may be postponed until after thoracic radiography.
Overall, the most useful tool is the thoracic radiograph. It is beyond the scope of this manuscript to review thoracic radiography. Specific changes that are useful in the differentiation of cardiac from respiratory causes of cough would include left vs. right heart enlargement, indicative respectively of cardiac and respiratory causes. The status of the lung, airways, and pulmonary vasculature is, likewise, often elucidating. Bronchial thickening, pulmonary infiltrate (other than pulmonary edema), pulmonary arterial enlargement (apical pulmonary artery larger than accompanying vein or proximal one-third of the fourth rib where they intersect) suggest respiratory disease with the latter finding most consistent with pulmonary hypertension (typically heartworm disease). Contrarily, enlargement of the pulmonary vein (apical pulmonary vein greater than accompanying artery or greater than the proximal one-third of the fourth rib where they intersect) suggests pulmonary venous congestion (left heart failure). Evaluation of the airways for dynamic function is best performed with fluoroscopy but can be approximated by maximizing the information gleaned from conventional radiography. This can be accomplished by supplementing routine full inspiratory lateral and ventrodorsal radiographs with a lateral exposure at full expiration, and ideally, a full inspiratory exposure focused over the cervical trachea. The former will demonstrate intrathoracic and the latter, extrathoracic airway collapse. It should be emphasized that a negative dynamic study such as this does not definitively rule out airway collapse.
Electrocardiographic findings compatible with respiratory disease (and heartworm disease which in reality is respiratory𤤖r pulmonary arterial珳isease) include slow rate, sinus arrhythmia, P-pulmonale (P waves > 0.4 mv, indicating right atrial enlargement), and occasionally, a right ventricular enlargement pattern (S waves in leads 1, 2 and 3, right axis deviation, and deep S waves in V3). Alternatively, dogs with mitral valvular insufficiency typically have normal mean electrical axis, tachycardia if in heart failure, P mitrale (widened and sometimes notched P waves), and possibly, left ventricular enlargement pattern (tall R waves and/or prolonged QRS complexes).
Specific information about the nature of respiratory disease can be obtained routinely with transtracheal aspiration (wash). This is accomplished under mild sedation (or none in debilitated animals) so that the cough reflex is not blunted. Standard surgical preparation is performed over the larynx. The cricothyroid ligament is palpated by feeling the indentation; this is accentuated by flexing and extending the neck. Lidocaine is infiltrated subcutaneously over this site. The dog is positioned in sternal recumbency or in a sitting position. It is important to keep the dog symmetrically positioned to allow accurate assessment of anatomic landmarks. The neck is extended and a small stab incision made over the cricothyroid membrane. A 12 to 18 inch 14- to 16-gauge intravenous catheter is used to puncture the membrane, with the trachea digitally stabilized. The catheter is directed down into the airway and the catheter advanced.[/size]

minibabyqq 2006-12-28 02:02 AM

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[color=Magenta][size=5][b]心力衰竭的臨床方法Clinical Approach to Congestive Heart Failure   [/b][/size][/color]


介紹的宗旨
回顧臨床技能和測試被使用診斷心臟病疾病和充血的心力衰竭(CHF) 。
總結通用知識、觀點, 和爭論何時並且怎樣對待CHF 。
鼓勵治療決定根據臨床研究結果, 不是您分配到患者的疾病。
鼓勵一種保守的方法對介入所有者參與的療法。
鼓勵skepticism.don.t 健康藥量相信一切您聽見或讀。
鎖上臨床診斷點
聽診是敏感試鏡頭為心臟病疾病; 這是一個相對地厚臉皮和未指明的測試為診斷的充血的心力衰竭。
肺爆裂聲在狗由肺纖維變性, 不肺腫鼓最共同地造成。
咳嗽, 雖然由CHF 有時導致, 由CHF 共同地不造成。
被舉起的心率並且/或者呼吸率由呼吸困難、胃腸膨脹, 或被裹住的心音陪同應該明顯增加充血的心力衰竭懷疑。
估計呼吸率, 在與所有者合作下, 是一個強有力的監視工具。
被舉起的頸部的多血脈性和中央多血脈性的壓力或hepatojugular 倒回建議右胸失敗。
造影是為查出CHF 和監測療法效力的一個重要工具。
  形象化腹水, 胸膜流出, 並且肺細胞間和齒齦音滲入。
  查出intrathoracic 肺並且/或者系統靜脈的擴大, 和擴大的liver/spleen 。
  Ultrasonography 可能非侵入性地定義解剖學並且心臟病疾病嚴肅並且查出胸膜和腹膜流出和肝多血脈性的engorgement 。
  在腹水或胸膜流出面前, 右胸擴大和擴大的肝靜脈支持充血的心力衰竭診斷。
  在肺腫鼓或胸膜流出(cats>dogs 面前), 左心臟, 左特別是atrial, 擴大支持充血的心力衰竭診斷。
在沒有dysrhythmia 時, electrocardiography 增加少許來心臟病疾病或CHF 診斷。
在貓, 但不是在狗:
  CHF 是腹水的相對地不凡的起因。
  低體溫症是共同在患者與CHF 但是極高熱是非常不凡的。
  Chylothorax 是反應療法為CHF CHF 的共同的顯示。
關鍵病因學和Pathophysiologic 點
心臟病損害(解剖或功能) 立刻或總不導致CHF 。
  有重大心臟病許多病人從未將開發充血的心力衰竭。
心力衰竭是臨床綜合症狀, 不應該被認為一個最後的診斷。
心力衰竭進來二形式: 充血(CHF) 並且低產品。
CHF 是存在當有增加的肺多血脈性的血絲(左心力衰竭) 或中央多血脈性的壓力(右胸失敗) 由於重大心臟病病理學。
糾正被支持的CHF 為被舉起的中央多血脈性的壓力描繪和體現和:
  Ascites.common 在狗, 不凡在貓
  周邊edema.not 一突出發現在小動物
左被支持的CHF 為被舉起的肺多血脈性的壓力描繪和體現作為肺腫鼓(和, 雖然一有爭議的概念, 胸膜流出在貓) 。
BIVENTRICULAR CHF 為被舉起的系統和肺多血脈性的壓力描繪, 可能體現作為任何上述標誌或胸膜流出。
心臟收縮的官能不良是被削弱的能力□出血液從ventricle(s) 。
舒張官能不良是ventricle(s) 的被削弱的能力填裝。
許多臨床工作者錯誤地不同CHF 聯繫在一起心肌失敗或心臟收縮的官能不良當, 實際上, 許多患者與CHF 有心肌失敗或心臟收縮的官能不良的證據。
CHF 也許起因於解剖或功能心臟收縮, 或舒張官能不良。
充血的心力衰竭是共同在導致左心臟容量超載的疾病(專利ductus arteriosus (PDA), 大動脈反流, 僧帽形的反流, 並且共同地較少, 心室氏族的瑕疵) 。
CHF 是不凡的在左心臟壓力超載(大動脈狹窄, 系統高血壓) 。
CHF 是不凡與溫和減輕tricuspid 反流在沒有阻礙時對正確的心室排斥譬如pulmonic 狹窄(PS) 或肺高血壓(酸鹼度) 。
CHF 不是不凡的在嚴厲右胸容量超載(atrial 氏族的瑕疵, tricuspid 反流) 案件, 特別是當與阻礙結合對正確的心室排斥。(PS 或酸鹼度)
正確被支持的CHF 不是不凡的在有深刻肺高血壓、先進的heartworm 心包的疾病, 或疾病病人。
有主要心肌失敗病人(膨脹的心肌病) 共同地將居住幾年與少數對沒有臨床標誌。CHF 或猝死是一次共同的結束階段事件在這些患者。
CHF, 經常由於部下的心臟病疾病的代償失調也許被觀察在高產品狀態(即, 甲狀腺機能亢進、貧血症, 懷孕) 。
關鍵治療點
治療的目標是:
  每當可能消滅或扭轉部下的解剖(即, 綁紮PDA 、款待dirofilariasis, 等) 或功能瑕疵(補充與牛磺酸在牛磺酸缺乏心肌失敗在貓和一些狗, 款待hemodynamically 重大心率失常, 等案件) 。
  減少血絲裝填壓力消滅或充分地減少腫鼓儲積當保留耐心健康和功能(一次平衡的行動) 。
治療工具是:
  物理操作: 每當可能, 從胸膜和胃腸空間取消所有流體為診斷目的和對安心難受或困厄的患者。
  幫助達到以上陳述的目標的藥物。
  飲食: 補充與牛磺酸並且/或者carnitine 在適當的情況(心肌失敗在被懷疑的或被證明的缺乏面前) 。避免高鈉進水閘。
  手術: 短預防, 最有力的療法為先天和valvular 情況。我們持續的依賴性在藥物反射不充分的技巧和資源。
藥物組常用對待CHF:
  利尿藥: 不非常性感而且, 顯然, 我們的最強有力的weapon. 。
  目標: 減少血管內的容量和降低多血脈性的血絲壓力。
  常用的代理: furosemide, spironolactone, hydrochlorothiazide 。
  效力: 我們能說的唯一的類, 毫不猶豫地, 拯救生命。
  純淨的血管舒張劑: 相當有用為深刻地unloading. 心臟和促進向前流程。
  目標: 促進向前流程, 減少反流, 和降低多血脈性的壓力。
  常用的代理: hydralazine, amlodipine, 硝普鹽(深刻Iv) 。
  效力: 硝普鹽罐頭buy 。我們時間acutely.but 他們can.t 回家對此; amlodipine 也許履行hydralazine 諾言沒有GI 副作用。
  血管緊縮素轉換的酵素抗化劑: 偉大附屬療法但過高估計和oversold 。
  目標: 禁止鹽和水的保留通過腎素血管緊縮素醛甾酮系統。
  常用的代理: enalapril, lisinopril, benazepril 。
  效力: 預防措施或單獨療法未經證明。利尿+ ACEI = 標準CHF 療法。
  正面inotropes: 幾年失望但pimobendan 也許贖回我們的希望。
  目標: 提高心臟病泵浦作用和效率。
  常用的代理: digoxin, dobutamine, 多巴胺。
  效力: digoxin, 口頭療法中流砥柱幾個世紀是相當微弱的inotropes 在狗和貓; dobutamine 和多巴胺也許是有利IV 為深刻短期support.; milrinone 從未做了它對主流; pimobendan 願最後是it. 。
戰略為患者以心臟病疾病但不是在充血的心力衰竭:
  沒有證據證明及早(在CHF 之前起始) 無症狀心臟病病人的藥物治療有慢性valvular 疾病修改生活的耐心質量或數量。
  是否有及早好處(在CHF 之前起始) 狗的藥物治療與膨脹的心肌病與一點抗化劑或貓以肥大性心肌病與鈣詞條預鍛模或beta-blockers 依然是有爭議。
戰略為患者提出在充血的心力衰竭:
  戰略為緩和療法(即, 利尿藥、血管舒張劑、正面inotropes 、paracentesis, 等。) 經常是同樣不管部下的官能不良或疾病。
  利尿藥, 主要furosemide, 繼續是療法中流砥柱與血管舒縮的口氣和神經內分泌斡旋人調制器有價值補充。
  心臟病tamponade 在有pericardial 流出病人是緩和藥方為CHF 也許是損傷的例外。Pericardiocentesis 應該首先被追求。
在所有患者, 戰略演講部下的解剖或功能瑕疵應該進取地尋求如果有充分證據建議對質量的正面生活的影響和數量。
背景和細節
充血的心力衰竭病理生理學:
(筆記: 保留以下在透視, 記得, 心血管系統的business 結束是血絲和他們的互作用與body.s 組織。心臟和我們聚焦的所有其它船存在作為泵浦和管為這個作用服務。)
過程和連續流: 心臟病損害(解剖或功能) 立刻或總不導致CHF 。
對the 侮辱的早期反應:
被減少的心輸出量(CO) 並且/或者動脈壓力(AP) 觸發器賠償機制。
  及早, 短命和精力充沛地昂貴, 有同情心的反應補償正常化CO 和動脈收縮壓力(AP) 通過增加的心率, 力量和血管縮小。
  較長期(幾小時對幾天), 更加長壽命, 較不精力充沛地更加昂貴, 賠償機制包括腎素血管緊縮素醛甾酮系統的活化作用(RAAS), 氨基胍基戊酸vasopressin (ADH), 低有同情心的神經系統的水平慢性刺激, 和地方血管收縮劑的系統。
  RAAS 和ADH 刺激了可變的儲積並且大電容多血脈性的船的venoconstriction, 如果未經檢查, 導致被舉起的心臟病多血脈性和血絲壓力以實際結果是一種不平衡狀態生效駕駛淨可變的運動向外橫跨血絲, 造成腫鼓的形成(CHF) 。Atrial natriuretic peptide (ANP) 抵抗這些作用一部分。
  一致地, 修改過的心臟病預壓和afterload 刺激心臟病改造(同心或異常肥大) 正常化心臟病牆壁重音(心臟收縮和舒張, 各自地) 。
無症狀, 很好補償的患者:
這些賠償機制的渴望的結果是回歸往正常CO 和AP 以正常低多血脈性和血絲裝填壓力以便高效率的交換在血絲可能繼續。
  休息這些患者有充分CO 並且AP 以多血脈性的血絲壓力足夠低導致增加淋巴排水設備足夠小數量的正常血絲可變的動力學或網廢氣流可能補償。
  臨床標誌也許這時有:
  鍛煉intolerance..asked 。完成更多工作, 系統無法對維護充分CO 和AP 以低多血脈性的血絲壓力; 患者更加迅速地疲倦和也許平衡decompensate 如果他們試圖做太多太長的時期。
  咳嗽由於心臟的物理擴大激怒主要導氣管
fragile 。或根據症狀, decompensated 患者:
作為部下的解剖或功能損害的嚴肅進步, 賠償機制也許被克服或成為損傷, 和患者decompensate 。
  充分CO 和AP, 被維護通過神經內分泌刺激和流體保留可能不再達到以正常血絲裝填壓力CHF 。
  另外, 對兒茶酚胺的過份暴露(beta-receptors 的心率失常、下來章程, 心臟病纖維變性), 醛甾酮、血管緊縮素II (心臟病肥大和纖維變性), 等, 可以對代償失調貢獻。
  這時是, 臨床干預是, 沒有疑義, 必要和有利的。

Objectives of the Presentation
Review the clinical skills and tests used to diagnose cardiac disease and congestive heart failure (CHF).
Summarize current knowledge, opinion, and controversies about when and how to treat CHF.
Encourage therapeutic decisions based upon clinical findings, not the disease you assign to a patient.
Encourage a conservative approach to therapy that involves owner participation.
Encourage healthy dose of skepticism珳on㦙 believe everything you hear or read.
Key Clinical Diagnostic Points
Auscultation is a sensitive screening test for cardiac disease; it is a relatively insensitive and nonspecific test for diagnosing congestive heart failure.
Pulmonary crackles in dogs are most commonly caused by pulmonary fibrosis, not pulmonary edema.
Coughing, although sometimes caused by CHF, is not commonly caused by CHF.
Elevated heart rate and/or respiratory rate accompanied by dyspnea, abdominal distension, or muffled heart sounds should markedly increase suspicion of congestive heart failure.
Assessing respiratory rate, in cooperation with owners, is a powerful monitoring tool.
Elevated jugular venous and central venous pressure or hepatojugular reflux suggests right heart failure.
Radiography is an important tool for detecting CHF and monitoring efficacy of therapy.
  Visualize ascites, pleural effusion, and pulmonary interstitial and alveolar infiltrates.
  Detect enlargement of intrathoracic pulmonary and/or systemic veins, and enlarged liver/spleen.
  Ultrasonography can noninvasively define the anatomy and severity of cardiac disease as well as detect pleural and peritoneal effusions and hepatic venous engorgement.
  In the presence of ascites or pleural effusion, right heart enlargement and enlarged hepatic veins support a diagnosis of congestive heart failure.
  In the presence of pulmonary edema or pleural effusion (cats>dogs), left heart, especially left atrial, enlargement supports a diagnosis of congestive heart failure.
In the absence of dysrhythmia, electrocardiography adds little to the diagnosis of cardiac disease or CHF.
In cats, but not in dogs:
  CHF is a relatively uncommon cause of ascites.
  Hypothermia is common in patients with CHF whereas hyperthermia is very uncommon.
  Chylothorax is a common manifestation of CHF that responds to therapy for CHF.
Key Etiologic and Pathophysiologic Points
Cardiac lesions (anatomical or functional) do not immediately or always lead to CHF.
  Many patients with significant heart disease will never develop congestive heart failure.
HEART FAILURE is a clinical syndrome and should not be considered a final diagnosis.
Heart failure comes in two forms: congestive (CHF) and low output.
CHF is present when there is increased pulmonary venous capillary (left heart failure) or central venous pressure (right heart failure) as a result of significant cardiac pathology.
RIGHT SIDED CHF is characterized by elevated central venous pressure and manifests as:
  Ascites櫘ommon in dogs, uncommon in cats
  Peripheral edema瑈ot a prominent finding in small animals
LEFT SIDED CHF is characterized by elevated pulmonary venous pressure and manifests as pulmonary edema (and, although a controversial concept, pleural effusion in cats).
BIVENTRICULAR CHF is characterized by elevated systemic and pulmonary venous pressures and can manifest as any of the above signs or pleural effusion.
SYSTOLIC DYSFUNCTION is an impaired ability to eject blood from the ventricle(s).
DIASTOLIC DYSFUNCTION is an impaired ability of the ventricle(s) to fill.
Many clinicians erroneously associate CHF with myocardial failure or systolic dysfunction when, in fact, many patients with CHF have no evidence of myocardial failure or systolic dysfunction.
CHF may result from anatomical or functional systolic, or diastolic dysfunctions.
Congestive heart failure is common in diseases that lead to left heart volume overload (patent ductus arteriosus (PDA), aortic regurgitation, mitral regurgitation, and less commonly, ventricular septal defect).
CHF is uncommon in left heart pressure overloads (aortic stenosis, systemic hypertension).
CHF is uncommon with mild to moderate tricuspid regurgitation in the absence of an obstruction to right ventricular ejection such as pulmonic stenosis (PS) or pulmonary hypertension (PH).
CHF is not uncommon in cases of severe right heart volume overload (atrial septal defect, tricuspid regurgitation), especially when combined with an obstruction to right ventricular ejection. (PS or PH)
Right-sided CHF is not uncommon in patients with acute pulmonary hypertension, advanced heartworm disease, or diseases of the pericardium.

minibabyqq 2006-12-28 02:03 AM

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[color=Magenta][size=5][b]慢性Valvular 心臟病在狗Chronic Valvular Heart Disease in Dogs   [/b][/size][/color]


Valvular endocardiosis 是未知的起因的退化變動影響subendocardial 閥門傳單和chordae tendineae 在中部變老對年長狗。更小的養殖是事先安排好的。亦稱慢性myxomatous valvular 心臟病, 這混亂是心臟病的最重要的起因在獸醫實踐。Endocardiosis 導致進步valvular 無能與血液的反流橫跨閉合的閥門。僧帽形的用具經常影響(實際上所有案件), 與tricuspid 閥門(34%) 並且動脈閥(3%) 較不頻繁地介入。在某些情況下, 閥門是重複和chordae tendineae 被延長, 導致閥門的prolapse 入心房。先進的endocardiosis 總損害包括節狀變厚和變短在閥門傳單的自由邊緣和基地。閥門看上去不透明和白色, 可能被滾動和被收縮在他們的自由邊緣。chordae 成為變厚在閥門附件附近, 也許爆裂。左心房(LA 的) 次要膨脹並且左心室(LV) 顯現出。二尖瓣環體可能還膨脹。心室肥大是異常型(膨脹的分庭), 並且微觀冠狀疾病可能導致局部缺血和纖維變性焦點區域。右心室也許膨脹從tricuspid 反流(TR) 由肺高血壓複雜化。
臨床病理生理學
endocardiosis 損害代表一個慢慢地進步過程, 不導致可發現的標誌在早期的結構變化的期間。在一些狗, chordae 或valvular 組織是重複或鬆馳和閥門將脫出導致midsystolic 點擊。最終, 重大valvular 畸變導致valvular 不足可發現的私語並且一些狗將開發心力衰竭。整個過程可能需要許多歲月。一旦二尖瓣無能, 血液regurgitates 從高壓(心室) 對低壓(atrial) 分庭。regurgitant 容量和疾病嚴肅定列式有: regurgitant 管口大小、壓力區別在LV 和LA 之間, 和時間從收縮起始對動脈閥的開頭。嚴厲僧帽形的反流(先生) 起因LV 容量超載, 可能導致左心力衰竭。先生並且預先處理對心率失常, 特別是那些發起於膨脹的心房。如果regurgitant 容量逐漸增加並且atrial 服從相應地增加, 心房擴張對大容量以一個最小的變化在atrial 壓力上並且情況很好被容忍。這解釋為什麼許多狗有嚴厲cardiomegaly 但最小的臨床標誌。如果regurgitant 容量是大的或如果反流突然顯現出得(和與和弦破裂), atrial distensibility 極限超出和卑鄙LA 壓力增量, 導致肺腫鼓。進步先生同被舉起的肺多血脈性的壓力, 增加的流體靜力的壓力聯繫在一起在肺血絲, 和最終由肺腫鼓。這些可能由1) regurgitant 容量的聯合的作用解釋; 2) 膨脹的LV 的被減少的distensibility; 並且3) 鈉和水的腎臟保留由被減少的心輸出量觸發。臨床後果包括呼吸迫促, hypoxemia, 疲倦, 和咳嗽。肺高血壓(被舉起的PA 壓力) 經常開發相關對增加的LA 壓力和可能從變窄在小肺動脈。這些增加抵抗流經肺。主要肺病可能還是一個因素在增長的肺抵抗。肺高血壓的發展安置裝載在右心室和預先處理對更多TR 。正確的被支持的CHF 的標誌可能接著而來, 包括鍛煉不寬容, 腹水, 和中略語。一些狗進步從左心力衰竭綜合症狀到一個右胸失敗。
先生的其它複雜化包括支氣管壓縮、心率失常、被爆裂的chordae LA 的tendineae, 和破裂。左atrial 擴張壓縮左mainstem 支氣管在主動脈和擴大的心房之間。支氣管激怒和exertional 咳嗽和喘息也許發生在沒有肺腫鼓時。Atrial 心率失常譬如過早的atrial 複合體被觸發在擴大的心房。心室過早的複合體也許顯現出在膨脹的LV, 雖然被承受的心室心動過速是較不共同在僧帽形的疾病比在狗以膨脹的心肌病。被爆裂的chordae tendineae 共同地被觀察在狗的echocardiographic 考試期間與先進的先生。根據和弦破裂的地點, 增加的血液動力學的負擔也許被容忍, 或嚴厲CHF 也許supervene 。左atrial 破裂, 當不凡, 可能發生橫跨線性淚花在心內膜; 出血入pericardial 空間導致心臟病tamponade 、低血壓症, 和可能死亡。
臨床研究結果
Endocardiosis 是最共同在玩具裡並且小養殖(長卷毛狗、Dachshund, 約克夏狗, 騎士國王查爾斯・Spaniel, Schnauzer, 斗雞家Spaniel) 並且情況是一偶然發生發現在許多年邁的狗。一些養殖(譬如CKCS) 影響相對地及早在生活中。更大的狗經常開發endocardiosis, 並且意志偶爾, 開發CHF 結果對valvular 不足; 但是, 損害通常是較不嚴厲的並且膨脹的心肌病是CHF 的更加重要的起因在這些養殖。一些犬養殖, 特殊spaniels, 德國牧羊人, 並且阿富汗追逐, 是有傾向對valvular 退化和心肌病。client.s 怨言是可歸屬的對心臟病疾病或左被支持的心力衰竭和包括疲倦, 進步咳嗽或呼吸迫促, 和中略語。中略語是一個特別麻煩問題, 也許與不足的向前流程、肺高血壓、心率失常, 或neurocardiogenic 中略語有關(不適當的心跳緩慢和vasodilation 由有同情心的浪湧或咳嗽觸發) 。
體格檢查研究結果變化。心率典型地, 但不總是, 規則和增加當CHF 是顯然的。發出音的靜脈竇心率失常是共同在補償的valvular 疾病。一早期auscultatory 發現在一些狗是midsystolic 點擊, 建議閥門prolapse 。先生由一句心臟收縮的私語大聲宣佈在僧帽形的區域和左尖頂。摘要和軟的心臟收縮的私語通常表明早期疾病除非與相關peracute CHF, 低血壓症, 或一致膨脹的心肌病。私語在幾個月內通常變成從軟性, decrescendo 私語對一句大聲, holosystolic 私語幾年。precordial 興奮也許是可觸知的在左尖頂(先生) 或tricuspid 閥門區域(表明TR) 。典型的先生私語放熱在regurgitant 噴氣機(背部地和craniad 或caudad) 並且項目的方向直接對正確的hemithorax 一旦私語到達強度等級3 或4 。這也許是纏擾不清的當TR 一句一致私語也許被查出在胸部的右邊, 特別是在狗以進步肺高血壓。第一心音也許是大聲的, 表明被保存的LV 心臟收縮的作用; 第二聲音也許tympanic, 建議肺高血壓。頂端心室疾馳(第三心音), 表明被舉起的LV 舒張壓, 聽見在一些狗與未經治療的CHF, 但經常解決隨後而來的成功的療法。心率失常, 特別是atrial 過早的敲打, 也許由聽診查出。當心臟擴大, 左頂端衝動的點轉移caudoventrally 表明左心室擴大。動脈脈衝是易變的根據向前行程排量、心臟病節奏, 和程度系統動脈vasodilation, 和將由醫療療法衝擊。動脈血壓通常是正常的但可能是降低在嚴厲CHF 。一些狗有系統高血壓與在過程中發生的腎臟或Cushing.s 疾病有關。這疑難當被舉起的收縮壓增加先生分數。如果肺壅塞顯現出從CHF, 透氣和支氣管聲音變得反常, 並且吸入的爆裂聲和青紫經常顯現出。喘息可以代表cardiac 哮喘從支氣管打或左mainstem 支氣管壓縮。胸膜流出作為一被隔絕的發現是罕見的在有正常靜脈竇節奏病人, 但不是不凡的在狗以atrial 原纖維形成作用(AF) 。如果右胸失敗, 頸部的脈衝成為突出, 頸部的多血脈性的壓力增量, 並且肝臟擴大。腹水表明先進的正確被支持的CHF 。
實驗室試驗可能證實診斷和允許臨床工作者分類患者。造影展示進步cardiomegaly 以左被支持的擴大predominating 。當疾病進步, 廣義cardiomegaly 、左mainstem 支氣管壓縮, 和肺多血脈性的膨脹被觀察。左被支持的CHF 增加肺密度(間隙植物和齒齦音滲入) 在perihilar 肺區域。這些滲入典型地背和雙邊相稱; 但是, 腫鼓也許是壞在正確的尾部耳垂。胸膜流出和腹水是先進的心臟病和biventricular 失敗的研究結果。Echocardiographic 研究結果包括cardiomegaly 、變厚的AV 閥門, 和增加的全球性LV 縮短分數。總之, 留下心室收縮性看上去正常對增加因為心肌失敗是這種疾病一個較不突出的特點並且LV □出行程排量的部份落後, 入低抵抗LA 。縮短分數幫助與膨脹的心肌病區別這個情況因為唯一主要valvular 疾病非典型事例減少變短分數(通常在大養殖狗) 。Valvular prolapse 由瘦長或被爆裂的chorda tendineae 造成頻繁地被觀察。多譜勒儀研究展示先生和TR, 和經常, 沈默大動脈反流。高速度TR (> 3 m/sec) 表明肺高血壓。心電圖也許顯露cardiomegaly; 但是, ECG 是正常的在一些狗並且這發現不排除CHF 診斷由於endocardiosis 。Atrial 擴大可能導致加寬(P-mitrale) 或增加的高度(P-pulmonale) P 揮動。左心室肥大由增加的電壓建議在尾部肢體帶領(II, III, aVF), 加寬QRS 複合體, 或ST 段忽略或coving 。心率和節奏通常是正常的直到重大cardiomegaly 顯現出。心率失常是共同因為疾病推進。靜脈竇心動過速、atrial 過早的敲打、paroxysmal 或被承受的atrial 或supraventricular 心動過速、AF, 和心室過早的複合體遇到在各自的案件。臨床實驗室試驗在endocardiosis 經常是血液動力學的變動或一致器官疾病的反射。Extracardiac 混亂譬如Cushing 的疾病、腎衰竭, 和藥方的作用(即, 利尿藥, 血管緊縮素轉換的酵素抗化劑(ACEI) 可能修改清液biochemistries 。重大肺腫鼓可能導致動脈hypoxemia (被減少的PaO2), hypocarbia, 和呼吸鹼中毒。組織hypoperfusion 導致新陳代謝的酸中毒。大約25% 狗與CHF 從endocardiosis 有溫和減輕增量在小圓麵包、清液肌氨酸酐, 或磷裡。利尿藥、減血壓藥方, 和ACEI 增量巨大azotemia 在一些狗。被減少的肝灌注和肝壅塞也許增加清液ALT 和AST; 但是, 這些海拔傾向於是溫和的減輕, 和堅持地被舉起的肝臟酵素, 特別是當> 400 iu/L 通常表明肝臟的主要混亂。Hypochloremia 、新陳代謝的鹼中毒, 和hypokalemia 經常醫原性, 由利尿療法導致。溫和減輕減退在清液氯化物裡被忽略。Hyponatremia 是一個粗劣的預斷標誌和表明自由水保留從嚴厲biventricular 心力衰竭。這經常被觀察在狗以明顯腹水接受高藥量利尿或組合利尿療法。CBC 是平凡的在許多情況下。
慢性valvular 心臟病有差別的診斷在狗包括膨脹的心肌病、先天AV 閥門畸形, 和細菌心內膜炎(一個相對地罕見的情況在小狗) 。典型的年齡、養殖素質, 和臨床介紹使診斷valvular endocardiosis 直接在許多情況下。echocardiogram 可能與先天閥門畸形或膨脹的心肌病區別endocardiosis; 但是, 這不是一項根本研究在經典介紹。活躍細菌心內膜炎應該造成multisystemic 問題(熱病、多關節炎、變形的傳染, proteinuria, 被舉起的WBC) 。主要呼吸疾病是纏擾不清的, 可能導致相同肺標誌(咳嗽, 呼吸, 呼吸迫促的不足, 喘息, 肺爆裂聲) 。共同的規則出口是氣管崩潰(特別是在玩具養殖), 主要支氣管崩潰、慢性支氣管炎、肺齒槽炎纖維變性、heartworm 疾病、肺炎, 和肺瘤形成。臨床工作者應該記得, 肺爆裂聲(rales) 表明小導氣管官能不良, 不一定wet 肺。
療法
當前, 無症狀狗的治療以私語由endocardiosis 造成不被推薦除非有緊急心力衰竭的證據譬如總cardiomegaly 和肺多血脈性的膨脹。斯堪的納維亞研究在CKCS 狗未顯露任何好處在無症狀狗; 結果從北美洲研究是即將發生的。當左被支持的CHF 發生並且肺腫鼓是顯然的, CHF 醫院療法應該被創始。最初的治療包括FON: Furosemide 為利尿(2-4 mg/kg, IV, IM 或平方q6-8h), 氧氣如果需要培養pO2, 和爆發油軟膏(。。英寸q12h 在小狗) 膨脹靜脈。如果肺腫鼓是嚴厲的, 並且如果心臟收縮ABP 是至少90 毫米百克, 一動脈血管舒張劑應該被給減少先生分數。或hydralazine (1.2 mg/kg PO q8-12h) 或鈉硝普鹽(0.5 到5 mg/kg/minute) 能被執行迅速地卸載LV 和減少分數先生。ACEI 並且降低血壓, 但在緊急情況, 行動起始慢的比與直接血管舒張劑。在成功的利尿以後, 療法被交換對口頭療程。
CHF 基礎線家庭療法從endocardiosis 介入FADD: Furosemide 、ACEI 、飲食修改, 和Digoxin 。Furosemide (2-4 mg/kg PO q8.24h) 被執行影響防止鈉保留、腫鼓和腹水。一點抗化劑(enalapril 、benazepril 、ramapril, 或quinapril) 最初地開始在0.5 mg/kg PO q24h 以意向增加藥量對q12h 當CHF 惡化。飲食鈉的合理的減少應該被推薦。Digoxin 被規定在適度對先進的CHF 或當有頻繁atrial 心率失常或AF 。digoxin 最初的藥量是0.005 mg/kg PO q12h. 禁忌症候對digoxin 是適度azotemia 和複雜心室ectopy 。清液digoxin 被報到七天。如果進步左邊支持了或在過程中發生的正確被支持的CHF 顯現出, spironolactone 增加(6.25 到12.5 毫克一次每日) 。另外的治療為推進CHF 包括hydrochlorothiazide (開始於1.2 mg/kg 在Monday/Wednesday/Friday; 當心: azotemia 和hyponatremia), 或第二血管舒張劑譬如amlodipine (0.05.0.1 mg/kg PO q24h; 當心低血壓症) 進一步減少先生分數。導氣管擴張肌(茶鹼) 並且咳嗽suppressants (hydrocodone, butorphanol) 也許增加為根據症狀的安心如果CHF 控制不緩和呼吸標誌。長期預測跟隨成功的療法變化, 但多數狗居住至少六個到12 個月以好家庭療法。後續考試應該集中生活水平問題(態度, 胃口), 活動和鍛煉容量、心臟節奏、呼吸標誌、可變的保留、血壓、腎臟作用, 和清液biochemistries 。


Valvular endocardiosis is a degenerative change of unknown cause affecting the subendocardial valve leaflets and chordae tendineae in the middle aged to elderly dog. Smaller breeds are predisposed. Also known as chronic myxomatous valvular heart disease, this disorder is the most important cause of heart disease in veterinary practice. Endocardiosis leads to progressive valvular incompetency with regurgitation of blood across the closed valve. The mitral apparatus is affected most often (virtually all cases), with the tricuspid valve (34%) and aortic valve (3%) less frequently involved. In some cases, the valves are redundant and the chordae tendineae elongated, leading to prolapse of the valve into the atrium. Gross lesions of advanced endocardiosis include nodular thickening and shortening at the free edge and base of the valve leaflets. Valves appear opaque and white and can be rolled and contracted at their free edge. The chordae become thickened near the valve attachment and may rupture. Secondary dilatation of the left atrium (LA) and left ventricle (LV) develop. The mitral valve annulus also can be dilated. Ventricular hypertrophy is of the eccentric type (dilated chamber), and microscopic coronary disease can lead to focal areas of ischemia and fibrosis. The right ventricle may be dilated from tricuspid regurgitation (TR) complicated by pulmonary hypertension.
Clinical Pathophysiology
The lesions of endocardiosis represent a slowly progressive process and do not cause detectable signs during the period of early structural change. In some dogs, the chordae or valvular tissue is redundant or lax and the valve will prolapse leading to a midsystolic click. Eventually, significant valvular distortion leads to detectable murmurs of valvular insufficiency and some dogs will develop heart failure. The entire process can take many years. Once the mitral valve is incompetent, blood regurgitates from the high pressure (ventricular) to the low pressure (atrial) chamber. The determinants of regurgitant volume and disease severity include: regurgitant orifice size, pressure differences between LV and LA, and time from onset of contraction to opening of the aortic valve. Severe mitral regurgitation (MR) causes LV volume overload, which can lead to left heart failure. MR also predisposes to cardiac arrhythmias, especially those originating in the dilated atrium. If the regurgitant volume increases gradually and atrial compliance increases correspondingly, the atrium distends to a large volume with a minimal change in atrial pressure and the condition is well tolerated. This explains why many dogs have severe cardiomegaly but minimal clinical signs. If the regurgitant volume is large or if the regurgitation develops suddenly (as with chordal rupture), the limits of atrial distensibility are exceeded and the mean LA pressure increases, leading to pulmonary edema. Progressive MR is associated with elevated pulmonary venous pressures, increased hydrostatic pressure in pulmonary capillaries, and eventually by pulmonary edema. These can be explained by the combined effects of 1) regurgitant volume; 2) reduced distensibility of the dilated LV; and 3) renal retention of sodium and water triggered by decreased cardiac output. Clinical consequences include tachypnea, hypoxemia, tiring, and coughing. Pulmonary hypertension (elevated PA pressures) often develops related to increased LA pressure and possibly from narrowing in small pulmonary arteries. These increase resistance to flow through the lungs. Primary lung disease also can be a factor in increasing lung resistance. The development of pulmonary hypertension places a load on the right ventricle and predisposes to more TR. Signs of right sided CHF can ensue, including exercise intolerance, ascites, and syncope. Some dogs progress from a syndrome of left heart failure to one of right heart failure.
Other complications of MR include bronchial compression, cardiac arrhythmias, ruptured chordae tendineae, and rupture of the LA. Left atrial dilation compresses the left mainstem bronchus between the aorta and the enlarging atrium. Bronchial irritation and exertional coughing and wheezing may occur even in the absence of lung edema. Atrial arrhythmias such as premature atrial complexes are triggered in the enlarged atria. Ventricular premature complexes may develop in the dilated LV, though sustained ventricular tachycardia is less common in mitral disease than in dogs with dilated cardiomyopathy. Ruptured chordae tendineae are commonly observed during echocardiographic examination of dogs with advanced MR. Depending on the location of the chordal rupture, the added hemodynamic burden may be tolerated, or severe CHF may supervene. Left atrial rupture, while uncommon, can occur across linear tears in the endocardium; hemorrhage into the pericardial space causes cardiac tamponade, hypotension, and possibly death.
Clinical Findings
Endocardiosis is most common in toy and small breeds (Poodle, Dachshund, Yorkshire Terrier, Cavalier King Charles Spaniel, Schnauzer, Cocker Spaniel) and the condition is an incidental finding in many aged dogs. Some breeds (such as the CKCS) are affected relatively early in life. Larger dogs often develop endocardiosis, and will on occasion, develop CHF consequent to valvular insufficiency; however, the lesions are usually less severe and dilated cardiomyopathy is a more important cause of CHF in these breeds. Some canine breeds, particularly the spaniels, German Shepherd, and Afghan Hound, are prone to both valvular degeneration and cardiomyopathy. The client𠏋 complaints are attributable to cardiac disease or left-sided heart failure and include tiring, progressive cough or tachypnea, and syncope. Syncope is a particularly bothersome problem and may be related to insufficient forward flow, pulmonary hypertension, arrhythmias, or neurocardiogenic syncope (inappropriate bradycardia and vasodilation triggered by sympathetic surges or coughing).
The physical examination findings vary. The heart rate is typically, but not always, regular and increased when CHF is evident. Pronounced sinus arrhythmia is more common in compensated valvular disease. An early auscultatory finding in some dogs is the midsystolic click, suggesting valve prolapse. MR is heralded by a systolic murmur loudest over the mitral area and left apex. Brief and soft systolic murmurs usually indicate early disease unless associated with peracute CHF, hypotension, or concurrent dilated cardiomyopathy. The murmur usually changes from a soft, decrescendo murmur to a loud, holosystolic murmur over a period of months to years. A precordial thrill may be palpable over the left apex (MR) or tricuspid valve area (indicating TR). The typical MR murmur radiates in the direction of the regurgitant jet (dorsally and craniad or caudad) and projects straight across to the right hemithorax once the murmur reaches an intensity of grade 3 or 4. This may be confusing as a concurrent murmur of TR may be detected over the right side of the thorax, especially in dogs with progressive pulmonary hypertension. The first heart sound may be loud, indicating preserved LV systolic function; the second sound may be tympanic, suggesting pulmonary hypertension. An apical ventricular gallop (third heart sound), indicating elevated LV diastolic pressure, is heard in some dogs with untreated CHF, but often resolves following successful therapy. Cardiac arrhythmias, especially atrial premature beats, may be detected by auscultation. As the heart enlarges, the point of the left apical impulse shifts caudoventrally indicating left ventricular enlargement. The arterial pulse is variable depending on forward stroke volume, cardiac rhythm, and degree of systemic arterial vasodilation, and will be impacted by medical therapy. Arterial blood pressure is usually normal but can be low in severe CHF. Some dogs have systemic hypertension related to intercurrent renal or Cushing𠏋 disease. This is problematic as elevated systolic pressure increases the MR fraction. If pulmonary congestion develops from CHF, ventilation and bronchial sounds become abnormal, and inspiratory crackles and cyanosis often develop. Wheezes may represent 𡤧ardiac asthma?from bronchial cuffing or left mainstem bronchial compression. Pleural effusion as an isolated finding is rare in patients with normal sinus rhythm, but is not uncommon in dogs with atrial fibrillation (AF). If the right heart fails, jugular pulses become prominent, jugular venous pressure increases, and the liver enlarges. Ascites indicates advanced right-sided CHF.

minibabyqq 2006-12-28 02:04 AM

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[color=Magenta][size=5][b]似犬心肌病Canine Cardiomyopathy  [/b][/size][/color]


介紹
心肌疾病是心力衰竭的同道會, 心率失常, 和心血管必死在狗。最共同似犬心肌疾病代表心肌層的primary. 混亂。這些被體現作為先天膨脹的心肌病(DCM), arrhythmogenic 心肌病(ACM), 或兩個問題。ACM 由心室ectopia 描繪為週期性atrial 心率失常, 孤立atrial 原纖維形成作用(AF), 或沒有心肌失敗的明顯的echocardiographic 證據。DCM 由在左心室排斥分數的無症狀減退最初地代表(所謂的隱密DCM) 被進步左心室官能不良跟隨達到高潮在充血的心力衰竭(CHF) 。突然的心臟病死亡可能發生以或者形式。心肌病多數案件被遺傳因素影響, 包括養殖、身體尺寸, 和性。
除DCM 和ACM 之外, 多數心肌病的其它形式被認為相對地罕見在狗。堅持atrial 停頓在Springer Spaniels 和其它似犬養殖分散地被診斷。主要肥大性心肌病是罕見的在狗但是一個有差別的診斷為猝死。肥大性心肌病並且遇到以一些規律性在成熟波士頓狗狗。似犬心肌疾病的次要起因包括肥大或傷害從系統高血壓、甲狀腺機能不足、醫原性甲狀腺機能亢進、兒茶酚胺、doxorubicin 、腦子心臟綜合症狀、局部缺血、Duchenne.s myopathy, 和心肌炎(包括Chagas 疾病) 。慢性容量或壓力超載(和以先天分流器或慢性valvular 疾病) 可能進步對超載cardiomyopathy, 。心室是hypertrophied 和心肌作用被削弱。心臟病tamponade 、瞬變心肌局部缺血, 和不懈的supraventricular 或心室心動過速是反演性心肌失敗的起因。
Arrhythmogenic 心肌病
期限arrhythmogenic 心肌病。(ACM) 是提到週期性或堅持心率失常在一個正常左心室排斥分數的設置的一個有用的期限。當一些尾隨受影響與ACM 清楚地開發經典DCM, 許多不, 並且在一些, 臨床管理的鑰匙是心率失常的控制。ACM 是特別共同在拳擊手(和一些英國牛頭犬) 期限arrhythmogenic 正確的心室心肌病(的地方ARVC) 有時使用表明心率失常的被假定的起源。Doberman Pinscher 是經常體現心室ectopics 在公開心肌失敗的發展之前的其它養殖(DCM) 。其它共同的例子是愛爾蘭Wolfhound (和其它巨人養殖); 這些狗是有傾向對atrial 原纖維形成作用(AF) 沒有LV 收縮性, 情況的明顯的損傷有時指孤立AF 。其它atrial 心率失常也許被認可在ACM 包括宮外的atrial 心動過速和atrial 振翼。
ACM 必須是卓越的從其它心率失常的起因譬如一個atrial 腫瘤(hemangiosarcoma), 電解質不平衡狀態(hypokalemia), 脾臟腫瘤, 或手術後心室心率失常(由局部缺血和reperfusion 大概造成) 。同樣, 療程歷史應該被獲得保險心率失常由療法不造成, 例如, 由持續的治療為呼吸疾病(使用仿交感神經作用的導氣管擴張肌) 或為甲狀腺機能不足(過份補充造成醫原性甲狀腺機能亢進) 。是有傾向對DCM 的一些養殖是還事先安排好的對甲狀腺機能不足, 也許接受補充L-thyroxin 。ACM 的成功的管理包括1) 估計節奏干擾使用慣例和能走(Holter) ECG; 2) 測量的LV 排斥分數由echocardiography; 3) 回顧相關的臨床標誌; 並且4) 判斷心率失常的臨床意義。
在狗與孤立AF, Holter 資料提供洞察關於每日心率和鍛煉心率。平均為超出90.95/min 的每日心率或適度級鍛煉超出的心率250/min 是合理的地面為減慢對AF 的心率反應。這可能做與一beta-blocker 譬如atenolol (6.25 到25 毫克PO q12h) 或metoprolol (12.5 毫克PO q12h 在巨人養殖) 。beta-blocker 的最初的藥量應該是降低防止慵倦, 但它可能被滴定二個到四個星期達到一種適當的平均每日費率(一般在範圍的70 到80/min) 。Digoxin 可能為孤立AF 被規定, 但心臟病glycosides 是較不有效的為控制過份與鍛煉相關的率和由作者不推薦除非有充血的心力衰竭。Diltiazem (0.5 到1.5 mg/kg PO q8h) 是非常有效的在控制心率, 但不商談cardioprotection 。beta-blockers 如果心率失常代表隱密DCM 。
分級心室心率失常嚴肅根據相對風險為猝死是更加困難的。清楚地, 臨床標誌(崩潰, 中略語) 出現是徵兆控制心室心動過速如果臨床工作者肯定tachyarrhythmia 是為的依據拼寫。如果不定, 事件螢幕(客戶被激活的ECG) 應該由狗規定和佩帶。共同的問題是沒有公開臨床標誌但頻繁心室宮外的敲打。這裡臨床工作者必須試圖判斷心率失常的重要性。如果Holter ECG 顯示心室心動過速(超出225/min), 頻繁ectopics (譬如超過7,000 每24 小時期間), 或warning. 心率失常迅速奔跑(譬如短被結合的PVC.s, 或振翼像心室心動過速奔跑), antiarrhythmic 療法被推薦。
治療依靠一部分個人特選。為頻繁唯一VPC/PVCs, 一簡單的beta-blocker 也許是有效的在控制節奏(參見藥量上面) 。為心室心動過速, 或sotalol (40 到80 毫克PO q12h 為一條大狗) 或mexiletine (5.8 mg/kg 的組合q8h) 加上beta-blocker 代表有效的療法為減少心室敲打和奔跑頻率。這些的價值在防止突然的心臟病死亡未被證明然而。在難處理案件, amiodarone 也許被嘗試。Procainamide 加上beta-blocker 由一些使用, 但看來是較不有效和更加讚成沒有節奏。它應該被強調, beta-blockers 、sotalol, 和amiodarone 是消極inotropic 藥物。Sotalol 特別是是類III 藥物以有力beta-blocker 作用並且它必須被使用與偉大的care.if 在all.in 充血的心力衰竭設置或當LV 排斥分數極大地被壓下。在狗與明顯的CHF, mexiletine 是更喜歡的治療控制嚴肅的心室心率失常。一旦CHF 被對待(參見下面), beta-blocker 的逐漸向上滴定法也許商談節奏和保護的更好的控制反對猝死。
膨脹的心肌病
膨脹的心肌病(DCM) 是一種先天, 基因, 或familial 心肌疾病為心臟病膨脹和被減少的心肌收縮性描繪。Histologic 損害包括缺乏炎症、變稀的波浪myocytes 纖維、損失, 和增加的心肌纖維變性出現。冠狀動脈是正常和閥門平凡, 除了在更舊的狗與一致僧帽形或tricuspid 閥門endocardiosis 。新陳代謝的基體缺乏(譬如L carnitine 或牛磺酸) 被發現在狗的少數, 但確切的起因和作用關係在這基體和DCM 之間殘缺不全地被瞭解。沒有出版證據為缺乏輔酵素Q10 在這混亂。心肌失敗和被限制的心輸出量起始被neurohormones 和cytokines 攻擊跟隨被發布支持動脈血壓。但是, neurohormonal 活化作用同進一步心肌損傷聯繫在一起。左心室排斥分數繼續減少, 心臟膨脹, 並且心室舒張官能不良可能由詳細的echocardiographic 研究認可。次要房室的valvular 反流經常開發導致僧帽形或tricuspid 反流私語。鈉和水的腎臟保留與被減少的左心室表現結合對產物CHF 。心率失常可能任何時候發生在疾病期間。中略語、突然的心臟病死亡, 或CHF 是這些事件的潛在的後果。頻繁地, biventricular CHF 由AF 的發展早先沉澱在一條狗以compensated 。DCM 。
膨脹的心肌病經常發生在中年, 男性, 大並且大的養殖尾隨, 譬如Doberman Pinscher, 了不起的丹麥人, 和愛爾蘭Wolfhound, 但DCM 可能影響任一年齡狗和許多其它這些養殖。經常男性是事先安排好或可能影響在年輕年齡。除之外大養殖狗, DCM 通常被認可各種各樣的spaniel 養殖, 並且情況分散地發生在小似犬養殖。為DCM 的精確基因依據未被展示。DCM 的四個最共同的臨床介紹是1) 隱密DCM; 2) 心率失常(參見上面); 3) 突然的心臟病死亡; 並且4) 充血的心力衰竭(CHF) 。
隱密DCM 表明一條公開地健康狗以心臟收縮的官能不良的echocardiographic 證據由echocardiography 。多數診斷被做當交配動物者請求一條重要狗的掩護或在獸醫考試揭露私語或心率失常之後。在許多情況下diagnosis 。隱密DCM 根據LV 心臟收縮的作用(縮短分數) 較小軸措施。價值在25% 以下被認為可疑在多數實驗室, 但沒有全體一致大約表明心肌失敗的一個具體圖。這種唯一線性方法可能對表示懷疑因為更大的狗變短相對地更多在頂端對基部的方向並且這行動由縮短分數措施不估計。在回報隱密DCM 診斷之前, 臨床工作者應該請求心臟收縮的作用更加詳細的echocardiographic 措施包括LV 短軸縮短區域, 頂端對基部的僧帽形的環型行動, 並且LV 排斥的容量估計分成幾部分運用圓盤或一個擴展的橢球模型方法。連續考試可能還是有用的在建立下降趨勢在LV 作用。Holter ECG 是有用的附屬為建立診斷在養殖有傾向對DCM 以心率失常。多數會認為> 50 VPC/PVC.s 每天反常。當隱密DCM 診斷肯定, cardioprotection 應該被考慮。這可能被創始與血管緊縮素轉換的酵素抗化劑(ACEI) 譬如enalapril 、benazepril 、ramapril (ramipril), 或quinapril 一次每日被給。如果堅持心率失常是顯然的, beta-blocker 或sotalol 應該並且被考慮(參見上面為藥量) 。
DCM 先進的案件被提出以鍛煉不寬容和CHF 的臨床標誌。那裡可能是被標記的減重和惡病質性。中略語與心室心率失常有關或neurocardiogenic 中略語(不適當的心跳緩慢和vasodilation) 也許由所有者關係。左被支持的CHF 的臨床標誌包括呼吸迫促, 呼吸困厄, 和咳嗽與肺腫鼓有關。正確被支持的CHF 為頸部的脈衝描繪和頸部的多血脈性的膨脹、hepatomegaly, 和腹水。Biventricular 失敗包括上述研究結果與胸膜流出一起。聽診也許顯露atrial 和心室疾馳、心臟收縮的私語, 或心率失常。動脈血壓通常是正常的由於血管縮小和neurohormonal 活化作用, 但將被減少在深刻DCM 以心臟性的震動。第一心音的動脈脈衝的強度和力量經常被減少, 表明被減少的LV 收縮性和行程排量。肺腫鼓或一條胸膜可變的線爆裂聲也許是顯然的。
實驗室研究支持診斷在DCM 先進的案件。EKG 也許展示反常性特點cardiomegaly (寬或高P 揮動; 寬或增加的高度QRS 複合體) 或心肌疾病(寬QRS, 被忽略R 揮動下降, 和ST 段coving) 。一個或更多上述的心率失常也許是顯然的, 雖然能走EKG 是需要的估計心室宮外的節奏頻率。信號平均的EKG 也許展示晚潛力表明增加的風險為心室原纖維形成作用。胸部造影顯露cardiomegaly, 也許展示心力衰竭典型的幅射線照相的特點。echocardiogram 顯示心室擴張、被減少的左心室縮短分數、增加的E 點對氏族的分離, 被減少的牆壁遊覽、左atrial 擴張和易變地正確被支持的cardiomegaly 。僧帽形的反流的多譜勒儀證據和tricuspid 反流, 肺高血壓, 和舒張心室官能不良是共同。定期實驗室試驗通常是正常的或反射在過程中發生的CHF 的疾病、CHF 療法的後果, 或複雜化。專業驗血為L carnitine 或牛磺酸也許執行在選擇的案件。
CHF 最初的醫院療法由DCM 造成包括利尿以furosemide (2.4 mg/kg IV, IM q6-8h), 補充氧氣、硝化甘油軟膏(1.1.5 英寸為大養殖尾隨q12h), 和休息。威脅生命的肺腫鼓可能被處理以鈉硝普鹽的furosemide 和注入(0.5.2.5 mcg/kg/min) 以仔細的關注給予對動脈血壓(滴定注入對85 到90 毫米百克的心臟收縮的價值) 。Thoracocentesis 被表明為適度對大胸膜流出。當有CHF 以系統低血壓症, 治療應該是furosemide 、氧氣, 和dobutamine (2.5 到10 mcg/kg/min) 。Dobutamine 可能有相對地長期好處和繼續至少二天, 到時藥物逐漸變細在一個6.12 小時期間當估計血壓。在低血壓症設置, 血管舒張劑被避免直到壓力由dobutamine 穩定至少二個小時在之後療法與或鈉硝普鹽或ACEI 可能被創始(參見下面) 。在狗以atrial 原纖維形成作用, digoxin (0.005 mg/kg PO q12h) 被規定控制心室率反應。
家庭療法為CHF 由DCM 造成包括furosemide 、一ACE 抗化劑、digoxin, 和鈉有限的飲食。可變的保留被控制以furosemide (2.4 mg/kg PO q8-12h) 並且鈉制約如果可能。Digoxin 療法被創始除非有禁忌症候(適度腎衰竭, 複雜的心室ectopics) 。ACEI 是被規定的僅此一次每日用途(以0.5 mg/kg PO 典型的藥量為enalapril 或benazepril), 和藥量增加到每日兩次在一兩個星期家庭關心以後。那裡可利用, pimobendan (phosphodiesterase 抗化劑鈣使inotropic 藥物敏感以舒張血管的物產) 應該被認為根據有限但有為的臨床研究。Spironolactone (12.5 到25 毫克PO q12h 在一條大狗) 也許增加阻攔醛甾酮的cardiotoxic 作用和妨礙鈉保留在末端nephron 。beta-blocker 也許被認為blunt 有同情心的神經系統的cardiotoxic 作用; 但是, 心力衰竭必須首先很好被控制。選擇beta-blocker 在人的患者是carvedilol 。這種藥物是beta-blocker 和幫助減少afterload 在左心室) 的阿爾法腎上腺素能的預鍛模(。Carvedilol 並且有也許有益於心肌層的抗氧化物產。不幸地, 處方藥(Coreg) 是昂貴的。藥量可能是困難的在不能容忍陰性inotropy 任何beta-blocker 的大狗。因而, 低最初的劑量是委託人(開始與。。3.125 毫克carvedilol 壓片q12h) 。藥物譬如心得安(0.1.0.25 mg/kg PO q8-12h) 更加容易藥量, 只是有不利更加偉大的inverse agonism. (撤消beta 感受器官活動狀態) 並且導致更加偉大消極inotropy 。長行動的Metoprolol (3.12.5 毫克q12h) 被學習了在實驗性似犬心力衰竭, 但藥物難藥量在少於12.5 毫克, 是太大的為最初的藥量。當有beta-blockers 的清楚的理論好處在似犬DCM, one.s 實用能力創始和維護治療也許是非常有限的並且CHF 可能惡化(經常以胸膜流出) 。一定, 當AF 使CHF 複雜化, 或beta-blocker 或diltiazem (0.25 到1.0 mg/kg PO q8h) 被規定控制心室率。Nutraceuticals (牛磺酸或L carnitine) 經驗主義地被使用在選擇的案件。當DCM 發生在spaniels 或小養殖狗, 牛磺酸補充(500 毫克q12h) 被推薦。魚油補充包含Ω3 脂肪酸也許改進胃口和減少心臟病惡病質性(EPA.30 對40 mg/kg PO q24h; DHA 20 到25 mg/kg PO q24h) 。嚴肅的心室心率失常在CHF 設置被處理與mexiletine (5.8 mg/kg q8h) 加上一低藥量beta-blocker 。Sotalol 被嘗試在更大的狗(40 毫克q12h) 但可能惡化CHF 。Holter EKG 應該使用估計療法。

Introduction
Myocardial diseases are a common cause of heart failure, arrhythmia, and cardiovascular mortality in the dog. The most common of the canine myocardial diseases represent 𢖯rimary?disorders of the myocardium. These are manifested as idiopathic dilated cardiomyopathy (DCM), arrhythmogenic cardiomyopathy (ACM), or both problems. ACM is characterized by recurrent atrial arrhythmias, lone atrial fibrillation (AF), or by ventricular ectopia without obvious echocardiographic evidence of myocardial failure. DCM is typified initially by asymptomatic decreases in left ventricular ejection fraction (so called occult DCM) followed by progressive left ventricular dysfunction culminating in congestive heart failure (CHF). Sudden cardiac death can occur in either form. Most cases of cardiomyopathy are influenced by genetic factors, including breed, body size, and sex.
Aside from DCM and ACM, most other forms of cardiomyopathy are considered relatively rare in dogs. Persistent atrial standstill in Springer Spaniels and other canine breeds is diagnosed sporadically. Primary hypertrophic cardiomyopathy is rare in dogs but is a differential diagnosis for sudden death. Hypertrophic cardiomyopathy is also encountered with some regularity in mature Boston Terrier dogs. Secondary causes of canine myocardial disease include hypertrophy or injury from systemic hypertension, hypothyroidism, iatrogenic hyperthyroidism, catecholamines, doxorubicin, brain-heart syndrome, ischemia, Duchenne𠏋 myopathy, and myocarditis (including Chagas disease). Chronic volume or pressure overloads (as with congenital shunts or chronic valvular disease) can progress to the 𡤧ardiomyopathy of overload,?wherein the ventricle is hypertrophied and myocardial function impaired. Cardiac tamponade, transient myocardial ischemia, and relentless supraventricular or ventricular tachycardias are causes of reversible myocardial failure.
Arrhythmogenic Cardiomyopathy
The term 弌rrhythmogenic cardiomyopathy?(ACM) is a useful term that refers to recurrent or persistent arrhythmia in the setting of a normal left ventricular ejection fraction. While some dogs affected with ACM clearly go on to develop classic DCM, many do not, and in some, the key to clinical management is control of the cardiac arrhythmia. ACM is particularly common in the Boxer (and some English Bulldogs) where the term arrhythmogenic right ventricular cardiomyopathy (ARVC) is sometimes used to indicate the presumed origin of arrhythmia. The Doberman Pinscher is another breed that often manifests ventricular ectopics prior to the development of overt myocardial failure (DCM). Another common example is the Irish Wolfhound (and other giant breeds); these dogs are prone to atrial fibrillation (AF) without obvious impairment of LV contractility, a condition sometimes referred to as lone AF. Other atrial arrhythmias may be recognized in ACM including ectopic atrial tachycardia and atrial flutter.
ACM must be distinguished from other causes of cardiac arrhythmia such as an atrial tumor (hemangiosarcoma), electrolyte imbalance (hypokalemia), splenic tumor, or post-operative ventricular arrhythmia (probably caused by ischemia and reperfusion). Similarly, a medication history should be obtained to insure the arrhythmia is not caused, for example, by ongoing treatment for respiratory disease (using sympathomimetic airway dilators) or by therapy for hypothyroidism (excessive supplementation resulting in iatrogenic hyperthyroidism). Some breeds that are prone to DCM are also predisposed to hypothyroidism and may be receiving supplemental L-thyroxin. Successful management of ACM includes 1) assessing the rhythm disturbance using routine and ambulatory (Holter) ECG; 2) measuring LV ejection fraction by echocardiography; 3) reviewing relevant clinical signs; and 4) judging the clinical significance of the arrhythmia.
In dogs with lone AF, the Holter data provide insight about the daily heart rate and the exercise heart rate. Average daily heart rates that exceed 90?5/min or moderate-level exercise heart rates that exceed 250/min are reasonable grounds for slowing the heart rate response to AF. This can be done with a beta-blocker such as atenolol (6.25 to 25 mg PO q12h) or metoprolol (12.5 mg PO q12h in giant breeds). The initial dose of the beta-blocker should be low to prevent lethargy, but it can be titrated up over two to four weeks to achieve an appropriate average daily rate (generally in the range of 70 to 80/min). Digoxin can be prescribed for lone AF, but cardiac glycosides are less effective for controlling excessive exercise-related rates and are not recommended by the author unless there is congestive heart failure. Diltiazem (0.5 to 1.5 mg/kg PO q8h) is very effective in controlling heart rate, but does not confer the 𡤧ardioprotection?of beta-blockers should the arrhythmia represent occult DCM.
Grading the severity of ventricular arrhythmias in terms of relative risk for sudden death is more difficult. Clearly, the presence of clinical signs (collapse, syncope) is an indication to control ventricular tachycardia if the clinician is certain that a tachyarrhythmia is the basis for the spells. If uncertain, an event monitor (client activated ECG) should be prescribed and worn by the dog. The more common problem is when there are no overt clinical signs but frequent ventricular ectopic beats. Here the clinician must attempt to judge the seriousness of the arrhythmia. If the Holter ECG shows rapid runs of ventricular tachycardia (exceeding 225/min), frequent ectopics (such as more than 7,000 per 24 hour period), or 𢘛arning?arrhythmias (such as short-coupled PVC𠏋, or flutter-like runs of ventricular tachycardia), antiarrhythmic therapy is recommended.
Treatment depends in part on personal preference. For frequent single VPC/PVCs, >><<ither sotalol (40 to 80 mg PO q12h for a large dog) or the combination of mexiletine (5? mg/kg q8h) plus a beta-blocker represent effective therapy for reducing the frequency of ventricular beats and runs. The value of these in preventing sudden cardiac death has not been proven however. In difficult to manage cases, amiodarone may be tried. Procainamide plus a beta-blocker is used by some, but appears to be less effective and more pro-arrhythmic. It should be emphasized that beta-blockers, sotalol, and amiodarone are negative inotropic drugs. Sotalol in particular is a class III drug with potent beta-blocker effects and it must be used with great care𡟙f at all𡟙n the setting of congestive heart failure or when LV ejection fraction is substantially depressed. In dogs with obvious CHF, mexiletine is the preferred treatment to control serious ventricular arrhythmias. Once CHF is treated (see below), the gradual upward titration of a beta-blocker may confer better control of the rhythm and protection against sudden death.
Dilated Cardiomyopathy
Dilated cardiomyopathy (DCM) is an idiopathic, genetic, or familial myocardial disease characterized by cardiac dilatation and reduced myocardial contractility. Histologic lesions include absence of inflammation, attenuated wavy fibers, loss of myocytes, and the presence of increased myocardial fibrosis. Coronary arteries are normal and the valves unremarkable, except in older dogs with concurrent mitral or tricuspid valve endocardiosis. Deficiency of metabolic substrates (such as L-carnitine or taurine) is found in a minority of dogs, but the exact cause and effect relationship between these substrates and DCM is incompletely understood. There is no published evidence for deficiency of co-enzyme Q10 in this disorder. The onset of myocardial failure and limited cardiac output is followed by an assault of

minibabyqq 2006-12-28 02:05 AM

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[color=Magenta][size=5][b]打噴嚏和Snorting#Sneezing and Snorting𦂤hat Should I Do   [/b][/size][/color]


慢性鼻炎可能是非常令人沮喪的disease.for 所有者和為我們! 對這些箱子的診斷方法雖然有些有限很好被定義。何時仔細地跟隨, 這種方法通常將帶領我們一種具體治療。以下討論概述我的方法對這些慢性案件的診斷和治療。
歷史
有也許同慢性鼻炎聯繫在一起的各種各樣提出的怨言, 有:
打噴嚏: 對subepithelial 刺激性感受器官的刺激和非常有力反射的一個正常反應也許被廢除以慢性疾病。特徵譬如起始、期間、頻率, 和用途應該是堅定的。反向打噴嚏, 並且稱aspiration 反射, 。是對背部鼻咽mucosa 的任一irritatation 的一個正常反應。
鼻放電: 確定型(漿液, mucoid, 化膿, 血淋淋的等), 數額, 是否(當首先注意) 單邊或雙邊, 如果字符改變了, 並且如果它是壞在任一天的特定時間。放電也許歸結於慢性肺炎(分泌物咳嗽入nasopharynx, 被注意作為鼻放電) 。
呼吸聲音: 動物做任何聲音當呼吸(以施加或休息)? 問如果有是任何聲音(吠聲, meow/purr) 變動(laryngeal 混亂) 。
具體呼吸聲音有:
Stertor, 打鼾的聲音, 由於斷斷續續的物理阻礙通常聽見在_發(即, 軟的上顎) 。
Stridor, 吸入喘息或吵鬧, 典型地聯繫了高的子宮頸tracheal/laryngeal 損害。
Snorting, 發現了以阻礙次要對分泌物儲積。
體格檢查
我測試對於導氣管明顯通過, 和估計氣流從, 各個鼻孔分開地。休息, 一個健康動物應該能呼吸沒有困厄通過一個鼻孔當它的嘴被拿著閉合。如果有任一個變化在努力或噪聲上與相關唯一鼻孔呼吸, 我假設有某一程度阻礙。看類型放電和問所有者怎麼這也許改變了隨時間(對早先治療的反應等) 。面部殘疾並且/或者periosteal 痛苦也許是表示的骨多或periosteal involvement.often 與相關腫瘤、牙的真菌感染, 或偶爾地abscessation 。
口腔
仔細地檢查牙, 艱苦和軟的上顎(視覺上和由直接手指觸診), 扁桃腺, 和喉如果它能被看見。能力評估這些區域取決於動物的合作。咽的神經學狀態可能經常根據怎樣動物抵抗pharyngeal 操作(檢查gag. 反射) 。
鼻翼狀摺疊depigmentation 遇到以慢性鼻炎和次要傳染(細菌或黴菌) 。小心區分在這和一些免疫癩之間(即, 盤狀lupus) 。Schirmer 淚花測試也許查出也許並且同分泌物聯繫在一起損失從側向鼻封墊的神經原的KCS, 並且臨床對一個單邊地乾燥鼻子(xeromycteria) 以阻礙邊的剩餘鼻分泌物(面部神經損傷次要對中耳疾病也許被介入在這些情況下) 。
各種各樣的診斷技術也許使用幫助診斷上部導氣管(鼻) 疾病。沒有是慢性鼻炎診斷的血液學或生物化學的測試, 但他們被表明在排除共存的疾病在必需為其它診斷測試的一般麻醉之前。
具體測試有:
為流鼻血: 以及動脈血壓看小片數字和作用(黏膜靈菌時間), PT/PTT 或行動(為系統高血壓); 檢查療程歷史至於阿斯匹靈和阿爾法苦悶者使用。
為似貓的calici 病毒(FCV): 只可利用由病毒隔離此時
為似貓的herpes 病毒(FVF), 披衣菌和Mycoplasma: PCR 測試有時間幫助診斷這些代理。測試也許執行在或一conjunctival 刮或組織(內眼膜或鼻) 切片檢查法; 特別運輸媒介必需。
黴菌血清學: 為似犬麴黴病(不非常敏感) 並且為似貓的cryptococcosis (乳汁膠合測試好敏感性) 。
鼻分泌物細胞學
通常獲得在rhinoscopy 期間從一個鼻沖洗或切片檢查法。偶爾, 它也許有作用微小地審查總放電。多數次, 細胞學簡單地將顯露PMNs, 但您得到幸運和有時發現具體起因為鼻炎(即, 寄生生物、瘤形成, 真菌感染) 。
細菌文化的解釋從鼻子也許是困難的, 主要細菌鼻炎是罕見的在狗和貓。文化被採取從先前nose/nostril 在哪裡dog.s 鼻子最近是!) 的有價值(據報導好反射。結果的先前對後部文化是定量地和定性地不同的。黴菌文化可能是引入歧途的因為真菌可能被開化從健康動物, 並且因此, 正面結果必須被解釋根據臨床標誌和其它測試。
鼻沖洗
各種各樣的技術被概述了在文學; 可以被使用獲得材料為細胞學和有時為病理組織學。技術包括總沖洗殘骸從鼻子, 沖洗和吐氣以導尿管, 和或挖出果核, 剛性導尿管切片檢查法技術。
寄生生物考試
一個有趣的問題在鼻子和視覺上最好做(即, 尋找小蜘蛛) 或在細胞學(即, 使用一個解剖的或低力量顯微鏡為蛋) 。鼻小蜘蛛共同地遇到在HW 預防物也許被使用較少比在國家的其它區域的科羅拉多; 鼻小蜘蛛被報告全世界。
頭骨radiography.preferred 看法



興趣範圍


看法



Turbinates


張嘴並且/或者內部口頭



靜脈竇


Frog 眼睛。或側面



上頷骨牙


側向傾斜和內部口頭牙齒影片(最好)



Nasopharynx/喉


Lateral.mouth 直接關閉了, head/neck


頭骨的造影
要求一般麻醉為優選安置和最佳的解釋。試圖做這些在一個醒的動物將考慮到一項充分研究和很少將被勸阻。胸口造影應該被認為排除鼻疾病(即, megaesophagus, 肺炎的) 額外鼻起因。
Rhinoscopy
並且要求一般麻醉但應該總做 在 頭骨造影以後。先前和後部rhinoscopy 是可能的, 根據設備可利用。設備變化從一個簡單的牙齒鏡子或otoscope, 對更加昂貴的剛性和靈活的endoscopes 。相當數量的決心可看見的空間(空氣渠道或管道的大小) 是基本的點掌握當觀察狗和貓鼻子。請務必有好配件, 打的氣管內管到位防止可變的志向。切片檢查法也許被採取或通過或沿邊範圍。柔和地做版本記錄為細胞學在定像組織之前和看他們在您的實踐為對問題的一個早期的評估。在做法的完成, 考慮鼻沖洗使用不育的鹽解答的大容量在高壓之下。潛在的複雜化包括靈菌和志向(血液、流體, 分泌物) 。Bronchoscopy 應該執行如果肺炎被考慮作為潛在的源泉的鼻放電。看分開的文章在呼吸內窺鏡檢察在這些行動。
牙周探查
第三步在評估鼻疾病; 它非常重要, 所有上部牙仔細地被審查, 探查各顆牙為也許是表示的abscessation 以次要鼻介入所有牙周口袋的出現。牙齒齲, 雖然不凡, 也許是源泉的infection/nasal 洞介入; 探查牙的冠為了查出軟的區域。
Pharyngeal 疾病
pharyngeal 疾病的標誌通常同氣流干涉並且/或者鼻放電的出現聯繫在一起。開放嘴呼吸(沒有困難) 在雙邊鼻阻礙面前是典型的。診斷被使用為鼻疾病被使用(最佳部分是側向radiograph.look 在鼻咽空氣專欄和尾部rhinoscopy) 。
我發現了lymphosarcoma 在貓的背部鼻咽mucosa, 或許由於慢性抗原刺激相似與小腸lymphosarcoma 的發展在慢性lymphoplasmacytic 腸炎案件。在我的經驗, 這些是典型地緩慢生長腫瘤提出為標誌與其他慢性鼻炎盒容易地被混淆。
鼻咽狹窄或帶子
一個問題在貓(主要) 任何年齡; 傷痕組織橫向板料形成了在軟的上顎和阻礙空氣流程之上通過nasopharynx 。典型地有一個小針孔大小開頭為氣流。帶子應該收效在恢復過程期間在各種各樣的傷害以後對氣道(感染, 創傷) 。傷痕組織並且被觀察了在鼻洞之內。診斷最好被做通過直接形象化(rhinoscopy) 。治療將外科地切除損害, 通常通過分裂軟的上顎, 去除網, 和關閉上顎。複雜化包括網的上顎和改革的開裂。
治療
鼻和鼻咽疾病的治療取決明顯地於問題的主要起因。次要細菌鼻傳染是共同並且伴生的放電經常將清除以幾乎任一種抗藥性療法。抗生素以好Gram-positive 光譜是好選擇。我的特選包括ampicillin, amoxicillin, Clavamox, 氯林肯黴素, doxycycline 。Azithromycin (Zithromax) 被推薦了在慢性鼻炎盒在貓(即, 病毒導致的次要細菌傳染) 。藥量被推薦最初地和然後是5 mg/kg 每日每48 個小時為慢性案件(有長的T. 在貓: 35 個小時!) 。最終, 治療必須被指揮在根本問題; 例子包括鼻外國身體、牙齒相關混亂, 和瘤形成。居住在一個更大的城市過去幾年, 我成為了說服, 慢性激怒從空氣汙染物是剩餘鼻分泌物的起因在某些情況下。診斷在這些情況下是困難的和主要是由其它起因和反應排除對抗發炎療法的。
似貓的病毒鼻炎大概是慢性鼻炎的同道會在貓。次要細菌傳染是共同。L 賴氨酸被顯示與氨基胍基戊酸競爭和干涉病毒複製在細胞培養實驗。被推薦用於貓的藥量慢性地是250.500 毫克q24h PO 。
有效的治療為鼻黴菌疾病存在在小動物(麴黴病在狗, cryptococcosis 在貓) 並且包括典型enilconazole (或clotrimazole) 並且itraconazole 口頭。對慢性鼻傳染的激動反應(細菌或黴菌) 通常是充足導致鼻turbinates (destructive 鼻炎損失。) 並且可以同一些堅持(漿液對類黏蛋白) 鼻放電聯繫在一起。
鼻小蜘蛛也許被對待與ivermectin (300 ug/kg PO 每週x 3) 或在大牧羊犬養殖使用Milbimycin (1 mg/kg PO 每週x 3) 。這是這樣一個共同的問題為我在當評估打噴嚏的和反向打噴嚏在狗, 我定期地推薦對待狗為鼻小蜘蛛在進行前與一充分rhinoscopy 的科羅拉多。其它共同性提出標誌聯繫了鼻小蜘蛛包括打噴嚏的, 漿液的鼻放電(不化膿), 面部激怒, 和流鼻血。
一些鼻情況導致結構反常性(鼻珊瑚蟲, 鼻咽帶子) 那起因鼻氣流阻礙但沒有阻礙對氣流通過嘴。這些情況必須外科地(或或許endoscopically 被對待或與laser), 但再現的預防重要, 也許是困難的在這些情況下。

Chronic rhinitis can be a very frustrating disease㻖or owners and for us! The diagnostic approach to these cases although somewhat limited is well defined. When carefully followed, this approach will usually lead us to a specific treatment. The following discussion outlines my approach to the diagnosis and treatment of these chronic cases.
History
There are a variety of presenting complaints which may be associated with chronic rhinitis, including:
Sneezing: a normal response to stimulation of subepithelial irritant receptors and a very potent reflex may be abolished with chronic disease. Characteristics such as onset, duration, frequency, and use should be determined. Reverse sneezing, also called the 弌spiration reflex,?is a normal response to any irritatation of the dorsal nasopharyngeal mucosa.
Nasal discharge: determine type (serous, mucoid, purulent, bloody etc.), amount, whether (when first noticed) unilateral or bilateral, if the character has changed, and if it is worse at any specific time of the day. The discharge may be due to chronic pneumonia (secretions coughed into the nasopharynx, noticed as nasal discharge).
Respiratory sounds: does the animal make any sound while breathing (with exertion or at rest)? Ask if there has been any voice (bark, meow/purr) changes (laryngeal disorders).
Specific respiratory sounds include:
Stertor, a snoring sound, due to an intermittent physical obstruction usually heard on inspiration (e.g., soft palate).
Stridor, an inspiratory wheeze or noise, typically associated with high cervical tracheal/laryngeal lesions.
Snorting, found with obstructions secondary to secretion accumulation.
Physical examination
I test for airway patency through, and estimate airflow from, each nostril separately. At rest, a healthy animal should be able to breathe without distress through one nostril when its mouth is held closed. If there is any change in effort or noise associated with single nostril breathing, I assume there is some degree of obstruction. Look at the type of discharge and ask the owner how this may have changed over time (response to previous treatments etc.). Facial deformity and/or periosteal pain may be indicative of bony or periosteal involvement𤤖ften associated with tumor, fungal infections, or occasionally abscessation of a tooth.
Oral cavity
Carefully check the teeth, hard and soft palate (visually and by direct finger palpation), tonsils, and the larynx if it can be seen. The ability to evaluate these areas depends on the animal's cooperation. The neurological status of the pharynx can often be based on how the animal resists pharyngeal manipulation (check the 孄ag?reflex).
Nasal alar fold depigmentation is encountered with chronic rhinitis and secondary infections (bacterial or fungal). Be careful to differentiate between this and some of the immune skin diseases (e.g., discoid lupus). Schirmer tear testing may detect neurogenic KCS that may also be associated with loss of secretions from the lateral nasal gland, and clinically to a unilaterally dry nose (xeromycteria) with excess nasal secretions that obstruct that side (facial nerve damage secondary to middle ear disease may be involved in these cases).
A variety of diagnostic techniques may be used to help diagnose upper airway (nasal) diseases. There are no hematological or biochemical tests which are diagnostic of chronic rhinitis, but they are indicated in excluding co-existing diseases prior to general anesthesia which is required for other diagnostic tests.
Specific tests include:
For epistaxis: look at platelet numbers and function (mucosal bleeding time), PT/PTT or ACT as well as arterial blood pressure (for systemic hypertension); check medication history for aspirin and alpha agonist use.
For feline calici virus (FCV): only available by virus isolation at this time
For feline herpes virus (FVF), Chlamydia and Mycoplasma: PCR tests are available to help diagnose these agents. The test may be performed on either a conjunctival scraping or tissue (conjunctiva or nasal) biopsy; special transport media is required.
Fungal serology: for canine aspergillosis (not very sensitive) and for feline cryptococcosis (Latex agglutination test?good sensitivity).
Cytology of nasal secretions
Usually obtained during rhinoscopy from a nasal flushing or biopsy. On occasion, it may be of value to examine the gross discharge microscopically. Most times, cytology will simply reveal PMNs, but sometimes you get lucky and find a specific cause for the rhinitis (e.g., parasites, neoplasia, fungal infection).
The interpretation of bacterial cultures from the nose may be difficult, primary bacterial rhinitis is rare in dogs >><<ere the dog𠏋 nose has been recently!). Results of anterior vs. posterior cultures are quantitatively and qualitatively different. Fungal cultures can be misleading since fungi can be cultured from healthy animals, and therefore, positive results must be interpreted in light of clinical signs and other tests.
Nasal flush
Various techniques have been outlined in the literature; may be used to obtain material for cytology and sometimes for histopathology. Techniques include gross flushing of debris from the nose, flushing and aspirating with a catheter, and or the coring, rigid catheter biopsy technique.
Parasite examination
An interesting problem in the nose and best done visually (e.g., look for mites) or on cytology (e.g., use a dissecting or low power microscope for eggs). Nasal mites are commonly encountered in Colorado where HW preventative may be used less than in other areas of the country; nasal mites are reported worldwide.
Skull radiography炥referred views



Area of Interest


View



Turbinates


Open mouth and/or intra-oral



Sinuses


焅rog-eye?or lateral



Maxillary Teeth


Lateral oblique and intra-oral dental films (best)



Nasopharynx / larynx


Lateral𤧥outh closed, head/neck straight


Radiography of the skull
Requires general anesthesia for optimal positioning and the best interpretation. Attempting to do these on an awake animal will rarely allow for an adequate study and is to be discouraged. Chest radiography should be considered to rule out extra-nasal causes of nasal disease (e.g., megaesophagus, pneumonia).
Rhinoscopy
Also requires general anesthesia but should always be done after skull radiography. Both anterior and posterior rhinoscopy is possible, depending on equipment available. Equipment varies from a simple dental mirror or otoscope, to the more expensive rigid and flexible endoscopes. The determination of the amount of visible space (size of the air channels or meatus) is the basic point to master when scoping dog and cat noses. Be sure to have a good fitting, cuffed endotracheal tube in place to prevent fluid aspiration. Biopsies may be taken either through or along side the scope. Gently make imprints for cytology before fixing tissue and look at them in your practice for an early assessment of the problem. Upon completion of the procedure, consider nasal flushing using large volumes of sterile saline solution under high pressure. Potential complications include bleeding and aspiration (blood, fluid, secretions). Bronchoscopy should be performed if pneumonia is being considered as a potential source of the nasal discharge. See the separate article on respiratory endoscopy in these proceedings.
Periodontal probing
The third step in evaluating nasal diseases; it is very important that all upper teeth be carefully examined, probing each tooth for the presence of any periodontal pockets which may be indicative of abscessation with secondary nasal involvement. Dental caries, although uncommon, may be a source of infection/nasal cavity involvement; probe the crown of the tooth in order to detect soft areas.
Pharyngeal diseases
Signs of pharyngeal disease usually are associated with airflow interference and/or the presence of a nasal discharge. Open mouth breathing (without difficulty) in the face of bilateral nasal obstruction is typical. Diagnostics used for nasal diseases are employed (the best ones are the lateral radiograph𡐤ook at the nasopharyngeal air column and caudal rhinoscopy).
I have found lymphosarcoma in the dorsal nasopharyngeal mucosa of cats, perhaps because of chronic antigenic stimulation similar to the development of intestinal lymphosarcoma in chronic lymphoplasmacytic enteritis cases. In my experience, these are typically slow growing tumors presenting for signs easily confused with any other chronic rhinitis case.
Nasopharyngeal stenosis or webbing

minibabyqq 2006-12-28 02:06 AM

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[color=Magenta][size=5][b]呼吸困難和咳嗽在小動物Dyspnoea and Coughing in Small Animal Practice   [/b][/size][/color]


咳嗽
咳嗽是空氣易爆的發行從肺通過嘴和一般被區分入有生產力或非生產性。
定義系統
心臟病對呼吸疾病
為有慢性咳嗽病人必須被回答的首先問題是是否咳嗽歸結於主要呼吸或主要心臟病疾病。這個分化可能經常是困難的, 但它是必要的所有歷史和體格檢查的方面被運用做這個評估。如果咳嗽歸結於呼吸疾病, 它可能進一步被分類作為歸結於上部或更低的呼吸道疾病。
定義解剖地點
非生產性咳嗽
非生產性咳嗽有苛刻的hacking. 聲音, 頻繁地發生在發作, 和也許被retching 跟隨。非生產性咳嗽一般同氣管或大導氣管疾病聯繫在一起, 通常激動或dysplastic 。許多這些混亂不會同呼吸困難聯繫在一起照原樣難極大遮沒流明這些相對地寬導氣管。有二著名的例外, 然而。你是氣管發育不全, 氣管的一種先天畸形導致重大變窄氣管和伴生的呼吸困難。秒鐘是不育的支氣管炎或allergic. 支氣管炎。在貓特別是, 導氣管的炎症由於各種各樣的hypersensitivities 導致炎症和不同程度bronchospasm 。後者結果在呼吸困難, 通常呼氣。
診斷過程。有非生產性咳嗽病人通常要求各種各樣的診斷步執行評估和描繪他們的官能不良。也許是有用的規程有:
Tracheoscopy/bronchoscopy 。
Transtracheal aspirate 。
支氣管wash/bronchoalveolar lavage 。
Radiology/fluoroscopy 。
有生產力的咳嗽和呼吸困難
有生產力的咳嗽聲音moist. 和結果在黏液、滲出液、腫鼓流體, 或血液從導氣管被交付對口腔。通常動物可示範地忍受材料。很少, 咳出發生和可能與嘔吐被混淆。有生產力咳嗽是經常伴生的以肺parenchymal 疾病。這些疾病並且頻繁地將生產呼吸困難或orthopnoea (位置呼吸困難) 。這是最著名的在失效或在_發和失效過程中。干涉正常動脈oxygenation 的任一主要肺問題或心臟病反常性可能導致呼吸困難。幾乎所有dyspnoeic 動物以肺parenchymal 疾病將有反常性在胸部聽診中。
正常肺聲音
通常胸部聽診顯露支氣管和多泡狀聲音。支氣管聲音是筒形聲音相似與那些聽見在氣管和是突出的在hilar 區域。多泡狀聲音被比作對wind 通過樹, 。是更軟的, 和更加周邊地聽見。
反常肺聲音
反常肺聲音被描述作為爆裂聲或喘息。
爆裂聲。 Non-musical, 不連續的噪聲相似與玻璃紙被弄皺或泡影流行。爆裂聲通常同肺parenchymal 反常性或exudate/oedema 聯繫在一起在導氣管之內。
喘息。 更加音樂, 更加連續的高水平吹哨的聲音。喘息建議導氣管變窄由於支氣管狹窄。
肺腫鼓...
當咳嗽, 呼吸困難, 並且反常胸部呼吸聲音歸結於肺腫鼓, 心臟病反常性應該並且是可發現的。這些也許有:
改變在可觸知或可聽見的心臟病衝動。
被減少的脈衝振幅。
Tachyarrhythmias 。
私語一致以大動脈狹窄或僧帽形的不足或私語建議左對正確轉軌。
心臟病官能不良的這些顯示可能由幅射線照相或echocardiographic 證據支持為改變在正常心臟病結構裡。所有主要呼吸問題也許導致某一程度肺高血壓, 可能導致次要正確的cardiomegaly 。
診斷過程...........
有有生產力咳嗽病人通常需要某一以下診斷過程的組合為他們的bronchopulmonary 疾病的進一步說明:
胸部造影。
支氣管洗滌物。
Transtracheal 洗滌物。
Transthoracic 肺吐氣。
Heartworm 測試: 血清學。
動脈血液氣體分析。
Open-chest 肺切片檢查法。
定義損害
氣管和支氣管的混亂
依照早先被提及, 氣管的混亂和大支氣管通常導致慢性非生產性的咳嗽。更小的支氣管的疾病也許導致有生產力的咳嗽, 和喘息並且爆裂聲共同地auscultated 。氣管的常見病和支氣管是:
似犬感染tracheobronchitis 。
崩潰的氣管。
過敏支氣管炎即, 似貓的asthma. 。
寄生支氣管炎(lungworm) 。
慢性支氣管炎。
令人沮喪這些疾病處理是慢性支氣管炎在小狗類型狗。我經常只瞬變地通常發現任何的組合以下可能是有用的, 但:... 。。。。。
類皮質激素。
Bisolvon 。
Bronchodilation (氨茶鹼或terbutaline) 。
+/ 物理療法(蒸汽治療) 。
麻醉能止咳即hydrocodone (Hycomine: (0.22 mg/kg s.i.d..q.i.d. p/o) 能是非常有用的在狗的管理以其它療程的氣管崩潰(類皮質激素, 支氣管擴張劑) 不給充分控制。參見最新筆記關於呼吸藥物為進一步細節。
肺parenchymal 疾病......
臨床標誌。 肺parenchymal 疾病為呼吸困難(或在失效期間或在呼吸週期過程中), 反常胸部肺聲音, 和有生產力咳嗽描繪。肺parenchymal 疾病的起因有:
炎症(傳染, 過敏, 免疫被斡旋) 。
Thromboembolism 。
瘤形成。
腫鼓。
氣腫。
激動肺parenchymal 疾病
分類。 激動肺parenchymal 疾病像感染或non-infectious 可能被分類(免疫斡旋) 。parenchymal 炎症的起因應該建立, 因為療法為各種各樣的免疫斡旋的激動問題contraindicated 在那些案件以感染原因論。感染肺parenchymal 疾病的各種各樣的起因有:
病毒。
細菌。
黴菌。
寄生......

Non-infectious 免疫斡旋的炎症也許有過敏原因論雖然根本原因經常是不適被定義。
肺Thromboembolism
什麼導致thromboemboli 對形式?Thromboemboli 一般形式由於疾病在器官不同於肺。流通的栓子譬如細菌、油脂、空氣、寄生生物, 和血栓的流通的部份從在別處身體可能被困住在肺血管系統。血栓可能顯現出在船之內由於:
多血脈性的stasis 。
動盪血流。
內皮細胞的損傷。
系統hypercoagulability 。
血栓通常被消滅在形成以後雖然這平衡也許成為干擾在許多疾病狀態。最共同的條件聯繫了thromboembolism 有:
Dirofilariasis/angiostrongylosis 。
Hyperlipidaemia 。
Hyperadrenocorticism 。
甲狀腺機能不足。
Glomerulopathies 。
免疫斡旋的溶血貧血症。
胰腺炎。
DIC 。
病理生理學。 干涉在肺血流導致由thromboemboli 結果在透氣灌注反常性導致低血氧症和低亞硫酸鈉或血碳酸過多症, 根據程度呼吸驅動。肺高血壓也許深刻地發生以巨型的阻礙或反射血管縮小。這通常發生在慢性案件以週期性疾病。肺梗塞是相對地不凡的。
臨床標誌。 低氧症突然的起始導致peracute 呼吸困難和呼吸迫促。偶爾咳嗽或反常肺聲音是存在。在案件以週期性疾病那裡也許是正確的cardiomegaly 或分裂第二心音; 證據為肺高血壓。
診斷。 診斷根據胸部造影、血管學和核閃爍錄像術。在許多情況下肺thromboembolism, 胸部射線照相是正常的儘管嚴厲呼吸標誌和血液氣體證據為明顯透氣灌注反常性。這樣的不一致是高度疑神疑鬼為肺血管疾病。被削的肺動脈偶爾地結束在細胞間或齒齦音radiodensities 焦點區域是罕見的pathognomonic 標誌。明確的診斷更加頻繁地要求截並且/或者血管內的裝填瑕疵的angiographic 示範。
肺腫鼓
肺腫鼓是很可能是左atrial 高血壓的結果由左被支持的心臟病達到。較少共同, 肺overperfusion 或肺vasculature 的增加的滲透性也許是部下的機制。
肺瘤形成
Primary 肺腫瘤、變形的瘤形成和multicentric 瘤形成可能全部介入肺柔膜組織。雖然多數主要肺腫瘤惡性, 轉移不是共同在疾病的早期的階段; 因而, 完全外科撤除為寬恕的一個重大手術後期間提供機會。
臨床標誌。通常, 臨床標誌是特點一般肺parenchymal 疾病。他們通常是慢性和慢慢地進步, 雖然peracute 顯示也許發生以複雜化譬如pneumothorax 或thromboembolism 。
放射學。 胸部造影頻繁地顯露增加的radiodensity 焦點區域以所有部下的結構的obliteration 。邊際經常分明並且氣蝕也許是存在。變形或multicentric 疾病導致一個散開細胞間的樣式有或沒有節狀變動。
診斷。組織診斷也許由支氣管洗滌物或bronchoalveolar lavage 達到雖然直接組織切片檢查法經常必需。


Coughing
A cough is an explosive release of air from the lungs through the mouth and is generally differentiated into productive or non-productive.
Define the system
Cardiac vs. respiratory disease
For the patient with a chronic cough the very first question that must be answered is whether the cough is due to primary respiratory or primary cardiac disease. This differentiation can often be difficult, but it is essential that all aspects of the history and physical examination be utilised to make this assessment. If the cough is due to respiratory disease, it can be further classified as being due to upper or lower respiratory tract disease.
Define the anatomical location
Non-productive coughing
Non-productive coughing has a harsh 蘔acking?sound, frequently occurs in paroxysms, and may be followed by retching. Non-productive coughing is generally associated with tracheal or large airway disease, usually inflammatory or dysplastic. Many of these disorders will not be associated with dyspnoea as it is difficult to significantly occlude the lumen of these relatively wide airways. There are two notable exceptions, however. One is tracheal hypoplasia, a congenital malformation of the trachea producing significant narrowing of the trachea and associated dyspnoea. The second is sterile bronchitis or 弌llergic?bronchitis. In cats in particular, inflammation of the airways due to various hypersensitivities produces inflammation and varying degrees of bronchospasm. The latter results in dyspnoea, which is usually expiratory.
Diagnostic procedures.Patients with non-productive coughing usually require various diagnostic steps to be performed to evaluate and characterise their dysfunction. Procedures that may be helpful include:
Tracheoscopy/bronchoscopy.
Transtracheal aspirate.
Bronchial wash/bronchoalveolar lavage.
Radiology/fluoroscopy.
Productive coughing and dyspnoea
Productive coughing sounds 𢘫oist?and results in mucus, exudate, oedema fluid, or blood from airways being delivered to the oral cavity. Usually the animals demonstrably swallow the material. Rarely, expectoration occurs and can be confused with vomiting. Productive coughing is most often associated with pulmonary parenchymal disease. Frequently these diseases will also produce dyspnoea or orthopnoea (positional dyspnoea). This is most notable on expiration or throughout inspiration and expiration. Any primary lung problem or cardiac abnormality that interferes with normal arterial oxygenation can result in dyspnoea. Almost all dyspnoeic animals with pulmonary parenchymal disease will have abnormalities on thoracic auscultation.
Normal lung sounds
Normally thoracic auscultation reveals bronchial and vesicular sounds. Bronchial sounds are tubular sounds similar to those heard over the trachea and are more prominent in the hilar areas. Vesicular sounds are likened to 𢘛ind through the trees,?are softer, and are heard more peripherally.
Abnormal lung sounds
Abnormal lungs sounds are described as crackles or wheezes.
Crackles. Non-musical, discontinuous noises similar to cellophane being crumpled or bubbles popping. Crackles are usually associated with pulmonary parenchymal abnormalities or exudate/oedema within airways.
Wheezes. More musical, continuous high-pitched whistling sounds. Wheezes suggest airway narrowing due to bronchoconstriction.
Pulmonary oedema??
When coughing, dyspnoea, and abnormal thoracic respiratory sounds are due to pulmonary oedema, cardiac abnormalities should also be detectable. These may include:
Alterations in palpable or audible cardiac impulse.
Reduced pulse amplitude.
Tachyarrhythmias.
Murmurs consistent with aortic stenosis or mitral insufficiency or murmurs suggesting left to right shunting.
These manifestations of cardiac dysfunction can be supported by radiographic or echocardiographic evidence for alterations in normal cardiac structures. All primary respiratory problems may produce some degree of pulmonary hypertension, which can result in secondary right cardiomegaly.
Diagnostic procedures??????
Patients with productive coughing usually require some combination of the following diagnostic procedures for further elucidation of their bronchopulmonary disease:
Thoracic radiography.
Bronchial washings.
Transtracheal washings.
Transthoracic pulmonary aspirates.
Heartworm tests: serology.
Arterial blood gas analysis.
Open-chest lung biopsy.
Define the lesion
Disorders of the Trachea and Bronchi
As previously mentioned, disorders of the trachea and large bronchi usually cause a chronic non-productive cough. Disease of the smaller bronchi may cause a productive cough, and wheezes and crackles are commonly auscultated. The most common disease of the trachea and bronchi are:
Canine infectious tracheobronchitis.
Collapsing trachea.
Allergic bronchitis e.g., feline 弌sthma.?/p>  Parasitic bronchitis (lungworm).
Chronic bronchitis.
The most frustrating of these diseases to manage is chronic bronchitis in small terrier type dogs. I usually find that a combination of any of the following can be helpful, but often only transiently:????
Corticosteroids.
Bisolvon.
Bronchodilation (aminophylline or terbutaline).
+/-physiotherapy (steam treatment).
Narcotic antitussives e.g. hydrocodone (Hycomine: (0.22 mg/kg s.i.d.𤥶.i.d. p/o) can be very useful in the management of dogs with tracheal collapse for whom other medications (corticosteroids, bronchodilators) do not give adequate control. See later notes on respiratory drugs for further details.
Pulmonary parenchymal disease???
Clinical signs. Pulmonary parenchymal disease is characterised by dyspnoea (either during expiration or throughout the respiratory cycle), abnormal thoracic lung sounds, and productive coughing. Causes of pulmonary parenchymal disease include:
Inflammation (infection, allergic, immune-mediated).
Thromboembolism.
Neoplasia.
Edema.
Emphysema.
Inflammatory pulmonary parenchymal disease
Classification. Inflammatory pulmonary parenchymal disease can be classified as infectious or non-infectious (immune-mediated). The cause of the parenchymal inflammation should be established, as therapy for the various immune-mediated inflammatory problems will be contraindicated in those cases with an infectious aetiology. The various causes of infectious pulmonary parenchymal disease include:
Viral.
Bacterial.
Fungal.
Parasitic. ???

Non-infectious immune-mediated inflammation may have an allergic aetiology although the underlying cause is often ill defined.
Pulmonary Thromboembolism
What causes thromboemboli to form?Thromboemboli generally form as a result of disease in organs other than the lungs. Circulating emboli such as bacteria, fat, air, parasites, and circulating parts of thrombi from elsewhere in the body can be trapped in the pulmonary vascular system. Thrombi can develop within vessels as a result of:
Venous stasis.
Turbulent blood flow.
Endothelial damage.
Systemic hypercoagulability.
Thrombi are usually eliminated soon after formation although this balance may become disturbed in many disease states. The most common conditions associated with thromboembolism include:
Dirofilariasis/angiostrongylosis.
Hyperlipidaemia.
Hyperadrenocorticism.
Hypothyroidism.
Glomerulopathies.
Immune-mediated haemolytic anaemia.
Pancreatitis.
DIC.

minibabyqq 2006-12-28 02:07 AM

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[color=Magenta][size=5][b]呼吸道Endoscopy.A 視覺評估 Visual Assessment of the Respiratory Tract   [/b][/size][/color]


呼吸內窺鏡檢察(當由一位老練的獸醫執行) 是最可貴的診斷的當中一個可利用為導氣管疾病的評估在狗和貓。考慮到對鼻洞、喉、tracheobronchial 樹和胸膜空間的評估的具體規程被開發了。這次研討會依照被觀看將集中於小動物導氣管徵兆、設備、做法和視覺出現使用rhinoscopy, 喉鏡檢查和tracheobronchoscopy 。和以許多規程, 好處和結果被獲得從這些規程與程度endoscopist 的經驗有關。一般麻醉必需為所有這些規程; 我更喜歡氣體麻醉為rhinoscopy 和可注射的麻醉劑為喉鏡檢查和bronchoscopy 。前麻醉劑實驗室試驗被表明排除也許影響麻醉劑選擇或影響animal.s 補救的共存的疾病。
Rhinoscopy
Rhinoscopy 是對鼻洞、nasopharynx (NP) 並且例如paranasal 靜脈竇的視覺評估。一次完全考試(介入先前和後部rhinoscopy) 要求一般麻醉和具體endoscopic 設備。徵兆為rhinoscopy 包括打噴嚏和反向打噴嚏, 鼻盡職, 並且/或者經常某一程度氣流阻礙。動物以流鼻血應該有凝固外形(即, 血小板計數, 和或法案或PT/PTT) 執行和他們的血液壓力被檢查在開始前。
為鼻洞的一個完全評估, 靜脈竇和nasopharynx 應該包括頭骨射線照相, rhinoscopy 和牙周探查。由於強的導氣管防護反射(打噴嚏和堵嘴), rhinoscopy 要求深刻的平面麻醉, 特別是為後部rhinoscopy 。典型lidocaine, 被噴洒在黏膜表面, 也許幫助直言這些反射。某一程度耐心和實踐必需操縱一個靈活的endoscope 在軟的上顎附近和入位置清楚地形象化NP 。它是有用記得, retroflexed endoscope 將倒置圖像依照由endoscopist 看見。當適當地安置以下結構應該是可看見的: 軟的上顎, 軟的上顎, 背部鼻咽牆壁的mucosa 的自由邊緣, 打開對eustachian 管(在背部, 側向牆壁上), choanae, 和一些ectoturbinates 在或鼻洞或vomer 骨頭和鼻中隔。mucosa 應該是桃紅色和不易碎的; 那裡應該是最小的分泌物並且choanae 應該是專利。
我遇到了在NP 的典型的損害有:
黏膜反常性: 炎症、充血、增加的黏膜脆弱或脆弱、和淋巴腺濾泡發展(表明慢性) 或黏膜擴散(這也許是淋巴瘤在貓) 。
正常空間量的損失在NP: 由於腫瘤、珊瑚蟲、外國身體、非難、網, 或剩餘分泌物。
混雜: 寄生生物(小蜘蛛), 排水設備從eustachian 管, NP 牆壁膿腫。
一旦NP 被審查了, 嘴堵嘴可能被去除和先前rhinoscopy 執行。endoscope 應該背部地最初地被指揮和中間(繞過球莖翼狀軟骨) 並且然後被調直和被推進入鼻洞(平行對鼻中隔) 。這保證, 範圍進入共同的管道和使潛力減到最小受損傷組織在鼻洞的入口。與小範圍和一個更大的大小的動物, 它也許是可能攀登鼻洞的長度和加入NP 。
以下結構定期地是可看見的在先前rhinoscopy 期間:
打開對翼狀軟骨的nasolacrimal duct.ventral 邊緣。
鼻中隔(垂直被排列, turbinates 對面) 。
Turbinates (背部和腹chonchae), 全部出現從鼻洞的側向方面。
四meatii (背部, 中間, 腹和common).it 非常重要注意這些導氣管的大小!
Ethmoidal 迷宮尾部。
上頷骨和前面sinuses.only 到達了如果有是turbinate destruction/loss 。
先前rhinoscopy 可能使非常簡單如果空氣渠道(meatii 的) 大小或相當數量可看見的空間仔細地簡單地被評估。相當數量可看見的空間可能 只 是: 1) 法線; 2) 增加; 或3) 減少。和在NP, 先前呼吸mucosa 應該是桃紅色, 不易碎以最小的分泌物當前。
我遇到了在先前rhinoscopy 期間的典型的損害有:
黏膜反常性: 炎症、充血、增加的黏膜脆弱或脆弱, 淋巴腺濾泡發展(較少共同地被發現比在NP) 。
增加的相當數量可看見的空間: turbinate 損失, 慢性炎症(通常與相關如此情況像似犬鼻麴黴病或次要對細菌傳染, 即, 牙膿腫、外國身體或似貓的病毒傳染) 。
被減少的相當數量可看見的空間: 正常空域(管道) 由分泌物、組織(腫瘤、肉芽腫, 珊瑚蟲), 和外國身體填裝。
分泌物: 所有型。
混雜研究結果: 寄生生物(鼻小蜘蛛), 黴菌匾。
文化從鼻洞, 雖然頻繁地正面, 不被認為代表主要細菌疾病。多數鼻細菌傳染是次要對其它問題和通常清理以最小的抗菌治療 如果 部下和主要問題是解決(即, 牙根膿腫, 外國身體) 。少量切片檢查法鑷子也許通過通過endoscope (剛性和靈活) 或沿邊範圍切片檢查損害在考慮中使用直接視覺教導。必須被保重獲得多個切片檢查法和得到樣品深在組織之內(避免抽樣損害的壞死的邊緣) 。在研究由借和Hawkins, 83% 94 個案件有一個明確的診斷被做使用總rhinoscopy 和rhinoscopic 協助的切片檢查法。接觸版本記錄為細胞學可能被回顧當等候病理組織學收效。
喉鏡檢查
喉鏡檢查 是黃金本位制為估計laryngeal 疾病因為它考慮到兩解剖損害的評估並且內在laryngeal function/motion 混亂。雖然定期設備也許被使用(舌頭壓器, 光源), 使用endoscope 考慮到喉的一個更加詳細的評估。我並且將使用endoscope 看入NP 和下來入氣管為所有共存的問題。在麻醉動物前, 是肯定評估為知覺作用(堵嘴反射) 任一損失在口咽, 因為這也許在將來同志向聯繫在一起一種增加的風險。通常, 輕平面麻醉(動物仍然如此理想地堵嘴) 被使用。在對解剖方面的評估以後, 我定期地推薦對呼吸興奮劑(doxopram HCl 、Dopram-V, 1 mg/lb BW Iv) 的用途克服對麻醉的深度的關心和最大化內在laryngeal 行動; 起始是快速的, 通常在~15.30 秒之內, 以期間~2.3 分鐘。
我觀察了在pharynx/larynx 在喉鏡檢查期間的典型的損害有:
Elonagted 軟的上顎: 如果被期望和被對待在觀察之時如果可能(切除術) 。
Laryngeal 黏膜腫鼓: 這可能是嚴厲的在動物中以上部導氣管噪聲的慢性歷史。
Edematous/everted laryngeal saccules (側向心室): 外翻可能嚴密是非常動態因此神色!
Laryngeal 痲痺: 可以是單邊或雙邊的。
Laryngeal 崩潰: 慢性上部航線堵塞的生活威脅的複雜化。
Laryngeal 瘤形成: 淋巴瘤, squamous 細胞癌, 其它癌是共同的型。
Epiglottic 陷害: 次要對其它吸入的問題, 典型地非常斷斷續續。
切片檢查法也許被採取在直接形象化之下。腫鼓被診斷或經常也許起因於蒼勁的laryngeal 操作; 它應該被對待與類皮質激素跟隨做法的完成。嚴厲地阻礙損害也許要求一個臨時氣管造口術的安置維護專利導氣管當輔助措施被採取對款待阻礙(類皮質激素為腫鼓, 許多損害的laser 切除術, 或或許明確的laryngeal 痲痺手術) 。
Bronchoscopy
Bronchoscopy 是呼吸實踐的整體部分在獸醫方面從至少70 年代初期。沒有bronchoscopy 的問題(包括bronchoalveolar lavage 為細胞學和文化) 是黃金本位制為更低的呼吸道疾病診斷在小動物。Bronchoscopy 也許被使用為診斷, 治療和預斷目的。診斷bronchoscopy 獲得視覺資訊關於導氣管(即, 壓縮、動態崩潰, 和擴張) 並且樣品(細胞學、文化, 和偶爾地切片檢查法) 幫助建立一個具體病因學診斷。一般麻醉是必要控制這些反射在bronchoscopy 期間, 因此防止精神創傷對導氣管, 和同時保護endoscope 在做法過程中。理想的麻醉劑應該提供好耐心克制, 有最小的心肺作用, 是或者雙面布料或短期和考慮到一個光滑的補救期間。更新, 短的代理並且/或者反演性可注射的麻醉劑的可及性允許bronchoscopy 執行在患者以最小的關心。我當前的麻醉的協議運用或atropine 或glycopyrolate, 或acepromazine 或butorphanol 與propofol 為做法。這個麻醉的形式是非常有利的因為它為做法不僅提供充分麻醉, 而且考慮到迅速耐心補救, 一個重要因素在老年醫學的患者。
bronchoscopist 必須有對正常endoscopic 肺解剖學的好理解如果she/he 將認可反常性和疾病。分化(認識) 法線從什麼是反常的是一主觀一個。經驗和實踐很大地改進臨床工作者的能力查出損害在早期。我儘可能定期地審查喉(解剖學和內在function/motion 如果可能), 子宮頸和intrathoracic 氣管和然後船底座在連續地評估所有lobar 和最後許多分裝式並且/或者次級分裝式支氣管之前(後者隨患者和endoscope 大小變化) 。變化在總解剖學, 固定的和動態流明大小上, 反常性在導氣管形狀, mucosal/submucosal 特徵, 和分泌物出現應該是著名。正常和反常內窺鏡檢察例子將被顯示; 當前的參考並且包含這些scopings 的優秀顏色相片。經驗和實踐將改進endoscopist 的能力查出早期的損害。樣品被獲得(細胞學、文化, 和切片檢查法) 然後被依靠建立一個具體診斷。
Bronchoalveolar lavage (BAL) 根本上是末端導氣管和小窩的洗滌物。材料被獲得從這個區域被認為代表末端導氣管、小窩, 和肺的intersitium 。bronchoscope (或導尿管) 柔和地被楔住在選擇的支氣管和10.20ml 不育鹽然後被沖洗入導氣管和立刻吐氣使用柔和的注射器吸。我使用二個整除數每站點和二個站點每動物。站點單獨地被評估以總細胞計數和一cytospin 為有差別的細胞計數但流體被結合為被定量的文化。困難以做法(粗劣的回歸) 也許被期望當一個均衡地大endoscope 防止楔住在更小的支氣管, 或當導氣管是malacic 。在前情況, 流體被分散入太大區域容易地被檢索, 並且在後者, 導氣管崩潰(以柔和的吸), 防止任一個infusate 的大量回歸。主要細胞在所有種類應該是齒齦音巨噬細胞(70+ %), 與少於3.8% 所有其它細胞類型(除了也許有由20+ % eosinophils 決定和仍然被認為健康) 的貓。
文化從更低的導氣管是有用的在建立一個具體診斷和選擇適當的抗生素根據敏感性結果。克汙點細胞學幫助在解釋文化結果。汙穢起因於混合上部呼吸道分泌物與更低的導氣管樣品必須明顯地被避免。(這由發現建議是都共同性對 口腔) 的squamous 皮膜並且/或者大細菌Simonsiella spp. 。Peeters 等, 最近表示, 被定量的BAL 文化是重要在導氣管殖民化的分化從實際傳染。Mycoplasma 文化是可能的使用專業運輸媒介(即, 艾米媒介) 並且隔夜發貨對選擇的實驗室。微生物學的結果必須總被解釋根據細胞學被獲得從同樣站點。

Respiratory endoscopy (when performed by an experienced veterinarian) is one of the most valuable diagnostics available for the evaluation of airway diseases in dogs and cats. Specific procedures have been developed which allow for the assessment of the nasal cavity, larynx, tracheobronchial tree and pleural space. This seminar will focus on the indications, equipment, procedure and visual appearance of small animal airways as viewed using rhinoscopy, laryngoscopy and tracheobronchoscopy. As with many procedures, the benefits and results obtained from these procedures will be related to the degree of experience of the endoscopist. General anesthesia is required for all these procedures; I prefer gas anesthesia for rhinoscopy and injectable anesthetics for laryngoscopy and bronchoscopy. Pre-anesthetic laboratory tests are indicated to exclude co-existing diseases that might influence the choice of anesthetics or affect the animal𠏋 recovery.
Rhinoscopy
Rhinoscopy is the visual assessment of the nasal cavity, nasopharynx (NP) and in some instances the paranasal sinuses. A complete examination (involving both anterior and posterior rhinoscopy) requires general anesthesia and specific endoscopic equipment. The indications for rhinoscopy include sneezing and reverse sneezing, nasal discharge, and/or often some degree of airflow obstruction. Animals with epistaxis should have a coagulation profile (e.g., platelet count, and either an ACT or PT/PTT) performed and their blood pressure checked prior to starting.
For a complete evaluation of the nasal cavity, sinuses and nasopharynx should include skull radiographs, rhinoscopy and periodontal probing. Due to strong airway protective reflexes (sneezing and gagging), rhinoscopy requires a deep plane anesthesia, especially for posterior rhinoscopy. Topical lidocaine, sprayed on the mucosal surfaces, may help blunt some of these reflexes. Some degree of patience and practice is required to maneuver a flexible endoscope around the soft palate and into a position to clearly visualize the NP. It is helpful to remember that the retroflexed endoscope will invert the image as seen by the endoscopist. When properly positioned the following structures should be visible: free edge of the soft palate, soft palate, mucosa of the dorsal nasopharyngeal wall, opening to the eustachian tubes (on the dorsal, lateral walls), choanae, and some of the ectoturbinates in either nasal cavity or vomer bone and the nasal septum. The mucosa should be pink and not friable; there should be minimal secretions and the choanae should be patent.
Typical lesions that I have encountered in the NP include:
Mucosal abnormalities: inflammation, hyperemia, increased mucosal fragility or friability, and lymphoid follicle development (indicates chronicity) or mucosal proliferation (this may be lymphoma in cats).
Loss of the normal amount of space in the NP: due to tumor, polyp, foreign body, stricture, web, or excess secretions.
Miscellaneous: parasites (mites), drainage from eustachian tubes, NP wall abscess.
Once the NP has been examined, the mouth gags can be removed and anterior rhinoscopy performed. The endoscope should initially be directed dorsally and medially (to bypass the bulbous alar cartilage) and then straightened out and advanced into the nasal cavity (parallel to the nasal septum). This will ensure that the scope enters the common meatus and minimizes the potential to traumatize tissues at the entrance of the nasal cavity. With a small scope and a larger sized animal, it may be possible to traverse the length of the nasal cavity and enter into the NP.
The following structures are routinely visible during anterior rhinoscopy:
Opening to the nasolacrimal duct錱entral edge of the alar cartilage.
Nasal septum (vertically aligned, opposite of turbinates).
Turbinates (dorsal and ventral chonchae), all arise from lateral aspect of the nasal cavity.
Four meatii (dorsal, middle, ventral and common)𡟙t is very important to note the size of these airways!
Ethmoidal labyrinth caudally.
Maxillary and frontal sinuses𤤖nly reached if there has been turbinate destruction/loss.
Anterior rhinoscopy can be made very simple if the size of the air channels (the meatii) or simply the amount of visible space is carefully evaluated. The amount of visible space can only be: 1) normal; 2) increased; or 3) decreased. As in the NP, the anterior respiratory mucosa should be pink, not friable with minimal secretions present.
Typical lesions that I have encountered during anterior rhinoscopy include:
Mucosal abnormalities: inflammation, hyperemia, increased mucosal fragility or friability, lymphoid follicle development (less commonly found than in the NP).
Increased amount of visible space: turbinate loss, chronic inflammation (usually associated with such conditions as canine nasal aspergillosis or secondary to bacterial infections, e.g., tooth abscess, foreign body or feline viral infection).
Decreased amount of visible space: the normal air space (meatus) is filled by secretions, tissue (tumor, granuloma, polyp), and foreign body.
Secretions: all types.
Miscellaneous findings: parasites (nasal mites), fungal plaques.
Cultures from the nasal cavity, although frequently positive, are not thought to represent primary bacterial disease. Most nasal bacterial infections are secondary to another problem and usually clear up with minimal antibacterial treatment if the underlying and primary problem is resolved (e.g., tooth root abscess, foreign body). Pinch biopsy forceps may be passed through the endoscope (rigid and flexible) or along side the scope to biopsy a lesion in question using direct visual guidance. Care must be taken to obtain multiple biopsies and to get samples deep within the tissue (to avoid sampling the necrotic edge of a lesion). In the study by Lent and Hawkins, 83% of 94 cases had a definitive diagnosis made using gross rhinoscopy and rhinoscopic assisted biopsy. Touch imprints for cytology can be reviewed while awaiting histopathology results.
Laryngoscopy
Laryngoscopy is the gold standard for assessing laryngeal disease as it allows for the evaluation of both anatomic lesions as well as disorders of intrinsic laryngeal function/motion. Although routine equipment may be used (tongue depressor, light source), using an endoscope allows for a more detailed evaluation of the larynx. I will also use the endoscope to look into the NP and down into the trachea for any co-existing problems. Prior to anesthetizing the animal, be sure to evaluate for any loss of sensory function (gag reflex) in the oropharynx, as this may be associated with an increased risk of aspiration in the future. Normally, a light plane of anesthesia (ideally so the animal is still gagging) is used. Following assessment of the anatomic aspects, I routinely recommend the use of a respiratory stimulant (doxopram HCl, Dopram-V, 1 mg/lb BW IV) to overcome concerns about anesthetic depth and to maximize intrinsic laryngeal motion; the onset is fast, usually within ~15?0 sec, with a duration ~2? minutes.
Typical lesions that I have observed in the pharynx/larynx during laryngoscopy include:
Elonagted soft palate: should be anticipated and treated at the time of scoping if possible (resection).
Laryngeal mucosal edema: this can be severe in animals with a chronic history of upper airway noise.
Edematous/everted laryngeal saccules (lateral ventricles): eversion can be very dynamic so look closely!
Laryngeal paralysis: may be unilateral or bilateral.
Laryngeal collapse: a life threatening complication of chronic upper airway obstruction.
Laryngeal neoplasia: lymphoma, squamous cell carcinoma, other carcinomas are the common types.
Epiglottic entrapment: secondary to other inspiratory problems, typically very intermittent.
Biopsies may be taken under direct visualization. Edema is often diagnosed or may result from vigorous laryngeal manipulation; it should be treated with corticosteroids following completion of the procedure. Severely obstructive lesions may require the placement of a temporary tracheostomy to maintain a patent airway while ancillary measures are taken to treat the obstruction (corticosteroids for edema, laser resection of mass lesions, or perhaps definitive laryngeal paralysis surgery).
Bronchoscopy

minibabyqq 2006-12-28 02:07 AM

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[color=Magenta][size=5][b]細菌肺炎的診斷和管理Diagnosis and Management of Bacterial Pneumonia   [/b][/size][/color]


更低的呼吸道的細菌傳染是病態和必死的重要起因在狗和貓, 特別是在住醫院的患者和在那些動物與其他部下的預先處理疾病。肺炎可能迅速地是致命的如果不及時地診斷和對待。
原因論
在許多情況下, 細菌肺炎大概是1) 主人的呼吸防禦的妥協的組合的結果; 2) 觸犯的細菌的致病性潛力; 並且3) 暴露的本質對細菌的。一個或更多的失敗主人的更低的呼吸道防禦機制通常必需為細菌殖民化。主人防禦反對細菌包括1) nasoturbinate 濾清; 2) 防護導氣管反射(打噴嚏, 咳嗽, 支氣管狹窄); 3) mucociliary 清除(黏液物產, ciliary 推進力); 並且4) 吞噬作用和殺害由齒齦音巨噬細胞。
光譜細菌孤立從動物以更低的呼吸道傳染(肺炎) 與孤立是相似由健康動物上部導氣管被做。呼吸道的常駐微生物群落被認為從oropharyngeal 細菌被獲得(即, 鏈球菌、 葡萄球菌、 Pasteurella、 Klebsiella、 E桿菌 , 和各種各樣的嫌氣性細菌的) 志向。因而, 多數細菌肺炎由這些oropharyngeal 細菌次要機會主義的入侵造成。呼吸道的主要主要細菌病原生物在狗和貓是 Bordetella bronchiseptica。主要呼吸病原生物可能並且包括mycoplasmas 、 披衣菌, 和真菌。
傳染路線
更低的呼吸道的細菌傳染可能發生由或吸入路線或hematogenous 路線。傳染吸入路線有: 1) 汙染的oropharyngeal 流體(正常分泌物和唾液) 或滲出液的志向聯繫了牙齒, oro-pharangeal, 或鼻傳染; 2) 食物的志向(譬如發生與反流由食管和吞下的混亂造成); 3) 嘔吐物的志向(特別是在被麻醉的, 沮喪的, 或recumbent 動物); 並且4) 汙染的氣管內管、氣管造口術運載細菌入更低的呼吸道的管, 和bronchoscopes 。
傳染hematogenous 路線介入播種肺從菌血症與相關任一個遙遠的組織站點的傳染。這可能包括靜脈內導尿管伴生的菌血症, 也許是醫院被獲取的肺炎的重要起因。
預先處理因素
有許多素質和高風險臨床設置為細菌肺炎。已存在主要呼吸傳染可能由次要細菌入侵複雜化; 例如, 似犬慍怒病毒; 狗窩咳嗽複合體; 似貓的感染呼吸疾病(herpesvirus 、calicivirus, 披衣菌); 系統真菌病; 並且肺寄生生物(肺蠕蟲, 肺比目魚) 。其它素質包括肺thromboembolism (包括heartworm 疾病); 食管咽下困難和反流; 胸部精神創傷和手術; 移居的肺外國身體(即, 狐尾芒); 煙吸入; 肺瘤形成; 系統sepsis; 並且免役缺陷綜合症狀。肺炎可能並且同長時期的recumbency 、昏迷, 或昏迷聯繫在一起從所有起因。
臨床顯示
細菌肺炎的最頻繁的臨床標誌是咳嗽、呼吸迫促、呼吸困難, 和慵倦。熱病是可變物, 發生在少於50% 案件中。鼻放電是一個少有的標誌。肺炎可能由失水複雜化。聽診也許顯露增加的或被減少的呼吸聲音, 爆裂聲的地區, 和喘息。
診斷
定期胸部造影一般顯露齒齦音肺滲入(蓬鬆齒齦音opacities 以空氣bronchograms) 分佈特別是對頭蓋骨和中間耳垂的腹地區。完全血液計數顯露neutrophilic 白血球增多以左移在大約60% 案件中。Cytologic 更低的呼吸道標本考試和文化高度被推薦證實診斷和引導療法。呼吸標本可能被獲得吐氣, 洗滌物, 或brushings 。
限制文化標本的oro pharyngeal 汙穢, transtracheal 洗滌物、不育的氣管內管洗滌物、bronchoscopic bronchoalveolar lavage, 或被守衛的microbiologic 標本刷子可能被使用。典型地, 文化是正面的並且cytologies 顯露mucupurulent 炎症與可看見的細胞內細菌。觸犯的細菌經常被觀察在被弄髒的cytologic 準備。細菌形狀和克弄髒的特徵可能引導最初的抗藥性選擇。球菌通常是鏈球菌或葡萄球菌。標尺通常是Gram-negative 細菌。分支的纖維狀標尺大概是放線菌或Noccardia 。
治療
抗生素、再水化(即, 可變的療法), 和預先處理因素排除或控制, 是重要性在對待的細菌肺炎。任一細菌孤立從肺炎嫌疑犯的更低的呼吸道應該遞交為感受性測試, 特別是從觸犯的有機體在狗並且貓經常是Gram-negative 細菌, 是極端易變的在他們的抗藥性敏感性。當等候文化和感受性的結果, 抗生素的最初的選擇也許由細菌的形狀的cytologic 決心引導(球菌被承擔是克正面並且標尺被承擔是克陰性) 。混雜的傳染發生在大約40% 案件中。建議的抗菌養生之道為肺炎是如下。為Gram-positive 球菌的最初的治療, 考慮amoxicillin clavulanate 、頭孢菌素, 或trimethoprim sulfa 。為Gram-negative 標尺的最初的治療, 考慮amoxicillin clavulanate 、fluoroquinolone 、頭孢菌素, 或trimethoprim sulfa 。為威脅生命的sepsis, 考慮amoxicillin clavulanate 和fluoroquinolone 在組合、amoxicillin clavulanate 和amikacin 在組合、頭孢菌素和amikacin 在組合, 或第三代頭孢菌素。為Bordetella bronchiseptica, 考慮amoxicillin clavulanate 、doxycycline 、fluoroquinolone, 或aerosolized gentamycin 。為mycoplasma, 考慮doxycycline 或fluoroquinolone 。抗藥性養生之道應該繼續在至少一個星期在傳染的臨床和幅射線照相的寬恕之外; 因而, 通常極小的期間是二個或三個星期。
措施促進滲出液和分泌物清除從更低的呼吸道有: 1) 腸外可變的療法維護優選的系統水合作用和因此防止導氣管分泌物的濃縮過程和保留; 2) 導氣管增濕(霧化器, 蒸發器) 減少導氣管分泌物黏度; 3) bronchodilation 使用茶鹼、terbutaline, 或albuterol; 4) 物理療法譬如溫和的鍛煉和胸口percussion/vibration (chest 拍手。) 促進咳嗽、肺被保留的呼吸分泌物和滲出液的擴展, 和動員; 並且5) 的能止咳藥物退避會壓制有利咳嗽反射。不用處方的expectorant 藥物限制了活動和可厭惡的口味。補充氧氣(氧氣籠子, 鼻氧氣管) 可能是有利的為嚴厲hypoxemia 和呼吸困難安心, 由血液氣體監視更好地引導如果可能。
治療的成功嚴密被監測得並且由熱病的決議表明, 聽診反常性、hypoxemia, neutrophilia, 和幅射線照相肺滲入。

Bacterial infections of the lower respiratory tract are an important cause of morbidity and mortality in dogs and cats, especially in hospitalized patients and in those animals with other underlying predisposing diseases. Pneumonia can be rapidly fatal if not promptly diagnosed and treated.
Etiology
In most cases, bacterial pneumonia is probably the result of a combination of 1) compromise of the host's respiratory defenses; 2) the pathogenic potential of the offending bacteria; and 3) the nature of the exposure to the bacteria. Failure of one or more of the host's lower respiratory tract defense mechanisms is usually required for bacterial colonization. Host defenses against bacteria include 1) nasoturbinate filtration; 2) protective airway reflexes (sneezing, coughing, bronchoconstriction); 3) mucociliary clearance (mucus properties, ciliary propulsion); and 4) phagocytosis and killing by alveolar macrophages.
The spectrum bacterial isolates from animals with lower respiratory tract infection (pneumonia) are similar to the isolates made from the upper airways of healthy animals. The resident microflora of the respiratory tract is thought to be derived from aspiration of oropharyngeal bacteria (e.g., Streptococcus, Staphylococcus, Pasteurella, Klebsiella, E coli, and various anaerobes). Thus, most bacterial pneumonias are caused by secondary opportunistic invasion of these oropharyngeal bacteria. The principal primary bacterial pathogen of the respiratory tract in dogs and cats is Bordetella bronchiseptica. Primary respiratory pathogens can also include mycoplasmas, Chlamydia, and fungi.
Routes of Infection
Bacterial infection of the lower respiratory tract can occur by either the inhalation route or the hematogenous route. The inhalation route of infection includes: 1) aspiration of contaminated oropharyngeal fluid (normal secretions and saliva) or exudate associated with dental, oro-pharangeal, or nasal infections; 2) aspiration of food (such as occurs with the regurgitation caused by esophageal and swallowing disorders); 3) aspiration of vomitus (especially in anesthetized, depressed, or recumbent animals); and 4) contaminated endotracheal tubes, tracheostomy tubes, and bronchoscopes that carry bacteria into the lower respiratory tract.
The hematogenous route of infection involves seeding of the lung from bacteremia associated with infection of any distant tissue site. This can include intravenous catheter-associated bacteremia, which might be an important cause of hospital-acquired pneumonia.
Predisposing Factors
There are numerous predispositions and high-risk clinical settings for bacterial pneumonia. Pre-existing primary respiratory infections can be complicated by secondary bacterial invasion; for example, canine distemper virus; kennel cough complex; feline infectious respiratory disease (herpesvirus, calicivirus, Chlamydia); systemic mycoses; and pulmonary parasites (lung worms, lung flukes). Other predispositions include pulmonary thromboembolism (including heartworm disease); esophageal dysphagia and regurgitation; thoracic trauma and surgery; migrating pulmonary foreign bodies (e.g., foxtail awns); smoke inhalation; pulmonary neoplasia; systemic sepsis; and immunodeficiency syndromes. Pneumonia can also be associated with prolonged recumbency, stupor, or coma from any cause.
Clinical Manifestations
The most frequent clinical signs of bacterial pneumonia are cough, tachypnea, dyspnea, and lethargy. Fever is variable, occurring in less than 50% of cases. Nasal discharge is an infrequent sign. Pneumonia can be complicated by dehydration. Auscultation may reveal regions of increased or decreased breath sounds, crackles, and wheezes.
Diagnosis
Routine thoracic radiography generally reveals alveolar pulmonary infiltrates (fluffy alveolar opacities with air bronchograms) distributed especially to the ventral regions of the cranial and middle lobes. A complete blood count reveals a neutrophilic leukocytosis with a left shift in approximately 60% of cases. Cytologic examination and culture of lower respiratory tract specimens is highly recommended to confirm the diagnosis and to guide therapy. Respiratory specimens can be obtained by aspirates, washings, or brushings.
To limit oro-pharyngeal contamination of culture specimens, transtracheal washings, sterile endotracheal tube washings, bronchoscopic bronchoalveolar lavage, or guarded microbiologic specimen brushes can be used. Typically, cultures are positive and cytologies reveal mucupurulent inflammation with visible intracellular bacteria. The offending bacteria are often observed in stained cytologic preparations. Bacterial shape and Gram staining characteristics can guide initial antibiotic choice. Cocci are usually streptococci or staphylococci. Rods are usually Gram-negative bacteria. Branching filamentous rods are probably Actinomyces or Noccardia.
Treatment
Antibiotics, re-hydration (i.e., fluid therapy), and elimination or control of predisposing factors, are the highest priorities in treating bacterial pneumonia. Any bacterial isolate from the lower respiratory tract of a pneumonia suspect should be submitted for a susceptibility test, especially since the offending organisms in dogs and cats are often Gram-negative bacteria, which are extremely variable in their antibiotic sensitivity. While awaiting the results of culture and susceptibility, the initial choice of an antibiotic may be guided by a cytologic determination of the shape of the bacteria (cocci are assumed to be Gram-positives and rods are assumed to be Gram-negatives). Mixed infections occur in approximately 40% of cases. Suggested antibacterial regimens for pneumonia are as follows. For initial treatment of Gram-positive cocci, consider amoxicillin-clavulanate, cephalosporin, or trimethoprim-sulfa. For initial treatment of Gram-negative rods, consider amoxicillin-clavulanate, fluoroquinolone, cephalosporin, or trimethoprim-sulfa. For life-threatening sepsis, consider amoxicillin-clavulanate and fluoroquinolone in combination, amoxicillin-clavulanate and amikacin in combination, cephalosporin and amikacin in combination, or a third generation cephalosporin. For Bordetella bronchiseptica, consider amoxicillin-clavulanate, doxycycline, fluoroquinolone, or aerosolized gentamycin. For mycoplasma, consider doxycycline or fluoroquinolone. The antibiotic regimen should be continued for at least one week beyond clinical and radiographic remission of the infection; thus, the usual minimum duration is two or three weeks.
Measures to facilitate clearance of exudate and secretions from the lower respiratory tract include: 1) parenteral fluid therapy to maintain optimal systemic hydration and thereby prevent inspissation and retention of airway secretions; 2) airway humidification (nebulizer, vaporizer) to reduce viscosity of airway secretions; 3) bronchodilation using theophylline, terbutaline, or albuterol; 4) physical therapy such as mild exercise and chest percussion/vibration (𡤧hest clapping? to promote cough, lung expansion, and mobilization of retained respiratory secretions and exudates; and 5) avoidance of antitussive drugs that would suppress the beneficial cough reflex. Over-the-counter expectorant drugs have limited activity and an objectionable taste. Supplemental oxygen (oxygen cage, nasal oxygen tube) can be beneficial for relief of severe hypoxemia and dyspnea, preferably guided by blood gas monitoring if possible.
The success of treatment is monitored closely and indicated by resolution of fever, auscultation abnormalities, hypoxemia, neutrophilia, and radiographic pulmonary infiltrates.

minibabyqq 2006-12-28 02:08 AM

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[color=Magenta][size=5][b]犬慢性支氣管炎診斷和療法   [/b][/size][/color]


介紹
Chronic 支氣管炎(CB) 是一種激動導氣管疾病, 與tracheobronchial 崩潰有關係, 大概是最共同的慢性似犬導氣管混亂。炎症在導氣管之內導致慢性咳嗽和過份黏液生產。由於, 狗can.t expectorate (唾液), 它總不容易知道如果狗做增加的導氣管黏液。所以, CB 診斷通常根據慢性咳嗽單獨。
由於我們診斷CB 根據每日咳嗽, 我們需要是肯定的, 其它慢性咳嗽的起因譬如心力衰竭、heartworm 大批出沒、肺炎、肺腫瘤, 等, 排除。這可能是複雜的, 一部分, 因為CB 是更舊的狗疾病, 並且這些動物也許有任何這其他, 共存的混亂, 獨自能, 起因咳嗽。另外, 某些藥物被使用對待CB 在狗也許是不適當和甚而contraindicated 為混亂不同於CB 。重要地然後, CB 診斷必須用某一把握被做避免潛在的複雜化與療法有關。
臨床研究結果在狗以慢性支氣管炎
對某人特徵的描述
狗被診斷與CB 一般是 > 6 年紀。那裡不似乎是清楚的性或助長嗜好雖然許多小和玩具養殖譬如長卷毛狗和Pomeranians 臨床被診斷了與CB 。
歷史
由定義, 狗與CB 有慢性咳嗽。這咳嗽一般是深和throatier. 比高被投的honking. 咳嗽由extrathoracic 氣管崩潰造成, 仍然苛刻比soft 潮濕咳嗽由肺炎造成。推測如果增加的黏液生產同咳嗽聯繫在一起, 要求客戶如果咳嗽終止在堵嘴, 吞下或堵塞。如果那樣, 狗提供和然後吞下黏液。
Some 狗與CB 也許是否則absolutely 正常的當其他人將是嚴厲地鍛煉有限的由他們的疾病。區別大概歸結於是存在的相當數量軟骨減弱, 並且發生的收效的導氣管崩潰當容易地被疲勞的狗開始行使。這些動物是否則明亮, 戒備, 和所有其他方面, 系統地很好。慢性支氣管炎在狗不導致消沉、慵倦、厭食, 等。如果這些標誌是存在, 您應該考慮其它混亂起因咳嗽。
體格檢查
唯一一致auscultable 發現在狗與CB 是吸入和呼氣爆裂聲。心率一般是正常的為養殖和年齡, 和也許是慢慢地比被期望。靜脈竇心率失常是非常共同, 可能由palpating 讚賞大腿骨脈衝及時以狗的呼吸的樣式。
診斷測試
由於CB 診斷根據慢性咳嗽的歷史, 它是只必要執行幫助確定其它混亂出現起因咳嗽的那些診斷測試。
胸部射線照相。 狗胸部射線照相與CB 也許看上去正常。這發現不排除CB! 通常然而, 胸部射線照相各自地顯露的doughnuts. 並且/或者tram 線出現是突出和變厚的支氣管牆壁被看見在末端或平行, 。
Bronchopulmonary 細胞學。 嗜中性通常是主要細胞從標本恢復由氣管洗滌採取; 這些細胞獨立地不表明潮流或通過傳染。細胞內細菌並且/或者嗜中性一次毒性出現當然會建議細菌傳染出現。黏液一般是豐富的既使當流體的相對地小容量恢復。很小數量的淋巴細胞、eosinophils, 和上皮細胞恢復在多數樣品。
齒齦音巨噬細胞也許被發現以各種各樣的形態階段, 從相對地淡靜對activated 。在所有正常動物並且在狗與CB 。技術譬如bronchoalveolar lavage 允許洗滌流體進入聯絡以肺表面和結果在齒齦音巨噬細胞的更高的百分比的檢索與氣管洗滌物比較。不管技術被使用, 齒齦音巨噬細胞是一absolutely 正常發現和不應該被解釋作為bronchopulmonary 炎症或病理學的標誌。
CB 也許有時同導氣管eosophilia 聯繫在一起在狗。在我的經驗, 這是共同在snow 狗。(Malamutes, 愛斯基摩等) 。這些寵物共同地是根據症狀的根據一個季節性依據唯一(建議觸犯的抗原的一個環境來源和導致為隨後咳嗽) 。這些箱子並且似乎顯著反應抗發炎療法(參見糖皮質激素的療法下面) 。
Tracheobronchial 文化。 bacterial. 支氣管炎一個根據推定的診斷最共同地被做當被開化的導氣管樣品生長有氧細菌的混雜的人口。記住雖則, 所有種類導氣管被學習, 包括狗, 貓和人們, 日間保留很小數量的細菌。那是我們咳嗽和清清我們的嗓子的原因的當中一個。在我的經驗, 細菌從患支氣管炎的狗導氣管恢復反射無害殖民化而不是傳染。
Bronchoscopy 。狗導氣管與CB 是普遍地erythematous 和通常有一次被粗化的或顆粒狀出現。mucosa 經常變厚, 不規則和edematous 。過份和厚實的黏液也許跨過導氣管的流明或會集作為黏液插座, 可能遮沒更小的導氣管。
背部氣管膜的崩潰入導氣管的流明是共同在狗與CB 。這發現不排除CB, 但是反而反射一致氣管崩潰與CB 有關係。一觸擊的發現在一些狗與CB 是intrathoracic 導氣管的崩潰在被動發散作用期間。這不能是明顯的在胸部射線照相並且在任何情況下是更加劇烈的當endoscopically 形象化在動態行動。在我的經驗, 狗以intrathoracic 導氣管崩潰只少量地反應療法, 和總之, 有一種較不幸運預測。
切片檢查法和病理組織學。慢性支氣管炎是一個臨床診斷, 不要求組織切片檢查法為確認。然而, 慢性支氣管疾病某些histologic 特點是典型的和包括觚細胞肥大和增生、單核細胞濾滲, 和增加的結締組織在lamina propria 之內。
治療選擇
慢性支氣管炎症, 不管起因, 導致黏膜和導氣管牆壁變厚, 黏液分泌過多, 和某一程度導氣管光滑的肌肉收縮。收效的標誌是似犬CB 定義的特點和包括咳嗽和鍛煉不寬容。 CB 的主要治療整個地根據控制導氣管炎症。 任一種療法的指導原則不必須總是if 在疑義, 做害處。
類皮質激素
Glucocorticoids 使用對待人以支氣管疾病50 年。他們清楚地是最有效的治療為這混亂, 雖然潛在地致衰弱的副作用限制他們的用途在這個臨床設置。即使類固醇不是主要能止咳, 由越來越少的炎症他們也許減少的導氣管知覺神經刺激負責對創始咳嗽在似犬CB 裡。另外, 類固醇減少黏液的容量由患支氣管炎的導氣管導致。在我的經驗, 類固醇是最有效的藥物可利用對待狗與CB, 和應該被認為慢性療法中流砥柱。我從強體松一般開始治療1 mg/kg q12h PO 為一個星期, 然後0.5 mg/kg q12h PO 一個另外的星期。第一星期或二治療將導致在臨床標誌的最劇烈的減退並且這通常是像狗曾經將得到在強體松一樣。逐漸變細繼續對最低的有效劑量那控制> 75% 咳嗽。如果咳嗽返回使用導致重大副作用強體松的藥量(依照由您和所有者確定), 我介紹被吸入的類固醇(flovent, 220 mcg q12h; 在別處參見文章在被吸入的療程在這些行動) 。
支氣管擴張劑
它會有道理使用支氣管擴張劑對待狗與CB 如果導致臨床標誌的某一程度支氣管狹窄存在了。有很少理由相信, 這是可靠對於多數狗與CB 。只一項非逸事研究收集客觀資料確定支氣管擴張劑療法的作用在狗與CB 。在那個報告, 和在我們的最新經驗, 只大約一個在七條狗有一個正面治療反應。另一方面, 支氣管擴張劑療法由吸入安全和容易執行(在別處參見文章在被吸入的療程在這些行動) 。由於它不是確切狗與CB 從支氣管擴張劑療法將有益於, 它可能試圖在任一條狗與沒有對類固醇的一個巨大反應的CB 。
抗生素
細菌傳染可能doesn.t 戲劇一個重大角色在許多情況下的似犬CB 。一個正面文化結果被獲得從一次tracheobronchial 洗滌不一定暗示臨床重大導氣管傳染的出現, 不應該導致抗藥性療法, 除非有純淨的細菌文化在一塊主要文化板材。這是因為有氧細菌從健康貓、狗, 和人導氣管恢復了, 不超出5 X 103 organisms/ml 。相反, 一個唯一有機體的成長恢復沒有對充實湯的用途暗示> 105 organisms/ml; 這與infected. 導氣管是一致的。當然, 如果主要文化返回, 抗藥性治療應該開始根據文化和敏感性資料。
咳嗽Suppressants
慢性導氣管炎症導致許多的生產厚實的黏液, 作為一個防護機制大概設陷井觸犯的刺激劑從到達肺。咳嗽是非常重要對明白這黏液, 應該被重視作為防護生理學反射。但是, 有咳嗽是乾燥和非生產性的許多案件。在這些情況, 咳嗽不是防護的並且服務進一步激怒導氣管, 導致一個狠毒週期咳嗽激怒咳嗽。另外, 一些狗以慢性咳嗽無法睡覺和也許喚醒他們的所有者在晚上。偶爾地, 一些狗以慢性咳嗽也許變得syncopal 。在每個這些臨床設置, 咳嗽鎮壓也許被表明。我使用hydrocodone 酸性酒石酸鹽, 0.22 mg/kg PO q6-12h 依照必要。這是開始的藥量, 並且我增加藥量和頻率直到咳嗽很大地被減少或狗睡著。逐字地!
實踐上, hydrocodone 大劑量的最共同的副作用在狗是睡意和便秘。我使用1 個茶匙metamucil 為便秘並且我日間減少hydrocodone 藥量減少思睡。
其它藥物
Mucolytics 被建議了作為療法的形式為狗以導氣管疾病與相關黏液的過份分泌物。當藥物譬如acetylcysteine 是能打破負責部份地對導氣管黏液的特別黏本質, 實踐上, aerosolized acetlycysteine 的二硫化物束縛是惱人的對導氣管皮膜, 能促進重大支氣管狹窄。
預測和結論
似犬CB 是共同, 進步, 和慢性導氣管混亂。標誌可能很大地被改進但疾病不是可醫治的。優秀客戶通信的創立是重要的以便客戶期望是現實的並且以便治療政權由臨床工作者建立被遵守。

INTRODUCTION
蟖hronic bronchitis (CB) is an inflammatory airway disease, which, in association with tracheobronchial collapse, is probably the most common chronic canine airway disorder. Inflammation within airways causes chronic cough and excessive mucus production. Because, dogs can㦙 expectorate (spit), it is not always easy to know if the dog is making increased airway mucus. Therefore, the diagnosis of CB is usually based on chronic cough alone.
Because we diagnose CB on the basis of a daily cough, we need to be sure that other causes of chronic cough such as heart failure, heartworm infestation, pneumonia, lung tumor, etc., have been ruled out. This can be complicated, in part, because CB is a disease of older dogs, and these animals may have any of these other, co-existing disorders, which can by themselves, cause cough. Additionally, certain drugs used to treat CB in dogs may be inappropriate and even contraindicated for disorders other than CB. Importantly then, the diagnosis of CB must be made with some degree of certainty to avoid potential complications related to therapy.
CLINICAL FINDINGS IN DOGS WITH CHRONIC BRONCHITIS
Signalment
Dogs diagnosed with CB are generally > 6 years of age. There does not seem to be a clear sex or breed predilection although lots of small and toy breeds such as Poodles and Pomeranians have been clinically diagnosed with CB.
History
By definition, dogs with CB have a chronic cough. This cough is generally deeper and 懀hroatier?than the high pitched 蘔onking?cough caused by extrathoracic tracheal collapse, and yet harsher than the 𦽳oft moist?cough caused by pneumonia. To figure out if increased mucus production is associated with the cough, ask the client if the cough terminates in gagging, swallowing or choking. If so, the dog is coughing up and then swallowing the mucus.
䒷ome dogs with CB may be otherwise absolutely normal while others will be severely exercise-limited by their disease. The difference is probably due to the amount of cartilage weakening that is present, and the resulting airway collapse that occurs when the easily fatigued dog begins to exercise. These animals are otherwise bright, alert, and in all other respects, systemically well. Chronic bronchitis in dogs does not cause depression, lethargy, anorexia, etc. If these signs are present, you should consider other disorders that cause cough.
Physical Examination
The only consistent auscultable finding in dogs with CB is inspiratory and expiratory crackles. Heart rate is generally normal for the breed and age, and may be a bit slower than anticipated. A sinus arrhythmia is very common and can be appreciated by palpating the femoral pulse in time with the breathing pattern of the dog.
Diagnostic Tests
Because the diagnosis of CB is based on a history of chronic cough, it is only necessary to perform those diagnostic tests that help to determine the presence of other disorders that cause cough.
Thoracic Radiographs. Thoracic radiographs of dogs with CB may appear normal. This finding does not rule out CB! More commonly however, thoracic radiographs reveal the presence of 𡞫oughnuts?and/or 懀ram lines?which are prominent and thickened bronchial walls seen on end or in parallel, respectively.
Bronchopulmonary Cytology. Neutrophils are usually the predominant cell recovered from specimens taken by tracheal wash; these cells do not independently indicate current or past infection. Intracellular bacteria and/or a toxic appearance of neutrophils would of course suggest the presence of bacterial infection. Mucus is generally abundant even when a relatively small volume of fluid is recovered. Small numbers of lymphocytes, eosinophils, and epithelial cells are recovered in most samples.
Alveolar macrophages may be found in various morphologic stages, from relatively quiescent to 弌ctivated?in all normal animals as well as in dogs with CB. Techniques such as bronchoalveolar lavage allow the wash fluid to come into contact with the lung surface and result in retrieval of a higher percentage of alveolar macrophages compared to tracheal washing. Regardless of the techniques used, the alveolar macrophage is an absolutely normal finding and should not be interpreted as a sign of bronchopulmonary inflammation or pathology.
CB may sometimes be associated with airway eosophilia in dogs. In my experience, this is more common in 𦽳now dogs?(Malamutes, Huskies etc). These pets commonly are symptomatic on a seasonal basis only (suggesting an environmental source of the offending antigen and cause for the subsequent cough). These cases also seem to respond most dramatically to anti-inflammatory therapy (see Glucocorticoid Therapy below).
Tracheobronchial Culture. A presumptive diagnosis of 弎acterial?bronchitis is most commonly made when cultured airway samples grow a mixed population of aerobic bacteria. Remember though, airways of all species studied, including dogs, cats and people, retain small numbers of bacteria throughout the day. That is one of the reasons we cough and clear our throat. In my experience, bacteria recovered from the airways of bronchitic dogs reflect innocuous colonization rather than infection.
Bronchoscopy.The airways of dogs with CB are universally erythematous and usually have a roughened or granular appearance. The mucosa is often thickened, irregular and edematous. Excessive and thick mucus may span the lumen of an airway or gather as a mucus plug, which can occlude smaller airways.
Collapse of the dorsal tracheal membrane into the lumen of the airway is common in dogs with CB. This finding does not rule out CB, but instead reflects concurrent tracheal collapse in association with CB. A striking finding in some dogs with CB is the collapse of intrathoracic airways during passive exhalation. This may not be apparent on thoracic radiographs and in any case is much more dramatic when visualized endoscopically in dynamic motion. In my experience, dogs with intrathoracic airway collapse respond only marginally to therapy, and in general, have a less fortunate prognosis.
Biopsy and Histopathology.Chronic bronchitis is a clinical diagnosis and does not require tissue biopsy for confirmation. Nevertheless, certain histologic features of chronic bronchial disease are characteristic and include goblet cell hypertrophy and hyperplasia, mononuclear cell infiltration, and increased connective tissue within the lamina propria.
THERAPEUTIC OPTIONS
Chronic bronchial inflammation, regardless of cause, causes mucosal and airway wall thickening, mucus hypersecretion, and some degree of airway smooth muscle constriction. The resulting signs are the defining features of canine CB and include cough and exercise intolerance. The primary treatment of CB is based entirely on controlling airway inflammation. The guiding principle of any therapy must always be 𧗽f in doubt, do no harm.?/p> Corticosteroids
Glucocorticoids have been used to treat humans with bronchial disease for over 50 years. They are clearly the most effective treatment for this disorder, although potentially debilitating side effects limit their use in this clinical setting. Even though steroids are not primary antitussives, by decreasing inflammation they may decrease stimulation of airway sensory nerves that are responsible for initiating cough in canine CB. Additionally, steroids decrease the volume of mucus produced by bronchitic airways. In my experience, steroids are the most effective drugs available to treat dogs with CB, and should be considered the mainstay of chronic therapy. I generally begin treatment with prednisone 1 mg/kg q12h PO for one week, then 0.5 mg/kg q12h PO for an additional week. The first week or two of treatment will cause the most dramatic decrease in clinical signs and this is usually as good as the dog will ever get on prednisone. Tapering continues to the lowest effective dose that controls > 75% of the cough. If the cough returns using a dose of prednisone that causes significant side effects (as determined by you and the owner), I introduce inhaled steroids (flovent, 220 mcg q12h; see article on inhaled medications elsewhere in these Proceedings).
Bronchodilators
It would make sense to use bronchodilators to treat dogs with CB if some degree of bronchoconstriction existed which led to clinical signs. There is very little reason to believe that this is true for most dogs with CB. Only one non-anecdotal study has collected objective data to determine the effect of bronchodilator therapy in dogs with CB. In that report, and in our later experience, only about one in seven dogs had a positive therapeutic response. On the other hand, bronchodilator therapy by inhalation is safe and easy to administer (see article on inhaled medications elsewhere in these Proceedings). Because it is not clear which dogs with CB will benefit from bronchodilator therapy, it can be attempted in any dog with CB that does not have a great response to steroids.
Antibiotics
Bacterial infection probably doesn㦙 play a significant role in most cases of canine CB. A positive culture result obtained from a tracheobronchial wash does not necessarily imply the presence of a clinically significant airway infection and should not lead to antibiotic therapy, unless there was a pure bacterial culture on a primary culture plate. This is because aerobic bacteria recovered from the airways of healthy cats, dogs, and humans, does not exceed 5 X 103 organisms/ml. In contrast, growth of a single organism recovered without the use of enrichment broth implies >105 organisms/ml; this is consistent with an 𧗽nfected?airway. Of course, if a primary culture is returned, antibiotic treatment should begin based on culture and sensitivity data.
Cough Suppressants
Chronic airway inflammation causes production of lots of thick mucus, probably as a protective mechanism to trap the offending irritant from reaching the lung. Coughing is very important to clear this mucus and should be thought of as a protective physiologic reflex. However, there are many cases in which the cough is dry and non-productive. In these situations, the cough is not protective and serves to further irritate the airway, leading to a vicious cycle of cough-irritation-cough. In addition, some dogs with chronic cough are unable to sleep and may awaken their owners at night. Occasionally, some dogs with chronic cough may become syncopal. In each of these clinical settings, cough suppression may be indicated. I use hydrocodone bitartrate, 0.22 mg/kg PO q6-12h as needed. This is a starting dose, and I increase the dose and the frequency until the cough is greatly reduced or the dog is asleep. Literally!
In practice, the most common side effects of high doses of hydrocodone in dogs are drowsiness and constipation. I use 1 teaspoon of metamucil for the constipation and I reduce the dose of hydrocodone during the day to decrease the somnolence.
Other Drugs
Mucolytics have been suggested as a form of therapy for dogs with airway disease associated with excessive secretion of mucus. While drugs such as acetylcysteine are capable of breaking the disulphide bonds that are partially responsible for the particularly viscid nature of airway mucus, in practice, aerosolized acetlycysteine is irritating to airway epithelium and can promote significant bronchoconstriction.
PROGNOSIS AND CONCLUSIONS
Canine CB is a common, progressive, and chronic airway disorder. Signs can be greatly improved but the disease is not curable. Establishment of excellent client communications is critical so that client expectations are realistic and so that the therapeutic regime established by the clinician is adhered to.

minibabyqq 2006-12-28 02:09 AM

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[color=Magenta][size=5][b]肺真菌病 Pulmonary Mycoses [/b][/size][/color]  


這將談論狗和貓四個主要系統真菌病的肺顯示和治療: histoplasmosis 、芽苞黴菌病、coccidioidomycosis, 和cryptococcosis 。
Histoplasmosis
histoplasmosis, Histoplasma capsulatum 的 起因, 是二形性土壤出生的真菌被發現在許多世界的溫和和亞熱帶地區。在北美洲, 疾病是最流行在中央美國的河谷地區, 特別是在區域毗鄰密西西比河和它的附庸國。在四周溫度, 土壤由分解豐富含氮問題(即, 鳥或棒排匯物) 提供理想成長媒介在mycelial 階段 Histoplasma。傳染主要路線是由空中孢子和mycelial 片段的吸入在windblown 土壤。 Histoplasma 有機體變換成導致肺巨噬細胞的細胞內傳染的酵母階段。普遍hemolymphatic 傳播對實際上任一個組織或器官系統可能發生。曝光結果被暴露程度影響; 年齡(臨床疾病是最共同在幼小動物少於四年紀); 養殖(大流行在炫耀和追逐養殖, 或許由於更高的曝光風險); 免疫抑制的因素(類皮質激素也許提高傳播); 並且主人細胞免疫。不明顯的傳染沒有臨床疾病的證據是共同。
臨床標誌
不明顯, 自已限制傳染被限制對呼吸道是自然傳染最共同的結果。它幅射線照相地被認可當多個謹慎鈣化的細胞間的焦點(不活潑的被濃縮的或被癒合的損害) 並且有時鈣化的tracheobronchial 淋巴結。histoplasmosis 的深刻肺形式為嚴厲猛烈的granulomatous 肺炎描繪以咳嗽、呼吸困難、熱病, 和嚴厲不適的標誌。幅射線照相的研究結果發出音散開線性或節狀細胞間肺滲入, 經常以補湊聯合的密度和適度地擴大的tracheobronchial 淋巴結。慢性肺形式比深刻形式共同和為慢性granulomatous 肺炎描繪(散開或multifocal 以導致外在導氣管壓縮的明顯tracheobronchial lymphadenopathy 。標誌包括慢性咳嗽和溫和的呼吸困難以易變的減重和熱病。幅射線照相地, tracheobronchial 淋巴結的巨型的擴大和易變的線性或節狀間隙植物滲入被看見。
小腸histoplasmosis 是最共同的extrapulmonary 形式在狗, 也許代表傳播或主要傳染由攝取。冒號、小腸, 或兩個的組合可能由廣泛granulomatous 變厚腸牆壁和黏膜潰瘍影響, 由腸繫膜和發自內心的lymphadenopathy 經常陪同。難處理的腹瀉和進步減重是最一致的臨床標誌。傳染其它extrapulmonary 站點包括肝臟(hepatomegaly 、icterus, 腹水); 脾臟(脾大); 淋巴結(周邊或胃腸lymphadenopathy); 骨髓(貧血症); 腹膜(網膜的大量, 腸繫膜黏附力, 節狀或顆粒狀serosal 表面); 眼睛(滲出先前uveitis 、multifocal granulomatous chorioretinitis, 視覺神經炎); 中央神經系統(不整齊、奪取, 等。); 皮膚(排泄pus 或皮膚和皮膚下根瘤也許是潰瘍的) 的管狀的短文; 骨頭(瘸與相關proliferative 或細胞溶解的骨多的損害); 並且口腔(潰瘍) 。多數貓以histoplasmosis 開發傳播的介入。
診斷
Histoplasmosis 應該被懷疑根據了臨床簽到動物從地方性區域。定期實驗室評估的結果是易變和未指明的。幅射線照相的研究結果以肺形式經常是高度暗示的histoplasmosis 。血清學提供一個根據推定的診斷, 但Histoplasma 有機體的 證明 是必要的為明確的診斷。血液學也許顯露normocytic-normochromic nonregenerative 貧血症、neutrophilic 白血球增多或嗜中性白細胞減少症以左移、monocytosis 、和溫和的thrombocytopenia 和macroplatelets 。貓能開發血細胞減少。
胸部造影也許顯露線性或節狀(miliary 。) 細胞間肺滲入, hilar 密度在氣管叉路附近由於tracheobronchial lymphadenopathy, 聯合的補湊齒齦音滲入, 鈣化的肺細胞間的根瘤(被癒合的損害), 和鈣化的tracheobronchial 淋巴結。
查出反Histoplasma 抗體的血清學 測試不是充足地可靠的為明確的診斷; 因而, 每一努力應該被做證實傳染通過Histoplasma 有機體的 證明 。補全定像滴定量1:16 或更加偉大或一個正面瓊脂膠凝體immunodiffusion (沉澱素) 測試被認為暗示histoplasmosis 。不幸地, 這些測試經常產生假消極結果在動物中以histoplasmosis 。預先的曝光也許導致一個假正面結果。另外, 其它mycotic 傳染(即, 芽苞黴菌病) 可以crossreact 在serodiagnostic 測試為histoplasmosis 和anticomplementary 清液也許使補全定像不能再用在一些動物。
histoplasmosis 明確的診斷要求Histoplasma 有機體的 證明 在細胞學、切片檢查法, 或文化標本。Cytologic 標本由導氣管洗滌物、bronchoscopic 齒齦音lavage, 或美好針肺志向獲得一般是最實用和最高的出產量方法為histoplasmosis 明確的診斷。懷特、Giemsa, 或Diff 快的汙點是理想的為Histoplasma 的證明 在細胞學準備。有機體像圓經常細胞內被發現在巨噬細胞之內細胞質對卵形身體, 2 到4 um 在大小, 由一典型清楚的光暈或pseudocapsule. 圍攏那結果從收縮在弄髒期間。呼吸標本可能並且被使用開化真菌在Sabouraud 的媒介; 但是, 這些真菌難隔絕並且mycelial 文化成長可能是感染的為人。
受影響的組織切片檢查法顯露granulomatous 炎症, 但有機體通常稀稀落落和難看與H & E 汙點。有機體的偵查在切片檢查法也許被促進利用特別黴菌汙點譬如舞步、Grocott-Gomori methenamine 銀, 或Gridley 。
治療
口頭itraconazole 是選擇的治療為histoplasmosis 。對待至少二個月在臨床決議之外, 通常要求一共計四個到六個月療法。為視覺和神經學介入加工困難的案件, 使用fluconazole 為眼睛和CNS 的它的更好的滲透。考慮結合amphoteracin B 和itraconazole 為嚴厲猛烈的肺或進步傳播的疾病的最初的治療。油脂complexed amphoteracin 公式化允許更高的劑量以較少毒力, 但費用是更高的。Ketoconazole 是較不有效的和有副作用比其它azoles; 但是, 它可能使用對待histoplasmosis 當費用是一個限制的因素。
芽苞黴菌病
Blastomyces dermatitidis 是二形性soilborne 真菌以地理分佈相似與 Histoplasma。有機體居住在含沙, 酸性土壤在水附近。多數被傳染的狗居住在400 米水之內。soilborne 孢子的吸入是傳染主要路線和導致mycotic 肺炎。焦點皮膚傳染可能發生從直接皮膚接種通過創傷。Extrapulmonary 傳播是非常共同在芽苞黴菌病。狗被認為高度易受影響芽苞黴菌病並且似犬傳染率在地方性區域是10 倍人的傳染率。芽苞黴菌病是罕見的在貓。
臨床標誌
年輕男性大養殖狗最頻繁地被傳染, 大概由於增加的曝光通過室外活動。熱病、厭食、減重, 和消沉的未指明的標誌是共同。標誌也許是深刻(幾天) 或慢性的(幾星期對幾個月) 。肺損害是存在在85% 案件中。咳嗽和呼吸困難是肺形式的典型的提出的標誌。呼吸顯示可能包括(以遞減順序頻率): 深刻或慢性細胞間的pyogranulomatous 肺炎, 散開地通常介入所有肺耳垂, 有時焦點; tracheobronchial lymphadenopathy; 並且胸膜流出。芽苞黴菌病非常共同地傳播, 特別是對皮膚(40% 案件), 眼睛(40% 案件), 和周邊淋巴結(60%), 但在一點程度上並且對骨頭(末端肢體瘸和膨脹), CNS (奪取、老年癡呆、盲目性, 不整齊), 男性生殖器、口腔, 和鼻洞。
診斷
血液學典型地顯露再生neutrophilic 白血球增多、淋巴球減少症、monocytosis, 和溫和的nonregenerative 貧血症。胸部造影通常顯露一節狀(通常miliary) 或散開肺間隙植物滲入和偶爾地一適度tracheobronchial lymphadenopathy 。較不頻繁研究結果包括齒齦音滲入, lobar 實變、焦點孤零零根瘤、胸膜流出, 和cavitary 損害。血清學提供芽苞黴菌病一個根據推定的診斷根據一個正面瓊脂膠凝體immunodiffusion 測試(AGID 90% 可靠) 或補全定像滴定量1:32 或更加偉大(較不可靠比AGID) 。細胞學或Blastomyces 有機體的切片檢查法 證明 提供一個明確的診斷。最好的選擇獲得標本和方法依靠介入站點(譬如transtracheal 洗滌物, bronchoalveolar lavage, 美好針肺aspirate, 皮膚印象汙跡, 淋巴結吐氣, 可變的標本) 。 Blastomyces 在組織出現作為細胞外酵母(5.20 um) 與廣泛發芽和突出的雙重refractile 細胞壁。任一個定期細胞學汙點可能被使用。激動樣式是pyogranulomatous 。對在診所開化的用途不被推薦因為mycelial 成長形成人的傳染風險。
治療
口頭itraconazole 是選擇的治療為芽苞黴菌病。Fluconazole 是還有效的。Ketoconazole 是較不有效的和有副作用; 但是, 它可能被使用當itraconazole 的費用是一個限制的因素。對待至少二個月在臨床決議之外, 通常要求一共計四個到六個月療法。Amphoteracin B 是還有效的, 但有腸外管理和頻繁nephrotoxicity 不利。考慮Amphoteracin B 在迅速地進步疾病為行動它的迅速起始與itraconazole 的組合。油脂complexed amphoteracin 公式化允許更高的劑量以較少毒力, 但費用是更高的。
Coccidioidomycosis
Coccidioides immitis 是soilborne 真菌地理上被分佈對乾燥沙漠像西南美國的地區。在土壤, Coccidioides 增長作為形成arthrospores 的菌絲體。傳染發生由這些土壤出生的和wind-blown arthrospores 的吸入。皮膚接種也許發生, 但很少。在身體組織, Coccidioides 形式大spherules (20-100 um) 那發行上百endospores 。
臨床標誌
臨床症狀不顯的肺傳染是最共同的形式。明顯的肺病為深刻或慢性granulomatous 肺炎和tracheobronchial lymphadenopathy 臨床描繪以咳嗽、熱病、不適, 和偶爾地呼吸困難的標誌。Extrapulmonary 傳播通常是慢性的, 也許介入骨頭和聯接(主要osteoproliferative 骨頭反應導致瘸和痛苦的膨脹); 胃腸內臟(脾臟、肝臟、淋巴結、網膜, 腎臟); 心臟和心包(心肌炎、心包炎, 充血的心力衰竭); 眼睛(uveitis); CNS; 男性生殖器; 並且皮膚(通常潰瘍的根瘤和fistulas 結束骨頭損害) 。骨頭介入是最共同在狗但是皮膚損害是主要發現在貓。
診斷
血液學也許顯示易變的白血球增多、monocytosis, 和nonregenerative 貧血症。造影顯露granulomatous 肺炎和hilar lymphadenopathy 相似與那被描述為histoplasmosis 。以心臟病介入, pericardial 流出或肺腫鼓也許被看見。傳播對骨頭特別是對長的骨頭的末端方面是共同, 並且它導致multifocal osteoproliferative 損害在射線照相。
一個合理地可靠的根據推定的診斷可能被做在血清學測試的依據這樣作為查出早期IgM 抗體反應和最新和被承受的IgG 反應的管沉澱素、補全定像, AGID, 和ELISA 測試。IgM 反應成為正面二個星期post-exposure 和堅持四個到六個星期。IgM 也許還被查出在傳播或recrudescence 之時與高的IgG 水平有關係。高IgG 滴定量(> 1:64) 一般表明嚴厲肺或傳播的疾病。
明確的診斷再取決於辨認有機體(spherules) 在受影響的組織使用細胞學或切片檢查法; 但是, spherules 也許難發現在某些情況下。損害是pyogranulomatous 。開化是太危害以至於不能推薦因為mycelial 成長是高度感染的為人。
治療
Coccidioidomycosis 有時長期或不確定地通常被對待與口頭azole 藥物(ketoconazole 、itraconazole, 或fluconazole 的當中一個) 為八個到12 個月極小值, 和。Amphoteracin B 是不相當當有效但能被使用在不容忍口頭azole 藥物的動物中。初步證據表明, lufenuron, 甲殼質綜合抗化劑被准許為蚤控制在狗和貓, 也許是一種有效的治療當每日給(而不是月度至於為蚤) 。不管治療, 復發是共同在許多月明顯的寬恕以後, 特別是當骨頭是包含的。
Cryptococcosis
Cryptococcus neoformans 被發現在許多地區並且傳染被獲取從土壤出生的有機體的吸入或在市區從有機體的吸入被發現在鴿子排泄物裡。有機體發芽擁有一個突出的多聚糖膠囊的酵母(4.7 um) 。這個厚實的膠囊對這真菌致病性是根本的因為它禁止血漿細胞作用、吞噬作用、白血球遷移, 和補全。膠囊允許有機體對傑出的事物在被弄髒的細胞學準備為容易的證明和並且是為cryptococcal 膠囊狀的抗原診斷測試的依據。
臨床標誌
在貓, Cryptococcus 有一種嗜好為空中有機體最初地放置的鼻洞, 佔慢性granulomatous 鼻炎和竇炎被看見在至少50% 貓中以疾病。與貓對比, 顯然鼻疾病臨床是罕見的在狗以cryptococcosis; 反而, CNS 和眼睛介入是主要研究結果。驚奇, 肺介入臨床只很少是顯然的, 50% 狗和貓有肺損害在屍體檢驗。熱病發生在少於25% 箱子中; 實際上, 溫度超出37 C 禁止 Cryptococcus。
鼻介入的主要標誌是單邊或雙邊mucopurulent 或血淋淋的鼻盡職, 打噴嚏, sniffling, 殘疾躺在上面鼻骨頭, 和mucinous 出現的鼻肉芽腫在鼻孔。更喜歡的站點為傳播是CNS 、眼睛, 和皮膚。CNS 介入從hematogenous 傳播或地方引伸通過cribiform 板材收效散開或大量像granulomatous meningoencephalitis 或myelitis 。標誌也許包括奪取, 盤旋, 頭按, 盲目性、老年癡呆、不整齊、局部痲痺, 或頭蓋骨神經(CN) 缺乏。視覺介入: 可以包括granulomatous (滲出) chorioretinitis 、先前uveitis, 或視覺神經炎。皮膚介入: 通常體現作為迅速地擴大的牢固的根瘤並且然後ulcerate 和滲流, 主要在頂頭區域, 經常在鼻孔附近。其它傳播站點: 願包括周邊淋巴結(特別submandibular), 咽和口腔、腎臟(30% 有肉芽腫在屍體檢驗), 肝臟、脾臟、心臟, 和骨骼肌。
診斷
血液學是經常正常的, 除了偶爾的neutrophilia 或嗜酸性白血球過多。鼻射線照相: 可以表明鼻骨頭病勢漸退或擴展, 或反常軟的組織密度在鼻洞或前面靜脈竇之內。血清學提供一個根據推定的診斷根據膠囊狀的抗原的偵查在清液、CSF, 或尿使用乳汁膠合或ELISA 。商業膠囊狀的抗原測試成套工具有高敏感性和特異性; 但是, 假的陰性發生, 特別是在nondisseminated 疾病。假的正面可能發生在患者治療以hetastarch 和在CSF 被沾染與滑石從乳汁手套。
明確的診斷要求有機體的證明在cytologies (即, 鼻滲出液, 腦脊髓流體、皮膚滲出液或印象, 淋巴結吐氣, 尿, oculo centesis) 使用克、舞步、新次甲基藍色, 或印度墨水汙點或在切片檢查法使用mucicarmine 、H & E 、舞步, 或銀色汙點。 Cryptococcus 可能並且被開化從相似的標本在Sabouraud 的媒介。
治療
對待cryptococcosis 以口頭itraconazole 或fluconazole 至少二個月在臨床決議之外, 通常範圍從六到10 個月(手段, 8.5 mo.) 。當眼睛或CNS 是包含的, fluconazole 更喜歡由於它的更好的滲透入這些組織。Ketoconazole 不是作為有效和有副作用比其它azoles; 但是, 它可能被使用當費用是一個限制的因素。Flucytosine 與amphoteracin B 被結合並且是一種有效的治療, 但有更加了不起的有害副作用不利, 特別是nephrotoxicity 。

This will discuss the pulmonary manifestations and treatment of the four major systemic mycoses of dogs and cats: histoplasmosis, blastomycosis, coccidioidomycosis, and cryptococcosis.
Histoplasmosis
The cause of histoplasmosis, Histoplasma capsulatum, is a dimorphic soil borne fungus found in many temperate and subtropical regions of the world. In North America, the disease is most prevalent in the river valley regions of the central United States, especially in areas bordering the Mississippi River and its tributaries. At ambient temperature, soil enriched by decomposing nitrogenous matter (e.g., feces of birds or bats) provides an ideal growth media for the mycelial phase of Histoplasma. The principal route of infection is by inhalation of airborne spores and mycelial fragments in windblown soil. Histoplasma organisms transform into a yeast phase that causes intracellular infection of pulmonary macrophages. Widespread hemolymphatic dissemination to virtually any tissue or organ system can occur. The outcome of exposure is influenced by level of exposure; age (clinical disease is most common in young animals less than four years of age); breed (highest prevalence in sporting and hound breeds, perhaps due to higher exposure risk); immunosuppressive factors (corticosteroids may enhance dissemination); and host cell-mediated immunity. Inapparent infections without evidence of clinical disease are common.
Clinical Signs
Inapparent, self-limiting infection confined to the respiratory tract is the most common outcome of natural infection. It is recognized radiographically as multiple discreet calcified interstitial foci (inactive encapsulated or healed lesions) and sometimes calcified tracheobronchial lymph nodes. The acute pulmonary form of histoplasmosis is characterized by severe fulminant granulomatous pneumonia with signs of cough, dyspnea, fever, and severe malaise. The radiographic findings are pronounced diffuse linear or nodular interstitial pulmonary infiltrates, often with patchy coalescing densities and moderately enlarged tracheobronchial lymph nodes. The chronic pulmonary form is more common than the acute form and is characterized by chronic granulomatous pneumonia (diffuse or multifocal with marked tracheobronchial lymphadenopathy that causes extrinsic airway compression. The signs include chronic cough and mild dyspnea with variable weight loss and fever. Radiographically, massive enlargement of the tracheobronchial lymph nodes and variable linear or nodular interstitial infiltrates are seen.
Intestinal histoplasmosis is the most common extrapulmonary form in dogs and may represent dissemination or primary infection by ingestion. The colon, small intestine, or a combination of both can be affected by extensive granulomatous thickening of the bowel wall and mucosal ulceration, often accompanied by mesenteric and visceral lymphadenopathy. Intractable diarrhea and progressive weight loss are the most consistent clinical signs. Other extrapulmonary sites of infection include liver (hepatomegaly, icterus, ascites); spleen (splenomegaly); lymph nodes (peripheral or abdominal lymphadenopathy); bone marrow (anemia); peritoneum (omental masses, mesenteric adhesions, nodular or granular serosal surfaces); eyes (exudative anterior uveitis, multifocal granulomatous chorioretinitis, optic neuritis); central nervous system (ataxia, seizures, etc.); skin (fistulous tracts that drain pus or skin and subcutaneous nodules that may be ulcerated); bone (lameness associated with proliferative or lytic boney lesions); and oral cavity (ulcers). Most cats with histoplasmosis develop disseminated involvement.
Diagnosis
Histoplasmosis should be suspected based on clinical signs in animals from endemic areas. The results of routine laboratory evaluations are variable and nonspecific. Radiographic findings in the pulmonary form are often highly suggestive of histoplasmosis. Serology provides a presumptive diagnosis, but identification of the Histoplasma organisms is necessary for definitive diagnosis. Hematology may reveal normocytic-normochromic nonregenerative anemia, neutrophilic leukocytosis or neutropenia with left shift, monocytosis, and mild thrombocytopenia and macroplatelets. Cats can develop pancytopenia.
Thoracic radiography may reveal linear or nodular (𢘫iliary? interstitial pulmonary infiltrates, hilar density around the tracheal bifurcation due to tracheobronchial lymphadenopathy, coalescing patchy alveolar infiltrates, calcified pulmonary interstitial nodules (healed lesions), and calcified tracheobronchial lymph nodes.
Serologic tests that detect anti-Histoplasma antibodies are not sufficiently reliable for definitive diagnosis; thus, every effort should be made to confirm infections through identification of the Histoplasma organisms. A complement fixation titer of 1:16 or greater or a positive agar-gel immunodiffusion (precipitin) test are considered suggestive of histoplasmosis. Unfortunately, these tests often yield false-negative results in animals with histoplasmosis. Prior exposure may cause a false-positive result. In addition, other mycotic infections (e.g., blastomycosis) may crossreact on serodiagnostic tests for histoplasmosis and anticomplementary sera may make complement fixation unusable in some animals.
Definitive diagnosis of histoplasmosis requires identification of Histoplasma organisms in cytology, biopsy, or culture specimens. Cytologic specimens obtained by airway washings, bronchoscopic alveolar lavage, or fine-needle lung aspiration are generally the most practical and high-yield methods for definitive diagnosis of histoplasmosis. Wright, Giemsa, or Diff-Quick stains are ideal for identification of Histoplasma in cytology preparations. The organisms are found most often intracellularly within the cytoplasm of macrophages as round to oval bodies, 2 to 4 um in size, surrounded by a characteristic clear halo or 𢖯seudocapsule?that results from shrinkage during staining. Respiratory specimens can also be used to culture the fungi in Sabouraud's media; however, these fungi are difficult to isolate and mycelial culture growth can be infectious for humans.
Biopsies of affected tissues reveal granulomatous inflammation, but organisms are usually sparse and difficult to see with H & E stain. Detection of organisms in biopsies may be facilitated by use of special fungal stains such as PAS, Grocott-Gomori methenamine silver, or Gridley.
Treatment
Oral itraconazole is the treatment of choice for histoplasmosis. Treat for at least two months beyond clinical resolution, which usually requires a total of four to six months of therapy. For refractory cases of ocular and neurologic involvement, use fluconazole for its better penetration of the eyes and CNS. Consider combining amphoteracin B and itraconazole for initial treatment of severe fulminant pulmonary or progressive disseminating disease. Lipid-complexed amphoteracin formulations allow higher dosages with less toxicity, but the cost is higher. Ketoconazole is less effective and has more side effects than other azoles; however, it can be used to treat histoplasmosis when cost is a limiting factor.
Blastomycosis
Blastomyces dermatitidis is a dimorphic soilborne fungus with a geographic distribution similar to Histoplasma. The organisms reside in sandy, acidic soil near water. Most infected dogs live within 400 meters of water. Inhalation of soilborne spores is the primary route of infection and leads to mycotic pneumonia. Focal skin infection can occur from direct cutaneous inoculation through a wound. Extrapulmonary dissemination is very common in blastomycosis. Dogs are considered highly susceptible to blastomycosis and the canine infection rate in endemic areas is 10 times the human infection rate. Blastomycosis is rare in cats.
Clinical Signs

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[color=Magenta][size=5][b]慢性腹瀉Chronic Diarrhea [/b][/size][/color]  


初步手段
腹瀉是狗被提出對獸醫的最共同的臨床問題的當中一個。在那腹瀉之外是最共同的臨床標誌的當中一個看在狗。腹瀉多數案件包括系統地不影響狗的一個被隔絕的情節。這些患者很少出席對獸醫。其它小組狗開發同系統臨床標誌聯繫在一起的深刻腹瀉並且要求進取的診斷和療法。其它案件是還深刻但前只幾天。寬恕接著而來沒有任一種治療或以根據症狀的療法在許多這些箱子。但是, 有並且有慢性腹瀉需要一適當醫療工作的一個大小組似犬患者。
有許多不同的方式接近工作狗以慢性腹瀉。區別也許歸結於也許取得到在一些診所但不是在其他人的某些診斷形式, 或他們也許歸結於在臨床工作者的臨床專門技術上的區別。區別也許並且歸結於一個特別共同的問題在一個地區。另外, 工作需要由緊急引導手頭。程度緊急最重要地依靠許多因素, 系統臨床標誌、迅速減重、出現和程度hypoproteinemia, 和終於, 容忍由所有者。例如, 患者的迅速減重要求一種更加進取的診斷方法比如果沒有減重根本。終於, 在工作上的區別可能並且歸結於一個區別以觀點。
至於任一個臨床問題, 仔細的歷史重要。它應該包括關於出席患者, 環境和農事的直接和過去臨床歷史的問題, 特別是因為它與飲食關係。臨床歷史應該並且包括其它寵物的歷史在家庭。如果歷史不顯露任何具體顯示為腹瀉的起因, 一個合理的初步手段包括仔細的糞便考試為寄生大批出沒和治療的證據與一個寬廣光譜驅蟲劑的代理譬如fenbendazole 不管糞便檢查的研究結果。
最重要的步為一個適當的診斷是決心是否腹瀉由一種主要食道疾病造成或是否它由其它器官系統混亂造成(參見圖1) 。這個目標可能達到的最容易由執行完全血液計數、清液化學外形, 和尿分析。某一另外的清液應該被收集和總結冰為未來分析。
圖1: 慢性腹瀉的起因


  
完全血液計數將幫助辨認內分泌混亂。例如, 狗以hypoadrenocorticism 顯示缺乏淋巴球減少症和eosinopenia, 或也許甚而有淋巴球過多症和嗜酸性白血球過多, 是與許多狗對比有一個增加的腎上腺皮質的反應由於任一個疾病過程的數字和顯示neutrophilia 、monocytosis 、淋巴球減少症, 和eosinopenia 。CBC 也許並且顯露貧血症。清液化學外形, 與比重一起從尿分析是有用排除慢性腎衰竭。Hyperkalemia 可能當前在狗以深刻oligouric 腎衰竭。另外, hyperkalemia 和hyponatremia 也許是存在在狗以hypoadrenocorticism 。但是, 它重要注意到, 沒有所有狗以hypoadrenocorticism 顯示這反常性。一些狗不缺乏礦物類皮質激素, 不會顯示電解質反常性。
被懷疑有hypoadrenocorticism 的狗應該被評估以促腎上腺皮質激素刺激測試。Hypoadrenocorticism, 如果未經治療, 可能是一種致命的疾病和甚而微弱的懷疑, hypoadrenocorticism 也許是當前保證執行這個測試。結果從清液化學外形並且幫助排除肝疾病。清液肝□活性是非常敏感的為肝疾病。不幸地, 他們不是非常具體的並且如果反常性, 溫和特別是那些, 被查出肝疾病出現需要被證實使用其它診斷modalities.(1) 清液白蛋白含量是相當厚臉皮的為肝疾病和並且不是非常具體的。清液膽紅素含量可能被增加在狗以主要肝疾病。但是, 它不是非常敏感的, 並且更加重要地, 它不是具體的。狗以這發現的需要仔細地評估了為任一hemolysis (PCV, 幻燈片膠合, 直接/間接的膽紅素的) 證據, 或extrahepatic 膽固醇沉著病(胃腸ultrasonography).(2) 如果有對肝疾病清液出現的任一疑義前並且postprandial 膽汁酸需要是evaluated.(3) A 新肝功能考驗, 13C aminopyrine demethylation 驗血, 當前是在調查之中也許是敏感和具體比其他肝功能考驗現在可以得到為狗的。
先進工作
外分泌的胰臟疾病可能並且導致慢性腹瀉並且狗以外分泌的胰臟不足(EPI) 經常經常有腹瀉作為最重要的臨床sign.(4) 另外狗與EPI 有減重, 排匯物, 惡臭排匯物的色變, 並且慢性皮膚disease.(4) 然而, 一些狗只顯示慢性腹瀉。EPI 在狗最共同地歸結於胰臟acinar 萎縮, 疾病主要看用德語牧羊人狗。但是, 在其它養殖, 慢性胰腺炎、EPI 的同道會在人和貓, 也許並且導致EPI 。不管起因, EPI 可能由serum TLI 集中容易地診斷。這個分析用試樣是可利用的通過許多實驗室, 應該總被評估與清液維生素B12 和葉酸集中一道。
一旦次要混亂排除, 型腹瀉應該被描繪。總之, 小和大腸腹瀉可能是卓越的。狗以小腸腹瀉有增加的糞便容量但唯一排糞一個溫和地增加的頻率。血液, 如果禮物, 被消化, 導致melena 。狗以大腸腹瀉經常勞損排糞; 他們經常並且有新血液和增加的相當數量黏液覆蓋物排匯物。另外, 減重通常不發生在狗以大腸腹瀉當狗以小腸腹瀉也許或不能有減重。但是, 多數狗以大腸腹瀉的臨床標誌有小腸的更加重大的疾病。與人對比, 被隔絕的colitis 是不凡的在狗。
許多狗以慢性腹瀉有正常完全血液計數和清液化學外形或只有未指明的變動譬如肝□活性的溫和的海拔。這些狗應該工作為主要食道疾病。作為早先被提及, 糞便考試為寄生生物大批出沒和療法與寬廣光譜驅蟲劑的代理應該試圖在任何另外步驟被採取之前如果狗的整體情況允許這延遲。重覆的鋅sulfate 漂浮是有用診斷賈第蟲病。
清液維生素B12 和葉酸集中是偉大診斷並且治療importance.(5) 清液葉酸集中可能被減少在接近小小腸混亂, 當清液維生素B12 集中可能被減少在末端小小腸混亂和EPI 。在狗以散開小小腸混亂, 清液folate 和維生素B12 含量可能被減少。終於, 被減少的清液維生素B12 集中和增加的清液葉酸集中能看在有小小腸細菌繁茂似犬病人(SIBO) 。Folate 和維生素B12 是是豐富的在似犬和似貓的飲食的水溶維生素。但是, 飲食folate 窮地被吸收, 因為它發生作為葉酸polyglutamate 並且需要是deconjugated 對葉酸單谷氨酸由葉酸deconjugase, jejunal 刷子疆界酵素。葉酸單谷氨酸由具體載體吸收在接近小腸。所以, 接近小腸的耐久和嚴厲混亂可能導致葉酸身體商店和被減少的清液folate 含量的取盡。相反, 在SIBO 微生物盒在小腸綜合葉酸, 可能導致在葉酸吸收的增量和反過來增加的清液folate 含量。飲食維生素B12 一定對飲食蛋白質。在胃, 飲食蛋白質由蛋白酵素部份地消化並且HCl 和維生素B12 被發布。但是, 維生素B12 立刻束縛對R 蛋白質。R 蛋白質由胰臟proteases 反過來消化在小腸。自由維生素B12 束縛對內在因素被發布主要在胰臟汁液裡。這些維生素B12 內在因素複合體被吸收通過具體感受器官在迴腸。所以, 末端小腸的嚴厲和耐久混亂並且外分泌的胰臟不足將導致維生素B12 身體商店的取盡和被減少的清液維生素B12 集中。終於, 微生物, 當前在過份數字在小腸在患者與SIBO, 將運用維生素B12 和與主人將競爭為飲食維生素B12 。一低清液維生素B12 與增加的清液葉酸集中的組合是具體的為SIBO 並且一次治療試驗與一個抗菌代理被表明。當前, 選擇抗藥性代理是tylosin 在10.15 mg/kg q12h 六個星期。供選擇地, metronidazole 可能並且被使用。增加的清液葉酸集中單獨是還表示的SIBO 並且試驗療法是適當的。但是, 在兩個案件狗應該反應在大約一個星期療法之內。疏忽顯示至少部份反應在那個期間內應該創始一進一步診斷workup 。
清液維生素B12 並且是治療利益。維生素B12 缺乏在人的患者被顯示導致villous 萎縮, 激動滲入小腸mucosa, 維生素B12 吸收不良, 並且其他改變。貓和狗以嚴厲維生素B12 缺乏經常不反應部下的食道混亂的療法直到維生素B12 被補充。因為維生素B12 缺乏起因維生素B12 吸收不良口頭補充不是有效的在有嚴厲維生素B12 缺乏病人。另外, 多維生素準備不包含充足的相當數量維生素B12 並且純淨的維生素B12 是需要的為療法。在狗, 250.500 .g 皮膚下地被給每週一次六個星期, 每隔一個星期跟隨被六個星期, 一個更多藥量每月在那以後, 和復校一個月在最後藥量以後。
為沒有次要慢性腹瀉、寄生, 或SIBO 的所有狗, 有二個選擇: 診斷測試或一次治療試驗。選擇取決於許多因素但最後依靠案件的緊急和所有者的目標。如果狗沒有任何系統臨床標誌, 不惡化, 一次治療試驗是合理的。有二種基本的方法對一次最初的治療試驗。許多狗以慢性腹瀉有飲食不寬容或飲食過敏症。無論如何, 一次飲食試驗使用飲食與新穎的蛋白質和一個新穎的碳水化合物來源是一個選擇。其它選擇將使用包含被水解的蛋白質的新飲食的當中一個。患者應該顯示對一次飲食試驗的某一反應一個到二個星期在_蒙以後, 但完全寬恕能佔去六個到八個星期。
但是, 如果狗不是穩定或迅速惡化, 或如果所有者想要做任何東西可能不管費用或預測, 診斷測試應該立刻執行。一些臨床工作者喜歡首先做胃腸超聲波由於它的non-invasiveness 。胃腸ultrasonography 可能是有用辨認造形術或黴菌損害, 鑒別部份阻礙通過外國身體或intussusception, 或形象化腸繫膜淋巴結。其它臨床工作者喜歡首先執行gastroduodenoscopy 因為診斷出產量為這個做法比為胃腸ultrasonography 在許多情況下高級。但是, 它並且更加蔓延性, 不允許其它胃腸結構的形象化。
該當提及的一個特別情節是患者與panhypoproteinemia 或hypoalbuminemia, 有或沒有慢性腹瀉。這些患者需要仔細地被篩選為可能的肝疾病和蛋白質丟失的腎病(PLN) 。肝疾病應該由清液化學外形排除和前和postprandial 膽汁酸, 當蛋白質丟失的腎病應該由執行排除尿蛋白質肌氨酸酐比率。如果狗沒有任何肝疾病或PLN 的證據, 蛋白質丟失enteropathy (PLE) 可能由測量證實糞便阿爾法1- proteinase 抗化劑含量。這個測試是還有用診斷增加的糞便蛋白質損失在未開發panhypoproteinemia 的狗。例如, 安排familial PLE/PLN 增加了糞便阿爾法1 Pi 的軟上漆的Wheaten 狗在所有臨床標誌是present.(6)There 之前是也許幫助診斷主要食道混亂在困難的案件的其它診斷測試。食道滲透性和黏膜作用測試是極端敏感和展示反常性在histopathologic 變化能看在切片檢查法標本上之前。清液未共軛膽汁酸和呼吸氫測試可能是有用的在支持小小腸細菌繁茂診斷。


Initial approach
Diarrhea is one of the most common clinical problems for which dogs are presented to a veterinarian. Beyond that diarrhea is one of the most common clinical signs seen in dogs. Most cases of diarrhea consist of an isolated episode that does not affect the dog systemically. These patients are rarely presented to a veterinarian. Another group of dogs develops acute diarrhea that is associated with systemic clinical signs and requires aggressive diagnosis and therapy. Other cases are also acute but last only for a few days. Remission ensues without any treatment or with symptomatic therapy in many of these cases. However, there is also a large group of canine patients that have chronic diarrhea that need a proper medical work-up.
There are many different ways to approach the work-up of dogs with chronic diarrhea. Differences may be due to certain diagnostic modalities that may be available in some clinics but not in others, or they may be due to differences in clinical expertise of the clinician. Differences may also be due to a particularly common problem in a geographic region. In addition, the work-up needs to be guided by the urgency at hand. The degree of urgency is dependant on many factors, most importantly systemic clinical signs, rapid weight loss, presence and degree of hypoproteinemia, and finally, the tolerance by the owner. For example, rapid weight loss of a patient requires a more aggressive diagnostic approach than if there is no weight loss at all. Finally, differences in the work up can also be due to a difference in opinion.
As for any clinical problem, a careful history is important. It should include questions about the immediate and past clinical history of the patient that is being presented, the environment and the husbandry, especially as it relates to the diet. The clinical history should also include the history of other pets in the household. If the history does not reveal any specific indicators for a cause of the diarrhea, a reasonable initial approach includes careful fecal examination for evidence of parasitic infestation and treatment with a broad-spectrum anthelmintic agent such as fenbendazole regardless of the findings of the fecal exam.
The most important step for a proper diagnosis is determination whether the diarrhea is caused by a primary gastrointestinal disease or whether it is caused by a disorder of another organ system (see Figure 1). This goal can be achieved easiest by performing a complete blood count, a serum chemistry profile, and a urinalysis. Some additional serum should always be collected and frozen for future analyses.
Figure 1: Causes of chronic diarrhea


  
A complete blood count will help to identify endocrine disorders. For example, dogs with hypoadrenocorticism can show a lack of lymphopenia and eosinopenia, or may even have a lymphocytosis and eosinophilia, which is in contrast to many dogs that have an increased adrenocortical response because of any number of disease processes and show neutrophilia, monocytosis, lymphopenia, and eosinopenia. A CBC may also reveal anemia. The serum chemistry profile, together with specific gravity from the urinalysis is useful to rule out chronic renal failure. Hyperkalemia maybe present in dogs with acute oligouric renal failure. In addition, hyperkalemia and hyponatremia may be present in dogs with hypoadrenocorticism. However, it is important to note that not all dogs with hypoadrenocorticism show this abnormality. Some dogs do not lack mineralocorticoids and will not show electrolyte abnormalities.
Dogs that are suspected of having hypoadrenocorticism should be evaluated with an ACTH stimulation test. Hypoadrenocorticism, if untreated, can be a deadly disease and even a weak suspicion that hypoadrenocorticism might be present warrants performing this test. Results from the serum chemistry profile also help to rule out hepatic disease. Serum hepatic enzyme activities are very sensitive for hepatic disease. Unfortunately, they are not very specific and if abnormalities, especially mild ones, are detected the presence of hepatic disease needs to be confirmed using other diagnostic modalities.(1) Serum albumin concentration is rather insensitive for hepatic disease and is also not very specific. Serum bilirubin concentration can be increased in dogs with primary hepatic disease. However, it is not very sensitive, and more importantly, it is not specific. Dogs with this finding need to carefully evaluated for any evidence of hemolysis (PCV, slide agglutination, direct/indirect bilirubin), or extrahepatic cholestasis (abdominal ultrasonography).(2) If there is any doubt about the presence of hepatic disease serum pre- and postprandial bile acids need to be evaluated.(3) A new hepatic function test, 13C-aminopyrine demethylation blood test, is currently under investigation that may be more sensitive and specific than any other hepatic function test currently available for the dog.
Advanced work-up
Exocrine pancreatic disease can also cause chronic diarrhea and dogs with exocrine pancreatic insufficiency (EPI) often have diarrhea as the most important clinical sign.(4) In addition dogs with EPI often have weight loss, discoloration of feces, malodorous feces, and chronic skin disease.(4) However, some dogs only show chronic diarrhea. EPI in dogs is most commonly due to pancreatic acinar atrophy, a disease mainly seen in German Shepherd dogs. However, in other breeds, chronic pancreatitis, the most common cause of EPI in human beings and cats, may also cause EPI. Regardless of the cause, EPI can easily be diagnosed by serum cTLI concentration. This assay is available through many laboratories and should always be evaluated in conjunction with serum cobalamin and folate concentration.
Once secondary disorders have been ruled out, the type diarrhea should be characterized. In general, small and large bowel diarrhea can be distinguished. Dogs with small bowel diarrhea have an increased fecal volume but only a mildly increased frequency of defecation. Blood, if present, is digested, causing melena. Dogs with large bowel diarrhea often strain to defecate; they also often have fresh blood and an increased amount of mucous covering the feces. In addition, weight loss does not usually occur in dogs with large bowel diarrhea while dogs with small bowel diarrhea may or may not have weight loss. However, most dogs with clinical signs of large bowel diarrhea have more significant disease of the small bowel. In contrast to humans, isolated colitis is uncommon in dogs.
Many dogs with chronic diarrhea do have normal complete blood count and serum chemistry profile or only have non-specific changes such as a mild elevation of hepatic enzyme activities. These dogs should be worked up for primary gastrointestinal disease. As previously mentioned, fecal examination for parasite infestation and therapy with a broad-spectrum anthelmintic agent should be attempted before any further steps are taken if the overall condition of the dog allows this delay. Repeated zinc sulfate floatations are useful to diagnose Giardiasis.
Serum cobalamin and folate concentrations are of great diagnostic and therapeutic importance.(5) Serum folate concentration can be decreased in proximal small intestinal disorders, while serum cobalamin concentration can be decreased in distal small intestinal disorders and EPI. In dogs with diffuse small intestinal disorders, both serum folate and cobalamin concentrations can be decreased. Finally, a decreased serum cobalamin concentration and an increased serum folate concentration can be seen in canine patients with small intestinal bacterial overgrowth (SIBO). Folate and cobalamin are both water-soluble vitamins that are plentiful in canine and feline diets. However, dietary folate is poorly absorbed, because it occurs as folate polyglutamate and needs to be deconjugated to folate monoglutamate by folate deconjugase, a jejunal brush border enzyme. Folate monoglutamate is absorbed by specific carriers in the proximal small intestine. Therefore, longstanding and severe disorders of the proximal small intestine can lead to a depletion of folate body stores and a decreased serum folate concentration. In contrast, in cases of SIBO microorganisms in the small intestine synthesize folic acid, which can lead to an increase in folate absorption and in turn to an increased serum folate concentration. Dietary cobalamin is bound to dietary protein. In the stomach, dietary protein is partially digested by pepsin and HCl and cobalamin is released. However, cobalamin immediately binds to R-protein. The R-protein in turn is digested by pancreatic proteases in the small intestine. Free cobalamin binds to intrinsic factor released mostly in pancreatic juice. These cobalamin-intrinsic factor complexes are absorbed through specific receptors in the ileum. Therefore, severe and longstanding disorders of the distal small intestine as well as exocrine pancreatic insufficiency will lead to a depletion of cobalamin body stores and to a decreased serum cobalamin concentration. Finally, microorganisms, present in excessive numbers in the small intestine in patients with SIBO, will utilize cobalamin and compete with the host for dietary cobalamin. A low serum cobalamin in combination with an increased serum folate concentration is specific for SIBO and a therapeutic trial with an antimicrobial agent is indicated. Currently, the antibiotic agent of choice is tylosin at 10?5 mg/kg q12h for six weeks. Alternatively, metronidazole can also be used. An increased serum folate concentration alone is also indicative of SIBO and a trial therapy is appropriate. However, in both cases the dog should respond within approximately one week of therapy. Failure to show at least partial response within that period should initiate a further diagnostic workup.
Serum cobalamin is also of therapeutic interest. Cobalamin deficiency in human patients has been shown to cause villous atrophy, inflammatory infiltrates of the intestinal mucosa, cobalamin malabsorption, and other changes. Cats and dogs with severe cobalamin deficiency often do not respond to therapy of the underlying gastrointestinal disorder until cobalamin is supplemented. Since cobalamin deficiency causes cobalamin malabsorption oral supplementation is not efficacious in patients with severe cobalamin deficiency. In addition, multi-vitamin preparations do not contain sufficient amounts of cobalamin and pure cobalamin is needed for therapy. In dogs, 250?00 µg are given subcutaneously once a week for six weeks, followed by every other week for six weeks, one more dose a month after that, and a recheck a month after the last dose.
For all dogs that do not have secondary chronic diarrhea, parasitism, or SIBO, there are two choices: more diagnostic tests or a therapeutic trial. The choice depends on many factors but ultimately is dependant on the urgency of the case and the goals of the owner. If the dog does not have any systemic clinical signs and does not deteriorate, a therapeutic trial is reasonable. There are two basic approaches to an initial therapeutic trial. Many dogs with chronic diarrhea have dietary intolerance or dietary hypersensitivity. In either case, a dietary trial using a diet with a novel protein and a novel carbohydrate source are one option. Another option is to use one of the new diets that contain hydrolyzed proteins. The patient should show some response to a dietary trial one to two weeks after initiation, but complete remission could take up to six to eight weeks.

minibabyqq 2007-1-3 10:35 PM

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[color=Magenta][size=5][b]為什麼臨床工作者應該使用他們[/b][/size][/color]


Why Clinicians Should Use Them   


介紹
標準獸醫食道workup 變化少許和圍繞在胃、十二指腸和冒號的endoscopic 考試中。獸醫採取歷史, 執行體格檢查, 和獲取資料庫(CBC 、清液化學外形、尿分析和一個或更多糞便漂浮) 。這也許由糞便文化和TLI 、cobalamin/folate 、FeLV 、FIV 和T4 清液分析用試樣補全。如果答復不是顯然的由這個階段, 排除試驗也許被設法排除有害反應對食物。下步通常是勘測胃腸射線照相、胃腸超聲波、內窺鏡檢察和切片檢查法, 或組合因此。壓力然後來在病理學家發現某事在切片檢查法樣品。可理解地在這個情況, 毀壞伴生的淋巴腺組織開始的正常補全被看待以巨大懷疑和我們不久有diagnosed. 溫和的激動腸疾病另外案件。
這是每令人滿意的事態為獸醫胃腸病學嗎? I don.t 相信如此。多數身體系統由由臨床工作者試探性地給標籤的不清楚的symptom. 複合體影響(譬如miliary 皮炎、FLUTD 、IBD, 和IBS) 首先認可臨床標誌的典型樣式。不幸地, 當其他人辨認同樣症狀複合體label. 變得時興和非常很快承擔diagnosis. 的可敬。對如此普通標籤的用途像diagnoses. 減弱臨床實踐根本嗎? 通常不是, 因為典型症狀複合體可能非常經常迅速和有效地應付由對應的treatment 複合體。然而, 那裡可能是這種方法傷亡。頻繁用途的這樣期限傾向於減少profession.s 刺激獲得是更加準確的診斷。有傾向對rest 在我們的月桂樹和做安慰聲明譬如狗的80% 貓在我的實踐, 禮物以慢性嘔吐有inflammatory 腸疾病。這方便地忽略事實所謂的激動腸疾病也許是食物敏感性、一個黏膜滲透性障礙瑕疵、能動性混亂、undiagnosed 傳染、小小腸細菌繁茂, 或甚而起初淋巴瘤。
如此獸醫食道診斷方法應該去從這裡? 它是相當清楚我們有很多得知食道傳染病診斷。另外, 我們是離瞭解意義很遠的唯一顯露一個更加高級比平均細菌數字的吐氣十二指腸的流體(即, 所謂的small 小腸細菌繁茂) 。我們並且有很多得知腸切片檢查法的解釋和只在最近冒險了入subtyping 的淋巴細胞複雜區域。同樣, 測量黏膜激動斡旋人的價值的我們的知識是在它的初期。最壞所有, 我們似乎忽略了估計腸作用整個範圍和用強調信仰替換這, 我們罐頭subcharacterise (即, diagnose 。) 所有腸疾病由形態學或文化。這珍惜的誤解忽略事實腸起作用譬如能動性, 分泌物, 滲透性, 吸收, 發自內心的敏感性並且口頭容忍可能減弱沒有任一形態反常性。逃不脫的結論是, 腸功能考驗是必要到達食道 怨言 一個準確診斷。
腸功能考驗
為什麼aren.t 腸功能考驗通常使用了? 。答復是複雜的和畫在目的一個重實效的看法的診斷工作。客戶薪水獸醫追求診斷工作幫助我們發現一個更好的方式對待他們的animal.not 到達診斷就其本身而言。因而, 目的診斷工作將確定疾病類型過程造成臨床標誌和細分類那個疾病過程對水平必要優選病人護理。老練的臨床工作者不countenance 執行測試除非他們被說服他們將治療患者那個測試的結果將影響預測或方式。使功能考驗通常影響預測或治療, 功能腸混亂必須是共同; 測試必須有好診斷準確性、可接受的risk/benefit 和cost/benefit 比率; 並且最適度一下的關心必須起因於疏忽認可功能混亂。現在讓我們審查具體腸作用確定如果實用功能考驗是可利用的和被表明在現代天食道工作上升。
消化
集體, maldigestion 和吸收不良是共同。Maldigestion 由於外分泌的胰臟不足可能由TLI 測試方便地和準確地診斷。雖然不是古典功能考驗, 它比消化作用更舊的測試證明有相似的診斷準確性為EPI 譬如BT-PABA 。Maldigestion 發生為原因不同於EPI, 但因為這些其它情況相對地不凡(或不太可能臨床是重大的), TLI 滿足作為優秀defacto 腸功能考驗。最適度一下的病人護理發生如果maldigestion 不被診斷。所以, 清液TLI 測試應該是一定期部份的任何工作似犬小腸腹瀉。
吸收
需要對於功能考驗為小腸吸收被事實減少滲透的腹瀉可能臨床方便地被認可(即, 中止當患者齋戒) 。滲透的腹瀉由於吸收不良可能被區分從那由於maldigestion 由TLI 。一旦吸收不良被辨認了, 下個問題是: 為什麼? 對這個問題的答復要求小腸吸收診斷測試譬如內窺鏡檢察和腸切片檢查法而不是測試。但是, 有它可能是有用測試小腸吸收性作用情況的一個精選的數字。一個這樣的情況是在貓診斷展示先天減重沒有腹瀉。在我的經驗, 缺乏腹瀉不排除吸收不良在貓。不同於狗, 貓有卓越的能力集中他們的排匯物反對一個高滲透的梯度, 意味那malabsorbed 食物微粒可能到達高濃度在挑釁腹瀉之前。在狗, 我發現了的二個最常見的情況腸吸收的測量有用是在評估溫和的IBD 診斷誠實並且在定量吸收不良為研究學習。在前情況, 我尋找功能反常性(即, 吸收不良) 幫助我估計臨床意義的溫和多孔滲入在小腸。溫和比溫和滲入沒有可示範的吸收不良滲入以一伴生的吸收不良是可能臨床重大的假說是。最後, 吸收性作用測試可能有價值在幼小動物被懷疑disaccharidase 缺乏。我更喜歡的腸吸收測試是呼吸氫測試。我不是木糖的風扇, 肥胖吸收, 或維生素B12/folate 測試雖然其他人發現後者測試可貴。
能動性混亂
能動性混亂(主要和次要) 集體是共同性。他們難認出單一地根據臨床標誌, 並且最適度一下的關心可能收效如果他們不被認可。臨床工作者明白沮喪的腸能動性通常選擇治療患者以prokinetic 藥物或飲食變動(即, 重罰) 。腸能動性現在可以得到的測試的risk/benefit 比率是一致地降低。但是, 他們的cost/benefit 比率變化以閃爍錄像術和fluoroscopy 是相對地昂貴的與幅射線照相的規程比較。閃爍錄像術和radiopaque 標誌診斷準確性是高的與研究比較以鋇懸浮。由於他們的便利、成本效益, 和建立的診斷準確性, radiopaque 標誌(BIPS, MedID) 成為了選擇author.s 技術的估計胃倒空和小和大小腸運輸和的排除部份腸阻礙。他們是我的診斷的一定期部份現在工作上升慢性嘔吐。
口頭容忍
口頭容忍是被忽略在臨床工作者的危險的其它腸作用。口頭容忍的失敗導致可能導致深刻或慢性食道怨言以後者不可能區分從IBD 沒有飲食排除向測試挑戰的食物過敏。飲食試驗應該是一定期部份的所有食道工作上升。其它方式估計口頭容忍將執行一個gastroscopic 食物敏感性測試(GFST) 。這個測試是有用的為那些想要對食道mucosa 反應的一個直接評估對食物抗原。它是類似於補釘測試皮膚和有潛力查出臨床症狀不顯的第一類型hypersensitivities 部下的腸官能不良。作者發現這個測試最有用為確定飲食蛋白質被避免在暴露於一許多飲食的複雜的犬IBD 患者。如果鞭痕發生在食物抗原適用於胃mucosa 的站點, 那個蛋白質來源被避免在patient.s 治療飲食。GFST 執行在食道切片檢查法標本獲得的同樣內窺鏡檢察做法期間。徵兆為GFST 被減少了以蛋白質水解物飲食出現, 因為水解物飲食避免需要做出一個準確選擇新穎的(原封) 蛋白質飲食處理食物過敏患者。
小腸滲透性
黏膜permselectivity 維護是一個重要腸作用並且滲透性的反常性看上去相對地共同。腸滲透性眾多的測試主張了包括評估分子段落從食道到血液的測試(即, 簡單的糖) 並且那些測量血漿蛋白質損失入食道(為診斷蛋白質丟失enteropathy) 。總之, 這些測試形成少量風險但一些相對地昂貴和難執行。他們是有用的為研究但不部分變得定期在臨床實踐因為增加的滲透性的認識不能影響patient.s 管理。對糖滲透性測試的最頻繁地提出的臨床用途將篩選為臨床症狀不顯的腸疾病。在IVABS, 我們開發了腸滲透性簡單的驗血對飲食蛋白質和希望開發這協助一定數量的臨床決定包括是否使用蛋白質水解物節食。它將是一年或二在私有實習者能對腸滲透性實際測試定期地能夠存取適當為臨床目的之前。
分泌物
有當前胃腸道分泌作用沒有實際測試可利用。在將來, 直腸透析袋子也許是有用的為這個評估。當前, 實習者必須依靠分泌腹瀉, 即, 繼續在齋戒期間的腹瀉的經典臨床標誌的認識。
發自內心的感覺
發自內心的感覺的反常性可能加固急燥的腸綜合症狀在狗像被懷疑在人。估計發自內心的感覺實用方法在小動物臨床患者當前未被開發, 但是對一個直腸氣球的被分級的膨脹的反應可能是情報的一旦一個規範化的協議被開發。
結論
總而言之, 一些腸作用(消化、吸收、口頭容忍, 和能動性) 實際測試供給臨床工作者和增加價值來診斷工作上升。臨床食道作用可適用的測試的發展和提煉是重要性為將來。

Introduction
The standard veterinary gastrointestinal workup varies little and centers on endoscopic examination of the stomach, duodenum and colon. Veterinarians take a history, perform a physical examination, and acquire a database (CBC, serum chemistry profile, urinalysis and one or more fecal flotations). This may be complemented by a fecal culture and serum assays of TLI, cobalamin/folate, FeLV, FIV and T4. If no answer is obvious by this stage, an elimination trial may be tried to rule out adverse reactions to foods. The next step is usually survey abdominal radiographs, abdominal ultrasound, endoscopy and biopsy, or a combination thereof. The pressure then comes on the pathologist to find something in the biopsy samples. Understandably in this situation, the normal complement of gut-associated lymphoid tissue starts to be regarded with great suspicion and before long we have 𡞫iagnosed?yet another case of mild inflammatory bowel disease.
Is this a satisfactory state of affairs for veterinary gastroenterology? I don㦙 believe so. Most body systems are affected by ill-defined 𦽳ymptom?complexes that are tentatively given labels (such as miliary dermatitis, FLUTD, IBD, and IBS) by the clinicians who first recognise the characteristic pattern of clinical signs. Unfortunately, as others identify the same symptom complex the 𢡠abel?becomes fashionable and very soon assumes the respectability of a 𡞫iagnosis.?Does the use of such generic labels as 𡞫iagnoses?compromise clinical practice at all? Usually not, because very often a characteristic symptom complex can be quickly and effectively dealt with by the corresponding 懀reatment complex.?Yet, there can be a casualty of this approach. The frequent use of such terms tends to reduce the profession𠏋 motivation to obtain diagnoses that are more accurate. There is a tendency to 𩂈est on our laurels?and make comforting statements such as ?0% of the dogs an cats in my practice that present with chronic vomiting have 𧗽nflammatory bowel disease.?This conveniently ignores the fact that the so-called inflammatory bowel disease may have been food sensitivity, a mucosal permeability barrier defect, a motility disorder, an undiagnosed infection, a small intestinal bacterial overgrowth, or even an incipient lymphoma.
So where should veterinary gastrointestinal diagnostic method go from here? It is quite clear we have a lot to learn about the diagnosis of gastrointestinal infectious disease. In addition, we are a long way from understanding the significance of a single aspirate of duodenal fluid that reveals a higher than average bacterial number (i.e., so called 𦽳mall intestinal bacterial overgrowth?. We also have a lot to learn about the interpretation of bowel biopsies and have only recently ventured into the complex area of subtyping lymphocytes. Similarly, our knowledge of the value of measuring mucosal inflammatory mediators is in its infancy. Worst of all, we seem to have neglected the entire area of assessing bowel function and replaced this with an emphatic belief that we can subcharacterise (i.e., 𡞫iagnose? all bowel disease by morphology or culture. This cherished misconception ignores the fact that bowel functions such as motility, secretion, permeability, absorption, visceral sensitivity and oral tolerance can be compromised without any morphologic abnormality. The inescapable conclusion is that bowel function tests are necessary to reach an accurate diagnosis of gastrointestinal complaints.
Bowel Function Tests
Why aren㦙 bowel function tests more commonly used??The answer is complex and draws on a pragmatic view of the purpose of a diagnostic work-up. Clients pay veterinarians to pursue a diagnostic work-up to help us find a better way to treat their animal瑈ot to reach a diagnosis per se. Thus, the purpose of a diagnostic work-up is to determine the type of disease process resulting in the clinical signs and to subclassify that disease process to the level necessary to optimize patient care. Experienced clinicians do not countenance performing a test unless they are convinced the results of that test will influence prognosis or the way they will treat the patient. For a function test to regularly influence prognosis or treatment, functional bowel disorders must be common; the tests must have good diagnostic accuracy, an acceptable risk/benefit and cost/benefit ratio; and suboptimal care must result from failure to recognize the functional disorder. Now let us examine specific bowel functions to determine if practical function tests are available and are indicated in modern day gastrointestinal work-ups.
Digestion
Collectively, maldigestion and malabsorption are common. Maldigestion due to exocrine pancreatic insufficiency can be conveniently and accurately diagnosed by the TLI test. Although not a classical function test, it has proved to have similar diagnostic accuracy for EPI than older tests of digestive function such as BT-PABA. Maldigestion does occur for reasons other than EPI, but because these other conditions are relatively uncommon (or unlikely to be clinically significant), the TLI suffices as an excellent defacto bowel function test. Suboptimal patient care occurs if maldigestion is not diagnosed. Therefore, a serum TLI test should be a routine part of any work-up of canine small bowel diarrhea.
Absorption
The need for a function test for intestinal absorption is reduced by the fact that osmotic diarrhea can be conveniently recognized clinically (e.g., stops when the patient is fasted). Osmotic diarrhea due to malabsorption can be differentiated from that due to maldigestion by the TLI. Once malabsorption has been identified, the next question is: why? The answer to this question requires diagnostic tests such as endoscopy and bowel biopsy rather than tests of intestinal absorption. However, there are a select number of circumstances in which it can be helpful to test intestinal absorptive function. One such situation is in the diagnosis of cats demonstrating idiopathic weight loss without diarrhea. In my experience, lack of diarrhea does not rule out malabsorption in cats. Unlike dogs, cats have a remarkable ability to concentrate their feces against a high osmotic gradient, which means that malabsorbed food particles can reach high concentrations before provoking diarrhea. In dogs, the two most common situations in which I have found measurement of bowel absorption useful is in evaluating the veracity of diagnoses of mild IBD and in quantifying malabsorption for research studies. In the former situation, I am looking for a functional abnormality (e.g., malabsorption) to help me assess the clinical significance of mild cellular infiltrates in the small intestine. The hypothesis is that mild infiltrates with an associated malabsorption are more likely to be clinically significant than mild infiltrates without demonstrable malabsorption. Lastly, tests of absorptive function are likely to be of value in young animals suspected of disaccharidase deficiency. The bowel absorption test I prefer is the breath hydrogen test. I am not a fan of the xylose, fat absorption, or vitamin B12/folate tests although others find the latter test valuable.
Motility Disorders
Motility disorders (both primary and secondary) are collectively common. They are difficult to recognize solely based on clinical signs, and suboptimal care can result if they are not recognized. Clinicians aware of depressed bowel motility usually choose to treat the patient with prokinetic drugs or dietary changes (e.g., gruels). The risk/benefit ratio of the currently available tests of bowel motility is uniformly low. However, their cost/benefit ratio varies with scintigraphy and fluoroscopy being relatively expensive in comparison to radiographic procedures. The diagnostic accuracy of scintigraphy and radiopaque markers is high in comparison to studies with barium suspensions. Because of their convenience, cost-effectiveness, and established diagnostic accuracy, radiopaque markers (BIPS, MedID) have become the author𠏋 technique of choice for assessing gastric emptying and small and large intestinal transit and for ruling out partial bowel obstructions. They are now a routine part of my diagnostic work-ups of chronic vomiting.
Oral Tolerance
Oral tolerance is another bowel function that is ignored at the peril of the clinician. A failure of oral tolerance results in food allergy that can cause acute or chronic gastrointestinal complaints with the latter impossible to differentiate from IBD without dietary elimination-challenge tests. Dietary trials should be a routine part of all gastrointestinal work-ups. Another way to assess oral tolerance is to perform a gastroscopic food sensitivity test (GFST). This test is useful for those who want a direct assessment of the reaction of the gastrointestinal mucosa to food antigens. It is analogous to patch testing the skin and has the potential to detect subclinical type 1 hypersensitivities underlying bowel dysfunction. The author finds this test most useful for determining dietary proteins to be avoided in complicated canine IBD patients that have been exposed to a multitude of diets. If a welt occurs at the site at which food antigen is applied to the gastric mucosa, that protein source is avoided in the patient𠏋 therapeutic diet. The GFST is performed during the same endoscopy procedure by which gastrointestinal biopsy specimens are obtained. The indications for GFST have been reduced with the advent of protein hydrolysate diets, because hydrolysate diets avoid the need to make an accurate choice of a novel (intact) protein diet to manage food allergic patients.
Intestinal Permeability

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[color=Magenta][size=5][b]處理的慢性痛苦: NSAIDs Managing Chronic Pain: The NSAIDs   [/b][/size][/color]


炎症和痛苦是非常共同的臨床問題在獸醫方面。這是一個巨大地擴展區域在人的醫學(所有小boomers 變老和遭受他們的體育活動像橡皮筋跳和山biking!) 。許多人的抗發炎藥物被探索用於動物。實習者需要對這些藥物的行動的基本的理解為了讚賞臨床區別在他們之間。
Chirality 和抗發炎藥物
一個重要概念在瞭解藥物(特別是新NSAIDs) pharmacokinetics 和藥效學是, 一些藥物存在作為立體異構體(對應異構體) 。立體異構體是化合物以同樣分子慣例, 但由於不對稱地針對的化工小組在空間, 他們導致nonsuperimposable 鏡像和為人所知作為chiral 化合物。這意味著, 他們是像您的手: superimposable 棕櫚對棕櫚, 但不是棕櫚支持。有提到不對稱的分子的配置幾個方式。為NSAIDs, 多數作者使用S. (陰險) 並且R. (rectus) 指定為每個一對對應異構體。雖然各名一對的成員對應異構體不同在三維取向, 他們的有形資產(熔化的和沸點, 折射率、可溶性, 等) 是相同的。但是, 它非常重要意識到, 生物系統是高度chiral 環境。每個的pharmacokinetics 和pharmacodynamic 作用一對對應異構體也許是非常不同的。治療效力並且/或者毒性作用也許具體地與一對應異構體有關。但是, 許多藥物被公式化作為外消旋的混合物, 包含相等的(50:50) 相當數量各對應異構體, 因為純淨的對應異構體化工綜合是非常昂貴的。所有propionic 酸NSAIDs (ketoprofen, carprofen, etodolac) 是chiral 化合物, 並且除了naproxen, 被公式化作為外消旋的混合物。Stereospecificity 也許發生在吸收、發行、新陳代謝, 和排泄的約物動力學的過程中, 特別是如果過程介入載體蛋白質。如果一個藥物分子的適合入束縛位置在蛋白質、酵素, 或感受器官介入chiral 中心, 親合力為附件然後將是不同的為每個一對對應異構體。進一步混淆排序的問題在不同的pharmacokinetics 之外為各對應異構體, 一些對應異構體可能進行 chiral 反向, 因為肝酵素轉換對應異構體的一個形式成另一形式。程度chiral 反向為任一種藥物變化在種類之間, 無法被外推從一個種類到另一個。
Cyclooxygenase 禁止
最近, 它被顯示, 有cyclooxygenase (考克斯的) 不同, 分明形式。結構性地表達的形式(正常為homeostasis) 指COX-1, 和可誘導形式(以回應傷害) 指COX-2 。COX-1 被發現在小片、腎臟和胃腸道。COX-2 被辨認了在成纖維細胞、chondrocytes 、內皮細胞的細胞、巨噬細胞, 和mesangial 細胞裡。COX-2 被對各種各樣的cytokines 、mitogens, 和內毒素的暴露導致, 並且它調控了以炎症。前列腺素生產了在胃腸道並且維護黏膜正直在GI 短文和腎臟灌注的腎臟看上去從COX-1 被獲得。所以, 鎮壓COX-1 活動由NSAIDs 應該對毒力的發展至關重要。它被建議, COX-2 有選擇性的NSAIDs 會壓制前列腺素綜合在炎症站點但會饒恕結構性前列腺素綜合在GI 短文和腎臟。現在可以得到的NSAIDs 變化在他們的有力作為COX-2 抗化劑, 但實際上所有比COX-2 是COX-1 更加有力的抗化劑。製藥公司賽跑開發COX-2 有選擇性的NSAIDs, 但這不能是完善的解答。如果COX-2 負責主要對中間痛苦、炎症和熱病, 它是不太可能的前列腺素COX-2 有選擇性的藥物更加治療地將是有效的, 因為可利用的NSAIDs 已經是非常COX-2 有效的抗化劑。它是可能的, COX-1 前列腺素對痛苦、炎症, 和熱病貢獻; 如此COX-2 有選擇性的NSAIDs 能是 較不 有效的。另外, COX-2 也許生產有利前列腺素; 因此, 高度有選擇性的COX-2 抗化劑也許導致有害反應沒看與現有的NSAIDs 。並且, 多數GI 潰瘍同重大黏膜炎症聯繫在一起。在這些情況, 它是可能的, COX-2 被表達, 並且被獲得的前列腺素負責對促進癒合(它是知名的NSAIDs 減速癒合潰瘍) 。
NSAIDs 主要抗發炎歸結於前列腺素生產的他們的禁止。所以, NSAIDs 不解決炎症, 而是防止它持續的發生。如此, 當前列腺素生產迅速地將減少, 任一早先當前前列腺素必須被去除在炎症將消退之前。從組織籠子工作, 它被顯示了phenylbutazone, flunixin, meloxicam, 和carprofen 延遲了高峰集中在炎症站點和堅持在激動滲出液長期在血漿集中是微不足道的之後。這解釋被延遲的起始和延長了不關聯以血漿pharmacokinetics 抗發炎行動的期間。另外, cyclooxygenase 禁止不解釋所有NSAIDs 的抗發炎活動。一些抗發炎行動看上去與他們的能力有關插入入細胞油脂bilayer 和打亂正常信號和蛋白質蛋白質互作用在細胞膜裡。NSAIDs 是親油性在低酸鹼度, 這樣被發現在被激起的組織。在嗜中性的細胞膜, NSAIDs 禁止嗜中性族聚, 減少酵素發行和superoxide 世代,和禁止lipoxygenase 。
鎮痛藥作用
NSAIDs 作為鎮痛藥由禁止考克斯和防止使輸入nociceptors 敏感在炎症周邊站點前列腺素的生產。但是, 那裡增加證據, 某一NSAIDs 有行動一個中央機制為痛覺缺失和協同作用地行動以opioids 。最近的工作表示, flunixin 的鎮痛藥作用在痛苦綿羊腳腐爛模型由鴉片製劑反對者的管理扭轉, naloxone 。進一步使對他們的鎮痛藥行動的我們的理解複雜化, 工作與某一NSAIDs 具體對應異構體顯示S. 對應異構體有好cyclooxygenase 禁止作用, 當R. 形式可能有微弱的活動反對cyclooxygenase 仍然導致痛覺缺失。所以, NSAIDs 可能是有效的作為鎮痛藥當炎症是痛苦過程的部份並且是有效的作為鎮痛藥當給在激動過程或侮辱的起始之前。時間對NSAIDs 鎮痛藥物產的起始和期間不關聯很好以他們的抗發炎properties.the 鎮痛藥作用可能有行動的更加迅速的起始和短期。所以, 劑量養生之道為有效的痛覺缺失也許需要不同的比為抗發炎物產。
新用途為NSAIDS
為一些腫瘤(冒號、乳房, 過渡細胞癌), 某一NSAIDs 看上去有anti-proliferative 作用與前列腺素的禁止有關。NSAIDs 並且似乎是防護的反對Alzheimer.s 疾病在人。有徵兆, COX-2 也許是Good 考克斯。在腦子或供選擇地, 那裡也許是酵素的另外的形式那we.ve 闡明。
Ketoprofen
Ketoprofen (Ketofen。, Anafen。) 是一個propionic 酸的衍生物可利用作為一種可注射的公式化(10 mg/ml) 並且片劑(5, 10, 20 毫克) 在加拿大至於短期使用在狗和貓。有一50 mg/tablet 人普通可利用的在加拿大。在美國, 有獸醫可注射為馬(Ketofen。, 100 mg/ml), 和OTC 人的公式化(Orudis 千噸。, 12.5 mg/tablet) 。Ketoprofen 存在作為二對應異構體, 有不同的排除半衰期, 但被公式化作為一個外消旋的混合物。S. 對應異構體同反前列腺素活動和毒力聯繫在一起, 當R. 對應異構體同痛覺缺失聯繫在一起, 不生產GI 潰瘍。由於chiral 反向, S. 異構體佔優勢在馬、狗和貓, R. 對應異構體佔優勢在綿羊。典型地, 血漿排除T. 是短, 大約一個小時在馬, 1.6 小時在貓, 和五個小時在狗。貓和狗可能通過射入(IV 給2 mg/kg 藥量, IM 或SC) 第一治療, 被1 mg/kg PO (片劑) 跟隨q24h 。標籤藥量在五天療法, 但0.25 mg/kg 被推薦了為慢性療法。ketoprofen 的不利影響是罕見但典型的為NSAID 。有動物以hemostasis 問題和急性腎衰竭報告跟隨麻醉和手術當ketoprofen 被執行了在perioperative 期間。
Carprofen
Carprofen (Rimadyl。), 像ketoprofen, 是S. 和R. 對應異構體一個外消旋的混合物。它是可利用的在美國和加拿大作為caplets (25, 75, 100 毫克) 為狗。大多數考克斯禁止抗發炎行動歸因於S. 對應異構體並且痛覺缺失歸因於R. 對應異構體。Carprofen 比COX-1 有更加巨大的活動反對COX-2, 但它的整體cyclooxygenase 禁止是微弱的, 因此抗發炎和鎮痛藥活動也許歸結於中央作用。Chiral 反向carprofen 不發生在狗。在狗, carprofen 有90% 生物相容性、發行的小容量, 和排除T. 8 個小時。排除T. 在貓是48 個小時, 但變化在個體之間。這是99% 區域對血漿蛋白質和被生物轉化消滅在肝臟, 被排泄跟隨入排匯物和尿。一些enterohepatic 回收發生。口頭caplets 被藥量在2.2 mg/kg 唯一藥量被使用了在貓的q12h., 但多藥量不被推薦的歸結於毒力易變的pharmacokinetics 和風險。Carprofen 也許導致一有氣質hepatopathy 在狗。
Etodolac
Etodolac (EtoGesic。) 是可利用的作為150 種或300 種毫克片劑在美國和很快來臨到加拿大用於慢性狗以骨關節炎。Etodolac 相當是COX-2 具體, 和像ketoprofen 和carprofen, 是S. 和R. 對應異構體一個外消旋的混合物。Etodolac 顯示巨大stereospecificity 在蛋白質捆綁和microsomal 新陳代謝。它有發行的大容量, 主要地由於S. 對應異構體的低蛋白質捆綁。排除T. 是7.12 小時。Etodolac 被肝新陳代謝和糞便排泄主要消滅, 和進行enterohepatic recirculation 。它被藥量在10.15 mg/kg PO q24h 。有某一協會以出血在矯形手術期間在狗接受15 mg/kg 。在毒力研究中, 大劑量生產了典型的食道潰瘍。在腎衰竭一個實驗性模型, etodolac 沒有不利影響在腎臟作用。
Tolfenamic 酸
Tolfenamic 酸(Tolfedine。) 是批准用於慢性用途在狗和短期貓在加拿大。它是可利用的作為6 種, 20 種和60 種毫克片劑, 和4% 可注射的解答。在狗, 它有相對大Vd 為1.2 L/kg NSAID 和排除T. 6.5 小時在狗和8 個小時在貓以enterohepatic 回收。在動物中以腎衰竭, 更多藥物接受肝排除。藥量是4 mg/kg q24h 3-5 天為劇痛和4 mg/kg q24h 3 天喪失七為慢性痛苦管理在狗。儘管高COX-1 特異性, tolfenamic 酸有好安全外形在狗和貓。在實驗性研究中, 食道潰瘍和nephrotoxicity 只看了以藥量> 10 倍治療藥量。
Meloxicam
Meloxicam (Metacam。) 是可利用的至於使用在狗在加拿大和現在批准為人在美國和加拿大(Mobic.) 。它是可利用的作為一種可注射的解答和口頭糖漿為骨關節炎慢性療法在狗。Meloxicam 有高活動反對COX-2; 在臨床研究, 它沒有影響在小片族聚或腎臟前列腺素綜合, 顯示饒恕COX-1 。排除T. 在狗是12.36 小時。口頭藥量在狗是0.2 mg/kg 一次性裝貨藥量被0.1 mg/kg PO 跟隨q24h 。一旦一個治療作用看了, 藥量可能被滴定對患者為最低的可能的每日藥量。Meloxicam 是高度有效和很好容忍, 以不利影響少量報告。在最近研究中, meloxicam 可注射pre-operatively 被給比butorphanol 有效的為痛苦控制, 沒有導致有害腎臟或血液學作用。
Celecoxib
Celecoxib (Celebrex。) 是一種新nonsteroidal 抗發炎藥物。與其它NSAIDs 對比禁止的兩isoforms, celecoxib 具體地禁止COX-2, 與375 摺疊更加巨大的特異性為COX-2 比COX-1 。雖然資料是有限的, celecoxib 不利影響外形也許有利的比那現有的NSAIDs 。最共同的不利影響在研究中是頭疼、消化不良, 和上部呼吸道傳染, 發生在相似或比安慰劑。因為celecoxib.s 發行在市場上, 患者10 死亡採取celecoxib 和GI 出血11 個案件被報告了。於10 死亡, 二名患者死了於深刻GI 出血。它是未知的什麼作用, 如果有, celecoxib 有在腎臟。celecoxib pharmacokinetics 被描繪了在小獵犬狗。Celecoxib 由狗廣泛地代謝對一種hydroxymethyl 代謝產物以隨後氧化對羥基酸類似物。有至少狗的二人口, 卓越由他們的容量從血漿消滅celecoxib 以或快速或緩慢的率在I.V. 管理以後。在242 個動物的人口之內, 45.0% 是EM 表現型, 53.5% 是PM 表現型, 並且1.65% 不能充分地被描繪。卑鄙(+/- S.D 。) 血漿排除T. celecoxib 是1.72 +/- 0.79 h 為EM 狗和5.18 +/- 1.29 h 為PM 狗。肝微粒體從EM 狗代謝了celecoxib 以一種更高的速率比微粒體從PM 狗。Celecoxib 是98.5% 蛋白質一定在狗。這種藥物不應該被執行對狗沒有進一步研究。當前, 沒有出版有用的資料看待rofecoxib (Vioxx。) 在狗。

Inflammation and pain are very common clinical problems in veterinary medicine. It is a tremendously expanding area in human medicine (all the baby boomers are getting older and suffering from their physical activities like bungee jumping and mountain biking!). Many of the human anti-inflammatory drugs are being explored for use in animals. Practitioners need a basic understanding of the action of these drugs in order to appreciate clinical differences between them.
Chirality and the Anti-inflammatory Drugs
An important concept in understanding the pharmacokinetics and pharmacodynamics of drugs (especially the new NSAIDs) is that some drugs exist as stereoisomers (enantiomers). Stereoisomers are compounds with the same molecular formula, but because of asymmetrically oriented chemical groups in space, they produce nonsuperimposable mirror images and are known as chiral compounds. This means that they are like your hands: superimposable palm to palm, but not palm to back. There are several ways of referring to the configuration of asymmetric molecules. For the NSAIDs, most authors use the 廍?(sinister) and 𣫮?(rectus) designation for each of a pair of enantiomers. Although each member of a pair of enantiomers differs in three-dimensional orientation, their physical properties (melting and boiling points, refractive index, solubility, etc) are identical. However, it is very important to realize that biological systems are highly chiral environments. The pharmacokinetics and pharmacodynamic effects of each of a pair of enantiomers may be very different. Therapeutic efficacy and/or toxic effects may be related specifically to one enantiomer. However, many drugs are formulated as racemic mixtures, containing equal (50:50) amounts of each enantiomer, because chemical synthesis of pure enantiomers is very expensive. All of the propionic acid NSAIDs (ketoprofen, carprofen, etodolac) are chiral compounds, and except for naproxen, are formulated as racemic mixtures. Stereospecificity may occur in the pharmacokinetic processes of absorption, distribution, metabolism, and excretion, especially if the process involves a carrier protein. If the fit of a drug molecule into the binding site on a protein, enzyme, or receptor involves the chiral center, then the affinity for attachment will be different for each of a pair of enantiomers. To further confuse the issue of sorting out the different pharmacokinetics for each enantiomer, some enantiomers can undergo chiral inversion, as hepatic enzymes convert one form of the enantiomer to the other form. The degree of chiral inversion for any drug varies between species and cannot be extrapolated from one species to another.
Cyclooxygenase Inhibition
Recently, it has been shown that there are different, distinct forms of cyclooxygenase (COX). The constitutively expressed form (normal for homeostasis) is referred to as COX-1, and the inducible form (in response to injury) is referred to as COX-2. COX-1 is found in platelets, the kidneys and the gastrointestinal tract. COX-2 has been identified in fibroblasts, chondrocytes, endothelial cells, macrophages, and mesangial cells. COX-2 is induced by exposure to various cytokines, mitogens, and endotoxin, and it up-regulated with inflammation. The prostaglandins produced in the gastrointestinal tract and the kidneys that maintain mucosal integrity in the GI tract and renal perfusion appear to be derived from COX-1. Therefore, suppressing COX-1 activity by NSAIDs is believed to be critical to the development of toxicity. It is suggested that COX-2 selective NSAIDs would suppress prostaglandin synthesis at sites of inflammation but would spare constitutive prostaglandin synthesis in the GI tract and kidney. The currently available NSAIDs vary in their potency as inhibitors of COX-2, but virtually all are far more potent inhibitors of COX-1 than COX-2. The pharmaceutical companies are racing to develop COX-2 selective NSAIDs, but this may not be the perfect solution. If COX-2 is primarily responsible for the prostaglandins that mediate pain, inflammation and fever, it is unlikely that COX-2 selective drugs will be more therapeutically effective, because the available NSAIDs are already very effective inhibitors of COX-2. It is still possible that COX-1 prostaglandins contribute to pain, inflammation, and fever; so COX-2 selective NSAIDs could be less effective. In addition, COX-2 may produce beneficial prostaglandins; therefore, highly selective COX-2 inhibitors may produce adverse reactions not seen with existing NSAIDs. Also, most GI ulceration is associated with significant mucosal inflammation. In these circumstances, it is likely that COX-2 is being expressed, and that the derived prostaglandins are responsible for promoting healing (it is well known that NSAIDs retard the healing of ulcers).
NSAIDs primarily are anti-inflammatory due to their inhibition of prostaglandin production. Therefore, NSAIDs do not resolve inflammation, but prevent its on-going occurrence. So, while prostaglandin production will rapidly diminish, any previously present prostaglandin must be removed before inflammation will subside. From tissue cage work, it has been shown that phenylbutazone, flunixin, meloxicam, and carprofen have delayed peak concentrations at the site of inflammation and persist in inflammatory exudates for long periods after plasma concentrations are negligible. This explains the delayed onset and prolonged duration of anti-inflammatory action that does not correlate with plasma pharmacokinetics. In addition, cyclooxygenase inhibition does not explain all of the anti-inflammatory activity of NSAIDs. Some anti-inflammatory action appears to be related to their ability to insert into the lipid bilayer of cell and disrupt normal signals and protein-protein interactions in cell membranes. NSAIDs are more lipophilic at a low pH, such is found in inflamed tissues. In the cell membrane of neutrophils, NSAIDs inhibit neutrophil aggregation, decrease enzyme release and superoxide generation,and inhibit lipoxygenase.
Analgesic Effects
NSAIDs act as analgesics by inhibiting COX and preventing the production of prostaglandins that sensitize the afferent nociceptors at peripheral sites of inflammation. However, there is increasing evidence that some NSAIDs have a central mechanism of action for analgesia and act synergistically with opioids. Recent work has shown that the analgesic effect of flunixin in a sheep foot rot model of pain is reversed by the administration of an opiate antagonist, naloxone. To further complicate our understanding of their analgesic action, work with the specific enantiomers of some NSAIDs has shown the 廍?enantiomers to have good cyclooxygenase inhibitory effects, while the 𣫮?forms can have weak activity against cyclooxygenase yet still produce analgesia. Therefore, NSAIDs are likely to be more effective as analgesics when inflammation is a part of the pain process and are more effective as analgesics when given prior to the onset of the inflammatory processes or insult. The time to onset and duration of analgesic properties of NSAIDs does not correlate well with their anti-inflammatory properties鍟he analgesic effect is likely to have a more rapid onset and shorter duration of action. Therefore, dosage regimens for effective analgesia may need to be different than for anti-inflammatory properties.
New Uses for NSAIDS
For some tumors (colon, breast, transitional cell carcinoma), some NSAIDs appear to have anti-proliferative effects related to the inhibition of prostaglandin. NSAIDs also seem to be protective against Alzheimer𠏋 disease in humans. There are indications that COX-2 may be the 䥲ood COX?in the brain or alternatively, there may be additional forms of the enzyme that we𠐔e yet to elucidate.
Ketoprofen
Ketoprofen (Ketofen?/sup>, Anafen?/sup>) is a propionic acid derivative available as an injectable formulation (10 mg/ml) and tablets (5, 10, 20 mg) in Canada for short-term use in dogs and cats. There is a 50 mg/tablet human generic available in Canada. In the US, there is a veterinary injectable for horses (Ketofen?/sup>, 100 mg/ml), and an OTC human formulation (Orudis KT?/sup>, 12.5 mg/tablet). Ketoprofen exists as two enantiomers, which have different elimination half-lives, but is formulated as a racemic mixture. The 廍?enantiomer is associated with anti-prostaglandin activity and toxicity, while the 𣫮?enantiomer is associated with analgesia and does not produce GI ulceration. Because of chiral inversion, the 廍?isomer predominates in horses, dogs and cats, where the 𣫮?enantiomer predominates in sheep. Typically, the plasma elimination t?is short, approximately one hour in horses, 1.6 hr in cats, and five hr in dogs. Cats and dogs can be given a dose of 2 mg/kg by injection (IV, IM or SC) the first treatment, followed by 1 mg/kg PO (tablets) q24h. The label dose is for five days of therapy, but 0.25 mg/kg has been recommended for chronic therapy. Adverse effects of ketoprofen are rare but typical for an NSAID. There are reports of animals with hemostasis problems and acute renal failure following anesthesia and surgery when ketoprofen was administered in the perioperative period.

minibabyqq 2007-1-3 10:37 PM

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[color=Magenta][size=5][b]狗和貓在感染腹瀉診斷[/b][/size][/color]


Diagnosis of Infectious Diarrhea in Dogs and Cats   


enteropathogenic 細菌的臨床文獻導致腹瀉在狗和貓由這些有機體出現覆蓋發生作為土產小腸植物群的一個正常組分。細菌文化是方法當前被運用為Campylobacter spp. , 沙門氏菌spp. , 突破芽孢梭菌, 和紡錘狀細菌屬的隔離 difficile。但是, 唯一糞便樣品文化是相對地不可靠的為牽連這些潛在地致病性傷寒的有機體作為腹瀉的起因。企圖在開化這些細菌病原生物頻繁地被做在獸醫診斷實驗室。許多動物接受不適當的抗藥性被懷疑的病原生物的療法隨後而來的隔離; 腹瀉的臨床標誌的決議經常錯誤地被視同以incriminating. 病原生物的剷除。定期糞便文化經常產生失望的結果由於稀有在恢復傷寒的病原生物、許多細菌傳染的自已限制的本質, 和困難被介入以結果的解釋。 體外 方法應用分子方法為毒素基因的證明從細菌孤立和immunoassays 為毒素的偵查在排匯物可能被運用提供細菌伴生的腹瀉一個迅速, 更加準確的診斷。糞便文化也許是有用的在動物中以暴露, 腹瀉爆發的歷史對細菌病原生物的在超過一隻寵物在家庭, 腹瀉起始之中在kenneling 或展示對一種公共衛生危險的出勤, 或關心以後。血淋淋的腹瀉深刻很大數量的糞便嗜中性起始與sepsis 有關係的證據, 或出現並且擔保糞便文化。
突破芽孢梭菌
突破芽孢梭菌 是絕氧的, 氧氣寬容, 不形成孢子欣然在試管內的gram-positive 桿菌。有機體是腸炎和羊傳染性腸毒病一個重要代理在家畜和人和被辨認了因為醫院和被獲取的深刻和慢性腹瀉的起因在狗。 狗以 C.-perfringens enterotoxicosis 一般展覽大腸腹瀉為腸運動增加的頻率描繪以裡急後重和糞便黏液和hematochezia 。四主要毒素(阿爾法的闡述-, ss €, 和 i) 是為鍵入有機體的依據入五產毒表現型; 但是, C.-perfringens enterotoxin (CPE), 是原則毒素被介入在 C.-perfringens food-borne 病症和同非食物出生的diarrheal 疾病聯繫在一起。孢子形成和CPE 的生產co 被調控, 並且毒素, 唯一多縮氨基酸35 kDa, 被發布在植物生長的細胞的病勢漸退。C.-perfringens 診斷 - 導致的enteropathy 在狗是視colitis 的典型的臨床標誌同時發生, 很大數量的抗熱C.-perfringens endospores 的 偵查 , 和enterotoxin 的immunodetection 而定在反常排匯物。由於 C.-perfringens 共同地被觀察以植物生長的形式在正常狗排匯物, C.-perfringens 的隔離 跟隨糞便文化在diarrheic 狗不一定關聯以臨床疾病。
二個商業可利用的血清學測試可能被使用查出 C.-perfringens enterotoxin 在排匯物。反向被動乳汁膠合(RPLA) 分析用試樣(Unipath Co., Ogdensburg, NY) 查出被淨化的CPE 4 ng/mL 極小值; 但是, 分析用試樣要求隔夜孵出並且結果的解釋是有些主觀的。酵素immunoassay (EIA) (Techlab, Inc., Blacksburg, VA) 合併monoclonal 抗體對epitope 在束縛對enterocytes 的CPE, 提供特異性。它的稀釋劑被公式化中立化糞便proteases 和其它未指明的反應。測試需要三個小時執行(多數這是孵出時間), 並且結果比RPLA 分析用試樣是容易解釋。
C.-perfringens enterotoxin 的 流行 在狗排匯物以和沒有腹瀉最近被估計了在144 條狗, 代表住醫院的狗(n=41) 或沒有(n=50) 腹瀉, 和臨床正常狗對待門診病人(n=53) 。RPLA 分析用試樣是正面的在大約25% 狗中, 不管他們的臨床狀態, 但是只9/144 狗(6.3%) 是EIA 正面。 cpe 基因由PCR 可靠地查出了, 並且大多這些張力生產了CPE 。這些研究結果強調假的正面結果的高發生被獲得以RPLA 分析用試樣。雖然糞便汙跡的cytologic 考試是快和簡單的試鏡頭辨認C.-perfringens endospores , 結果是非決定性的因為endospores 的相似的數字被觀察在汙跡被獲得從健康狗和狗以腹瀉。C.-perfringens endospores 的數量 在人的糞便標本是在參考範圍之內在69% enterotoxin 正面患者中, 表明endospores 的一個高數字不是有用的在確定腹瀉的起因。RPLA 分析用試樣被評估了在一個分開的小組142 條狗以51 條狗的腹瀉(36%) 測試正面為CPE 。EIA 替換了RPLA 分析用試樣在加州大學戴維斯分校, 並且這個分析用試樣的一個最近評估在一個分開的小組131 條狗以腹瀉查出了CPE 在只11 狗中(8%) 。五EIA 正面狗沒有endospores 被查出在糞便汙跡。對基因的用途探查並且PCR 分析用試樣為產毒C.-perfringens 的偵查 當前被評估。這些方法不要求有cpe 細胞培養的維護為毒素分析用試樣, 和 孤立, 但不形成孢子 在試管內, 可能欣然被查出, 減少假的陰性。分子方法並且將促進劇毒因素的證明, 譬如beta2 毒素, 同壞死的腸炎聯繫在一起在小豬和結腸炎在馬。
紡錘狀細菌屬difficile
紡錘狀細菌屬difficile 是一把大, gram-positive, 絕氧spore-forming 能動的標尺和是抗生素伴生的pseudomembranous colitis 的主要起因在人的患者。具體測試為 C. difficile 毒素被使用在診斷實驗室包括細胞培養, 依靠生物活躍毒素出現, 並且一個酵素連接的免疫吸附劑分析用試樣, 免疫學上查出活躍毒素也許或不能是生物活躍的。PCR 技術可能歧視在有機體的產毒和nontoxigenic 張力之間, 但是絕氧文化方法不能。
大腸微生物群落的中斷與產毒C. 一起出現 difficile, 是前提對於疾病。 C. difficile 生產損壞大腸皮膜的二抗原分明毒素: 毒素A (enterotoxin) 並且毒素B (cytotoxin) 。毒素A 導致上皮細胞的出血性的可變的儲積和獨立小分隊。毒素B 協同作用地行動與毒素A 因為一cytotoxin 在皮膜之後由毒素A. Extravasation 傷害了血漿蛋白質並且水和電解質運輸的改變隨後而來。大約10% 無症狀狗流洒了產毒 C. difficile 在排匯物。人的嬰兒的高百分比被拓殖以產毒 C. difficile, 但不顯示疾病症狀。
C. 的糞便流行 difficile 在是患者在加州大學獸醫醫療教的醫院的狗是18.4% (28 152 條狗) 根據直接鍍層在Cycloserine cefoxitin 果糖瓊脂(CCFA) 並且確認由乳汁微粒膠合測試。孤立從14 這些患者(50%) 依照由PCR 分析確定包含了基因為毒素A 和B 以確認由Southern 汙點雜交。腹瀉是一臨床發現在五(35.7%) 狗中運載C. 產毒孤立 difficile, 但是腹瀉只被注意了在二14 狗(14.3%) 流出nontoxigenic 孤立中。C. 流出頻率 difficile 從狗以和沒有腹瀉不是顯著不同的; 但是, C. 的支架率 difficile 是顯著高的為住院病人對門診病人。對抗生素或免疫抑制的藥方的一致用途未被發現顯著不同的在是C. difficile 正面 或陰性和在產毒和nontoxigenic 孤立之間的狗之間。
C. 的流行 difficile 在糞便標本從是患者在加州大學獸醫醫療教的醫院的貓是9.4% (23 245 隻貓) 根據文化在有選擇性的媒介和證明由乳汁微粒膠合測試。毒素A 和B 序列被辨認了在8/23 孤立和由Southern 汙點雜交證實了。所有貓拓殖了以產毒 C. difficile 有 > 風險因素(抗藥性用途, antineoplastic 療法) 與相關 C. difficile 傳染在人的患者。四八隻貓被拓殖以產毒 C. difficile 被對待了以metronidazole 和有腹瀉和消極糞便文化的決議在隨後測試。隔絕nontoxigenic C. 的意義 difficile 在無症狀人的患者是不定的因為有機體是大腸微生物群落的一個正常組分在一些個體。C. 多張力 difficile 經常被隔絕在C. 期間爆發 difficile- 伴生的腹瀉; AP-PCR 可能被運用辨認C. 不同的基因型 difficile 在醫院人口之內。這個方法由辨認證實了環境汙染的潛在的角色在細菌傳輸細菌在環境以相同基因型對那些與患者被隔絕。
Campylobacter jejuni
腹瀉生產了由這把小, 彎曲的, 能動, microaerophilic gram-negative 標尺被看見主要在更加幼小的動物, 雖然它被看見了在所有年齡中動物。它可能與高百分比被隔絕(大約40% 的排匯物是kenneled, 特別在動物控制設施中的) 的健康動物。禽畜和禽畜產品, 並且unpasteurized 牛奶, 是主要來源為人的傳染。小狗和小貓並且是來源為人; 但是, 人也許並且是感染有機體的來源為狗和貓。 Campylobacter 可能生存幾天在水面裡和只要四個星期在排匯物。排泄的期間在被傳染的狗和貓可能是只要四個月和被傳染的動物應該quarantined 從孩子在這個期間。
C. jejuni 可能拓殖空腸、迴腸、盲腸, 和冒號; 但是, histologic 變動主要被制約對冒號。有機體遵守小腸皮膜通過外表面蛋白質和生產導致分泌腹瀉由循環安培斡旋的enterotoxin 。 Campylobacter 有機體並且詳盡闡述大概負責對上皮損傷的一細胞毒素的enterotoxin 。臨床標誌範圍從溫和的瞬變腹瀉對黏液裝載血淋淋的凳子以colitis 的伴生的標誌。傳染由 Campylobacter spp 。 可以被懷疑當他們的典型彎曲的或螺旋形狀的gram-negative 標尺出現是著名在新鮮的排匯物克被弄髒的汙跡從患者。排匯物可能並且被開化使用幾個有選擇性的媒介的當中一個被設計禁止多數其它小腸植物群(即, CVA 瓊脂成長, 糧食與藥物管理局瓊脂) 。板材被孵化在microaerophilic 條件下在42 C 。
Campylobacter spp. 與13 個糞便標本被隔絕了被獲得從279 條狗(4.7%) 以腹瀉在加州大學戴維斯分校VMTH, 但是糞便汙跡展示了 Campylobacter- 像有機體在4/277 狗(1.4%) 。糞便標本被獲得從貓以腹瀉產生了正面文化在4/68 貓(5.9%), 但是克被弄髒的糞便汙跡展示了 Campylobacter- 像有機體在7/66 貓(10.6%) 。這些研究結果強調依靠的局限糞便汙跡為診斷的 Campylobacter jejuni 作為腹瀉的起因。雖然腹瀉由Campylobacter 有機體 導致通常自已限制, zoonotic 潛力和動物的年齡需要治療與抗菌代理。有效的藥物是大環內酯(紅黴素) 或quinolones (enrofloxacin) 。紅黴素是選擇藥物, 儘管伴生的食道副作用。雖然enrofloxacin 缺乏食道副作用, 抵抗的迅速發展對antimicrobials 這組的, 和在導致聯合反常性的潛力在幼小動物做出這種藥物第二個選擇為處理的Campylobacter 傳染。

The clinical documentation of enteropathogenic bacteria causing diarrhea in dogs and cats is clouded by the presence of these organisms occurring as a normal component of the indigenous intestinal flora. Bacterial culture is the method currently utilized for isolation of Campylobacter spp., Salmonella spp., Clostridium perfringens, and Clostridium difficile. However, culture of single fecal samples is relatively unreliable for incriminating these potentially pathogenic enteric organisms as a cause of diarrhea. Attempts at culturing these bacterial pathogens are frequently made in veterinary diagnostic laboratories. Many animals receive inappropriate antibiotic therapy following isolation of a suspected pathogen; the resolution of clinical signs of diarrhea is often wrongly equated with eradication of the 𧗽ncriminating?pathogen. Routine fecal cultures often yield disappointing results due to the rarity in recovering enteric pathogens, the self-limiting nature of many bacterial infections, and the difficulties involved with the interpretation of results. In vitro methods applying molecular approaches for identification of toxin genes from bacterial isolates and immunoassays for detection of toxins in feces can be utilized to provide a rapid, more accurate diagnosis of bacterial-associated diarrhea. Fecal cultures may be helpful in animals with a history of exposure to bacterial pathogens, outbreaks of diarrhea among more than one pet in a household, onset of diarrhea after kenneling or show attendance, or concern about a public health hazard. Acute onset of bloody diarrhea in association with evidence of sepsis, or presence of large numbers of fecal neutrophils also warrants fecal culture.
Clostridium perfringens
Clostridium perfringens is an anaerobic, oxygen tolerant, gram-positive bacillus that does not sporulate readily in vitro. The organism is an important agent of enteritis and enterotoxemias in domestic animals and humans and has been identified as a cause of both nosocomial and acquired acute and chronic diarrhea in dogs. Dogs with C. perfringens enterotoxicosis generally exhibit large-bowel diarrhea characterized by increased frequency of bowel movements with tenesmus and fecal mucus and hematochezia. The elaboration of four major toxins (alpha-, ß, €, and i) is the basis for typing the organism into five toxigenic phenotypes; however, C. perfringens enterotoxin (CPE), is the principle toxin involved in C. perfringens food-borne illness and is associated with non-food-borne diarrheal disease. Sporulation and the production of CPE are co-regulated, and the toxin, a single polypeptide of 35 kDa, is released upon lysis of the vegetative cell. The diagnosis of C. perfringens-induced enteropathy in dogs has been contingent upon the simultaneous occurrence of typical clinical signs of colitis, the detection of large numbers of heat resistant C. perfringens endospores, and the immunodetection of enterotoxin in abnormal feces. Because C. perfringens is commonly observed in a vegetative form in normal dog feces, isolation of C. perfringens following fecal culture in diarrheic dogs does not necessarily correlate with clinical disease.
Two commercially available serologic tests can be used to detect C. perfringens enterotoxin in the feces. The reverse passive latex agglutination (RPLA) assay (Unipath Co., Ogdensburg, NY) detects a minimum of 4 ng/mL of purified CPE; however, the assay requires overnight incubation and interpretation of the results is somewhat subjective. An enzyme immunoassay (EIA) (Techlab, Inc., Blacksburg, VA) incorporates a monoclonal antibody to the epitope on CPE that binds to enterocytes, providing specificity. Its diluent is formulated to neutralize fecal proteases and other nonspecific reactions. The test takes three hours to perform (most of this is incubation time), and results are easier to interpret than the RPLA assay.
The prevalence of C. perfringens enterotoxin in feces of dogs with and without diarrhea was recently assessed in 144 dogs, representing hospitalized dogs with (n=41) or without (n=50) diarrhea, and clinically normal dogs treated as outpatients (n=53). The RPLA assay was positive in approximately 25% of dogs, regardless of their clinical status, whereas only 9/144 dogs (6.3%) were EIA positive. The cpe gene was reliably detected by PCR, and most of these strains produced CPE. These findings underscore the high incidence of false positive results obtained with the RPLA assay. Although cytologic examination of fecal smears is a quick and simple screening test to identify endospores of C. perfringens, the results are inconclusive because similar numbers of endospores are observed in smears obtained from healthy dogs and dogs with diarrhea. The number of endospores of C. perfringens in human fecal specimens is within reference range in 69% of enterotoxin positive patients, which indicates that a high number of endospores is not useful in determining cause of diarrhea. The RPLA assay was evaluated in a separate group of 142 dogs with diarrhea in which 51 dogs (36%) tested positive for CPE. The EIA has replaced the RPLA assay at UC Davis, and a recent evaluation of this assay in a separate group of 131 dogs with diarrhea detected CPE in only 11 of the dogs (8%). Five of the EIA positive dogs had no endospores detected on fecal smear. The use of gene probes and PCR assays for detection of toxigenic C. perfringens is currently being evaluated. These methods do not require maintenance of cell cultures for toxin assays, and isolates that have cpe, but do not sporulate in vitro, can be readily detected, reducing false negatives. Molecular approaches will also facilitate the identification of virulence factors, such as the beta2 toxin, which has been associated with necrotic enteritis in piglets and enterocolitis in horses.
Clostridium difficile
Clostridium difficile is a large, gram-positive, anaerobic spore-forming motile rod and isthe major cause of antibiotic-associated pseudomembranous colitis in human patients. Specific tests for C. difficile toxins used in the diagnostic laboratory include cell culture, which relies on the presence of biologically active toxin, and an enzyme-linked immunosorbent assay, which detects immunologically active toxin that may or may not be biologically active. PCR techniques can discriminate between toxigenic and nontoxigenic strains of the organism, whereas anaerobic culture methods cannot.
Disruption of the colonic microflora together with the presence of toxigenic C. difficile, are the prerequisites for disease. C. difficile produces two antigenically distinct toxins which damage colonic epithelium: toxin A (enterotoxin) and toxin B (cytotoxin). Toxin A causes hemorrhagic fluid accumulation and detachment of epithelial cells. Toxin B acts synergistically with toxin A as a cytotoxin only after the epithelium has been injured by toxin A. Extravasation of plasma proteins and alteration of water and electrolyte transport follow. Approximately 10% of asymptomatic dogs shed toxigenic C. difficile in feces. A high percentage of human infants are colonized with toxigenic C. difficile, but do not show signs of disease.
The fecal prevalence of C. difficile in dogs who were patients at the University of California Veterinary Medical Teaching Hospital was 18.4% (28 of 152 dogs) based on direct plating on Cycloserine cefoxitin fructose agar (CCFA) and confirmation by a latex particle agglutination test. Isolates from 14 of these patients (50%) contained the genes for toxins A and B as determined by PCR analysis with confirmation by Southern blot hybridization. Diarrhea was a clinical finding in five (35.7%) of the dogs carrying toxigenic isolates of C. difficile, whereas diarrhea was only noted in two of 14 dogs (14.3%) shedding nontoxigenic isolates. The frequency of shedding of C. difficile from dogs with and without diarrhea was not significantly different; however, the carriage rate of C. difficile was significantly higher for inpatients versus outpatients. The concurrent use of antibiotics or immunosuppressive drug therapy was not found to be significantly different between dogs that were C. difficile positive or negative and between the toxigenic and nontoxigenic isolates.
The prevalence of C. difficile in fecal specimens from cats who were patients at the University of California Veterinary Medical Teaching Hospital was 9.4% (23 of 245 cats) based on culture on selective media and identification by a latex particle agglutination test. Toxin A and B sequences were identified in 8/23 isolates and were confirmed by Southern blot hybridization. All of the cats colonized with toxigenic C. difficile had > of the risk factors (antibiotic use, antineoplastic therapy) associated with C. difficile infection in human patients. Four of the eight cats colonized with toxigenic C. difficile were treated with metronidazole and had resolution of the diarrhea and negative fecal culture on subsequent testing. The significance of isolating nontoxigenic C. difficile in asymptomatic human patients is uncertain because the organism is a normal component of the colonic microflora in some individuals. Multiple strains of C. difficile are often isolated during outbreaks of C. difficile-associated diarrhea; AP-PCR can be utilized to identify the different genotypes of C. difficile within a hospital population. This method has confirmed the potential role of environmental contamination in bacterial transmission by identifying bacteria in the environment with identical genotypes to those isolated from the patient.
Campylobacter jejuni

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[color=Magenta][size=5][b]犬和貓的食道瘤形成 [/b][/size][/color]

[size=12px]雖然食道(GI) 瘤佔大約2% 所有似犬和似貓的瘤, 臨床標誌與相關GI 瘤像那些根本上是相同與相關這些器官激動或阻礙疾病。最共同的臨床標誌與mass 作用有關。腫瘤以臨床顯示根據腫瘤的站點在小腸短文之內。胃腫瘤典型地同慢性嘔吐, 減重, 和inappetence 聯繫在一起。十二指腸、空腸, 和迴腸的腫瘤同嘔吐, 腹瀉(melena), 和減重聯繫在一起, 但是冒號的腫瘤同裡急後重和hematochezia 聯繫在一起。臨床標誌也許起因於變形的損害對肝臟, 脾臟, 腸繫膜淋巴結, 並且中央神經系統, 生產簽字譬如icterus 、胃腸出血, 和奪取。貓也許提出與蒼白黏膜和有microcytic 貧血症次要對慢性失血。它重要記得, 沒有胃腸道的所有節狀損害造形術。差別包括肉芽腫從激動腸疾病、FIP 、真菌感染, 或外國身體滲透。
胃腺癌
胃的最共同的腫瘤在狗是胃腺癌。其它胃腫瘤被診斷較少共同地包括leiomyoma/leiomyosarcoma 、淋巴瘤, 和腺瘤。一個男性優勢被報告了並且一種強的養殖嗜好是存在為比利時牧羊人(在義大利) 並且粗礪的大牧羊犬。胃腫瘤是罕見的在貓並且淋巴瘤佔優勢。
行為
胃腺癌經常metastasize, 特別對perigastric 淋巴結和內臟。多數腫瘤延伸到或通過serosa 從mucosa, 創造深潰瘍與hematemesis 和melena 。
診斷
胃腸觸診也許顯露大胃大量(腺癌) 或散開地變厚的胃牆壁(淋巴瘤) 。簡單的胃腸射線照相並且/或者正面對比射線照相也許顯露變厚胃牆壁, 缺乏rugal 摺疊, 裝填瑕疵, 或管腔內大量。胃腸洞的Ultrasonographic 考試也許顯露另外的大量或轉移對肝臟和脾臟。診斷被證實通過一個胃切片檢查法獲得了或通過內窺鏡檢察或在一種試探性剖腹術期間。多數癌發生在胃中, 特殊幽門的更低三分之二。胸部射線照相應該總執行在胃腫瘤的外科切除術之前因為30% 狗以胃癌可能有可看見的變形的肺損害在最初的介紹。
治療
預測為胃腺癌是窮的由於先進的階段以診斷、他們的散開本質, 和他們的轉移的高速率。多數腫瘤是nonresectable 由於他們的大小或invasiveness 。多數狗死在四個月手術從地方再現或轉移內儘管寬切除術(Billroth I 做法) 。化療的結果為腺癌未被報告。
食道淋巴瘤
不同於狗, 胃腺癌在貓是罕見的, 並且胃是最少共同地受影響的食道站點在貓。淋巴瘤是最共同的胃腫瘤在貓, 也許是孤零零或系統介入一個組分。多數貓以胃淋巴瘤是消極的為似貓的白血病病毒。小腸淋巴瘤有二個形態形式; 散開型和節狀型。散開淋巴瘤為lamina propria 和submucosa 的廣泛的濾滲描繪與也許導致吸收不良、steatorrhea 、腹瀉, 和減重的造形術淋巴細胞。節狀形式經常導致一分裝式變厚腸, 在ileocolic 區域, 以總值luminal 變窄和部份小腸阻礙。轉移對地方淋巴結是共同以兩個疾病的形式。胃淋巴瘤在貓很少被限制對胃和最好被對待以輔藥系統化療。預測為貓以胃淋巴瘤是極端易變的與被對待的貓有生存時間範圍從少於二個月對超過一年。輔藥化療(表1) 並且被推薦跟隨孤零零lymphomatous 大量的外科切除
在39 隻貓一個最近報告以很好被區分的食道淋巴瘤, 最共同的臨床標誌嘔吐(87%), 減重(79%), 厭食(53%), 腹瀉(53%), 和慵倦(47%) 。百分之九有不嘔吐亦不腹瀉。胃腸大量palpated 在26% 貓中, 當32% 變厚了食道圈。二十六隻貓被對待了23 接受強體松(5 毫克q12h) 並且chlorambucil (2 毫克每貓每四到五天) 。十四個(61%) 達到的完全寬恕(CR) 。那些疾病自由間隔時間達到CR 範圍從5.75 到24 月(中點15.5 月) 。整體生存範圍從0.33 到25 個月(中點12 個月) 。沒有在無疾病間隔時間或生存上的重大區別由於年齡、性、胃腸大量的養殖、palpability, retroviral 腫瘤的狀態、hypoalbuminemia 地方化, 或出現。Endoscopic 切片檢查法是相當有用的為獲得一個明確的診斷。生存時代在這項研究中比那些好被看見在貓以窮地被區分的食道淋巴瘤被對待以更加複雜和更加昂貴的協議。淋巴瘤很少被限制對胃和最好被對待以系統化療。貓反應以食道淋巴瘤對vincristine 、cyclophosphamide, 和強體松是窮的, 用被對待的貓有少於二個月的中間生存時光。
21 隻貓的一項最近回顧展研究以有營業的淋巴瘤對待了以強體松, L-asparaginase, vincristine, cyclophosphamide, doxorubicin 一個更加昂貴的multidrug 協議, 並且methotrexate 顯露了20 個星期第一個寬恕的整體中間期間, 和40 個星期的整體中間生存時光。唯一的因素顯著與相關第一個寬恕的期間是是否貓有一個完全反應跟隨歸納化療; 第一個寬恕的期間顯著同生存時間聯繫在一起。貓很好容忍了治療; 只一隻貓有延遲在治療日程表由於嗜中性白細胞減少症。所有貓是消極的為FeLV 並且3/19 貓是正面的為FIV 。十三個腫瘤是階段III, 七是階段IV, 並且你是階段V. Immunophenotyping 執行了在13 個腫瘤; 10 是T 細胞並且三是B 細胞淋巴瘤。這反駁早先文學那闡明, 幾乎所有小腸淋巴瘤是B 細胞起源。
其它小腸瘤
小腸腫瘤最共同地發生在狗和貓的小腸直腸和冒號。淋巴瘤是貓最共同的小腸腫瘤, 並且腺癌和帆柱細胞腫瘤跟隨淋巴瘤在頻率。其它腫瘤影響小腸短文包括fibrosarcoma 、undifferentiated 肉瘤、carcinoids 、leiomyomas/leiomyosarcomas, 和plasmacytoma 。小腸癌典型地發生在更舊的動物。任一個食道的地區可能是受影響的, 但在貓, 腺癌最共同地發生在空腸和迴腸, 但是腺癌在狗最頻繁地發生在大腸和十二指腸。暹羅貓比其它養殖被報告有小小腸腺癌一個更高的頻率。黏膜潰瘍是頻繁, 可能導致melena 和慢性失血貧血症。
肚腑的[i]Leiomyosarcomas [/i]是最共同的肉瘤和經常發生在盲腸和空腸。這些腫瘤當地是是慢的metastasize 的蔓延性惡性光滑的肌肉瘤。 [i]小腸淋巴瘤[/i] 代表大約7% 所有似犬淋巴瘤案件和最共同地發生在中年狗。在貓, 小腸淋巴瘤經常作為一種multicentric 疾病的部分。空腸和迴腸是最共同地受影響的以淋巴瘤在貓。多數貓以小腸淋巴瘤是還似貓的白血病病毒(FeLV) 陰性。
行為
多數小腸瘤惡性。小腸 [i]腺癌[/i] 通常是在一個先進的階段當診斷。瘤的引伸在腸牆壁之外被發現了在85% 狗和71% 貓中在屍體檢驗。轉移最共同的站點在狗包括地方淋巴結、肝臟, 和肺。在貓, 轉移最共同的站點是胃腸serosa 、淋巴結、肺, 和肝臟。腺癌被描述了像環型或管腔內。似犬腺癌組織學上被分類了入也許重疊的四個小組: acinar, 堅實, mucinous, 和乳頭狀。乳頭狀的癌傾向於水平地傳播以少量遙遠的轉移。相反, acinar, 堅實, 和mucinous 腺癌傾向於顯示更加垂直的成長和延伸到腸牆壁、serosa, 和其它器官。臨床, 總, 和形態類型似貓的小腸腺癌與那是相似在狗。
小腸 短文的主要小腸 [i]帆柱細胞瘤形成[/i]是三最共同的似貓的小腸腫瘤在淋巴瘤和腺癌以後。小腸帆柱細胞腫瘤被區分比皮膚帆柱細胞腫瘤。小腸通常是受影響的並且損害可能是孤零零或多, 1 到7 cm 直徑, 企業分裝式thickenings 肚腑。多數貓有可發現的腹腔內大量由或觸診或幅射線照相的考試辨認。腹膜流出、熱病, 和溫和的貧血症也許是著名。貓頻繁地有一致肝並且脾臟介入和腹膜流出可能發生。小腸MCT 同普遍傳播聯繫在一起和運載一種粗劣的預測。不同於脾臟MCT.s, 小腸MCT.s 不同一周邊mastocytosis 聯繫在一起。轉移對腸繫膜淋巴結和肝臟是共同, 被脾臟、肺, 和骨髓跟隨。地方淋巴結的切片檢查法被推薦提供出現或缺乏變形的疾病。由於流通的帆柱細胞也許被觀察在食道疾病, 正面buffy 外套汙跡的意義在這種特殊疾病必須小心地被解釋。多數動物或死或是euthanized 在診斷以後。如果手術是可行的, 寬外科邊際, 包括5 到10 cm 正常腸接近和末端對腫瘤被推薦。Ranitidine (1 到2 mg/kg 口頭q12h) 應該被執行跟隨小腸MCT 診斷的確認。類皮質激素應該被扣壓直到14 天崗位手術保證充分癒合enterotomy 站點。
診斷
體格檢查也許顯露胃腸大量、變厚的腸圈, 或腸繫膜lymphadenopathy 。多數狗與colorectal 腺癌有可能palpated 通過數字式直腸考試的直腸大量。肺轉移很少被查出在胸部射線照相。Proctoscopy 或colonoscopy 應該總執行從事數字式直腸考試辨認另外的腫瘤接近對直腸。對比幅射線照相的研究, 特殊enteroclysis, 可以顯露黏膜反常性或阻礙損害。Ultrasonography 是一套可貴的診斷器械, 也許顯露腸變厚, 地方化的腸塞痛, 或擴大的腸繫膜淋巴結。最共同的反常性在hemogram 和清液生物化學的外形是貧血症和hypoproteinemia, 和被舉起的清液肝酵素含量。
明確的診斷由小腸切片檢查法通常做通過celiotomy 或內窺鏡檢察。小心必須行使當診斷小腸淋巴瘤通過內窺鏡檢察。在一些貓, 最初的切片檢查法被解釋作為激動腸疾病(lymphocytic plasmacytic 腸炎), 並且患者頻繁地顯示對飲食修改和糖皮質激素的療法的一個有利反應。這些患者最後變得加工困難對療法並且屍體檢驗顯露小腸淋巴瘤。它是不定的是否最初的損害代表了prelymphomatous 變動或是否它是錯誤的由於抽樣誤差。
治療
最共同的治療為孤零零小腸腫瘤是外科切除術以邊際至少4 cm 是目標。輔藥化療為小腸腺癌和leiomyosarcoma 被推薦了雖然這樣的治療效力未被報告在狗和貓。小腸淋巴瘤應該外科地被處理如果腫瘤同小腸阻礙或穿孔聯繫在一起。切片檢查法和印象汙跡為細胞學評估應該執行在毗鄰肚腑、淋巴結、脾臟, 和肝臟臨床演出疾病。散開小腸淋巴瘤應該被處理以系統化療一旦診斷被證實了。
[i]腺瘤珊瑚蟲[/i] 是良性的pedunculated 出現從mucosa 和推出入流明的大量。直腸珊瑚蟲最共同地發生在直腸和下降的冒號在狗, 但是他們最共同地發生在貓的小腸。似犬直腸腫瘤的百分之五十顯示了轉折從良性polypoid 損害與腺癌在一項研究。直腸珊瑚蟲被報告的似貓的事例的百分之五十是在亞洲祖先貓。直腸 [i]腺瘤珊瑚蟲[/i] 也許是pedunculated 或有一個sessile 基地。多數珊瑚蟲是在2 cm 之內肛門, 也許由外科切除、electrosurgery, 或cryosurgery 對待。直腸珊瑚蟲在莖可能被刺穿以ligature 和基地結冰以cryoprobe 。有切除直腸腫瘤的幾個外科技術。各種各樣的技術譬如端到端接合(通常要求一骨盆osteotomy 為通入), 直腸拉扯通過, 或背部直腸方法被描述了。病態和必死同直腸腫瘤底線的外科切除術困難聯繫在一起在決定怎麼處理這些腫瘤。地方切除和cryosurgery 為冒號的腺癌顯著延長狗生活比較外科治療其它方法, 然而82% (9/11 狗) 對待了以cryosurgery 遭受的複雜化(直腸prolapse 、非難、perineal 疝氣, 和再現) 。Electrosurgery 也許是一個可實行的治療選擇當腫瘤不環型和被找出末端上促進直腸的prolapse 。預測為完全地被切除的直腸珊瑚蟲優秀, 雖然大或sessile 珊瑚蟲可能再發生。
狗與 [i]大腸或直腸腺癌[/i] 是通常euthanatized 由於地方失敗由疏忽體現控制dyschezia 和hematochezia 。臨床標誌聯繫了轉移未被觀察在78 條狗與被證實的colorectal 腺癌。在其它研究, 狗以外科地被處理的小腸癌有6.9 月卑鄙生存以地方再現是euthanazia 的原因。狗與唯一, pedunculated, polypoid 腺癌損害有32 個月卑鄙生存, 那些與節狀或鵝卵石像損害有12 個月的卑鄙生存時光, 並且狗以環型大量導致非難有1.6 月的卑鄙生存時光。高藥量放射療法看上去有效為直腸和肛門的末端一半的減輕的腺癌。直腸脫出與逗留縫合並且射線由一個錐體制約區域大約1 cm 大於總可看見的腫瘤的直徑。預測為小小腸腺癌是窮的由於先進的疾病當診斷的時候。卑鄙生存隨後而來的手術是大約七個月, 雖然二或更多年生存被報告了。
表1: 化療協議為貓和狗以食道淋巴瘤 [table][tr][td=1,1,285][b]Chlorambucil 和強體松協議[/b] [b]為貓[/b]
[/td][td=1,1,475][/td][/tr][tr][td=1,1,285]Chlorambucil
[/td][td=1,1,475]2 毫克(1 種片劑每貓) PO 每4-5 天
[/td][/tr][tr][td=1,1,285]強體松
[/td][td=1,1,475]5 毫克q12h 為貓生活的剩餘
[/td][/tr][tr][td=1,1,285][/td][td=1,1,475][/td][/tr][tr][td=1,1,285][b]COAP 協議[/b]
[/td][td=1,1,475][/td][/tr][tr][td=1,1,285]Cyclophosphamide
[/td][td=1,1,475]50 mg/m2 PO 4 天每星期或每隔一天8 個星期
[/td][/tr][tr][td=1,1,285]Vincristine
[/td][td=1,1,475]0.7 mg/m2 IV 每週一次8 個星期
[/td][/tr][tr][td=1,1,285]胞嘧啶arabinoside
[/td][td=1,1,475]100 mg/m2 IV 或SC q12h 4 天
[/td][/tr][tr][td=1,1,285]強體松
[/td][td=1,1,475]40-50 mg/m2 PO q24h 七天; 然後20-25 mg/m2 PO 每隔一天七個星期; 在貓用途5 毫克裡q12h 為剩餘貓生活
[/td][/tr][tr][td=1,1,285][b]警察協議[/b]
[/td][td=1,1,475][/td][/tr][tr][td=1,1,285]Cyclophosphamide
[/td][td=1,1,475]50 mg/m2 PO 4 天每星期或每隔一天8 個星期
[/td][/tr][tr][td=1,1,285]Vincristine
[/td][td=1,1,475]0.7 mg/m2 IV 每週一次8 個星期
[/td][/tr][tr][td=1,1,285]強體松
[/td][td=1,1,475]40-50 mg/m2 q24h PO 七天; 然後20-25 mg/m2 PO 每隔一天七個星期; 在貓用途5 毫克裡q12h 為剩餘貓生活
[/td][/tr][tr][td=1,1,285][b]Adriamycin 協議[/b]
[/td][td=1,1,475][/td][/tr][tr][td=1,1,285]Adriamycin (doxorubicin)
[/td][td=1,1,475]30 mg/m2 IV 每3 個星期為狗或20 mg/m2 為貓(不要超出240 mg/m2 共計); 或1 mg/kg IV 每3 個星期為小狗和貓
[/td][/tr][tr][td=1,1,285][b]L Asp VCAP 協議[/b]
[/td][td=1,1,475][/td][/tr][tr][td=1,1,285]L-asparaginase
[/td][td=1,1,475]10,000 IU/kg IP 在天一個療法
[/td][/tr][tr][td=1,1,285]Vincristine
[/td][td=1,1,475]0.7 mg/m2 IV 每個星期4 個星期, 然後每3 個星期
[/td][/tr][tr][td=1,1,285]Cyclophosphamide
[/td][td=1,1,475]250 mg/m2 PO 在星期7, 13, 16, 和22 療法
[/td][/tr][tr][td=1,1,285]Adriamycin
[/td][td=1,1,475]30 mg/m2 在星期10 和19
[/td][/tr][tr][td=1,1,285]強體松
[/td][td=1,1,475]40-50 mg/m2 q24h PO 七天; 然後20-25 mg/m2 PO 每隔一天七個星期; 在貓用途5 毫克裡q12h 為剩餘貓生活
[/td][/tr][/table]Although gastrointestinal (GI) neoplasms account for approximately 2% of all canine and feline neoplasms, the clinical signs associated with GI neoplasms are essentially the same as those associated with inflammatory or obstructive diseases of these organs. The most common clinical signs are related to the 𢘫ass effect?of the tumor with clinical manifestations depending on the site of the tumor within the intestinal tract. Gastric tumors are typically associated with chronic vomiting, weight loss, and inappetence. Tumors of the duodenum, jejunum, and ileum are associated with vomiting, diarrhea (melena), and weight loss, whereas tumors of the colon are associated with tenesmus and hematochezia. The clinical signs may result from metastatic lesions to the liver, spleen, mesenteric lymph nodes, and central nervous system, producing signs such as icterus, abdominal hemorrhage, and seizures. Cats may present with pale mucous membranes and have microcytic anemia secondary to chronic blood loss. It is important to remember that not all nodular lesions of the gastrointestinal tract are neoplastic. Differentials include granulomas from inflammatory bowel disease, FIP, fungal infections, or foreign body penetration.
Gastric Adenocarcinoma
The most common tumor of the stomach in dogs is gastric adenocarcinoma. Other gastric tumors diagnosed less commonly include leiomyoma/leiomyosarcoma, lymphoma, and adenoma. A male predominance has been reported and a strong breed predilection is present for Belgian Shepherds (in Italy) and Rough Collies. Gastric tumors are rare in cats and lymphoma predominates.
Behavior
Gastric adenocarcinomas often metastasize, particularly to the perigastric lymph nodes and viscera. Most tumors extend to or through the serosa from the mucosa, creating deep ulcers with hematemesis and melena.
Diagnosis
Abdominal palpation may reveal a large gastric mass (adenocarcinoma) or a diffusely thickened gastric wall (lymphoma). Plain abdominal radiographs and/or positive-contrast radiographs may reveal thickening of the gastric wall, absence of rugal folds, filling defects, or an intraluminal mass. Ultrasonographic examination of the abdominal cavity may reveal additional masses or metastases to the liver and spleen. The diagnosis is confirmed by means of a gastric biopsy procured either via endoscopy or during an exploratory laparotomy. Most carcinomas occur in the lower two thirds of the stomach, particularly the pylorus. Thoracic radiographs should always be performed prior to surgical resection of gastric tumors because up to 30% of dogs with gastric carcinoma can have visible metastatic lung lesions on initial presentation.
Treatment
The prognosis for gastric adenocarcinomas is poor because of the advanced stage at diagnosis, their diffuse nature, and their high rate of metastases. Most tumors are nonresectable because of their size or invasiveness. Most dogs die within four months of surgery from local recurrence or metastases despite wide resection (Billroth I procedure). Results of chemotherapy for adenocarcinoma have not been reported.
Gastrointestinal Lymphoma
Unlike the dog, gastric adenocarcinoma in the cat is rare, and the stomach is the least commonly affected gastrointestinal site in the cat. Lymphoma is the most common gastric tumor in the cat and may be solitary or one component of systemic involvement. Most cats with gastric lymphoma are negative for feline leukemia virus.Intestinal lymphoma has two morphologic forms; a diffuse type and a nodular type. Diffuse lymphoma is characterized by extensive infiltration of the lamina propria and submucosa with neoplastic lymphocytes that may cause malabsorption, steatorrhea, diarrhea, and weight loss. The nodular form causes a segmental thickening of the bowel, most often in the ileocolic region, with resultant luminal narrowing and partial intestinal obstruction. Metastasis to regional lymph nodes is common with both forms of the disease. Gastric lymphoma in cats is rarely confined to the stomach and is best treated with adjuvant systemic chemotherapy. The prognosis for cats with gastric lymphoma is extremely variable with treated cats having survival times ranging from less than two months to more than one year. Adjuvant chemotherapy (Table 1) is also recommended following surgical excision of a solitary lymphomatous mass
TABLE 1: Chemotherapy Protocols for Cats and Dogs with Gastrointestinal Lymphoma [table][tr][td=1,1,285][b]Chlorambucil and Prednisone Protocol[/b] [b]for Cats[/b]
[/td][td=1,1,475][/td][/tr][tr][td=1,1,285]Chlorambucil
[/td][td=1,1,475]2 mg (1 tablet per cat) PO every 4-5 days
[/td][/tr][tr][td=1,1,285]Prednisone
[/td][td=1,1,475]5 mg q12h for the rest of the cats life
[/td][/tr][tr][td=1,1,285][/td][td=1,1,475][/td][/tr][tr][td=1,1,285][b]COAP Protocol[/b]
[/td][td=1,1,475][/td][/tr][tr][td=1,1,285]Cyclophosphamide
[/td][td=1,1,475]50 mg/m2 PO 4 days a week or every other day for 8 weeks
[/td][/tr][tr][td=1,1,285]Vincristine
[/td][td=1,1,475]0.7 mg/m2 IV once a week for 8 weeks
[/td][/tr][tr][td=1,1,285]Cytosine arabinoside
[/td][td=1,1,475]100 mg/m2 IV or SC q12h for 4 days
[/td][/tr][tr][td=1,1,285]Prednisone
[/td][td=1,1,475]40-50 mg/m2 PO q24h for seven days; then 20-25 mg/m2 PO every other day for seven weeks; in cats use 5 mg q12h for rest of cats life
[/td][/tr][tr][td=1,1,285][b]COP Protocol[/b]
[/td][td=1,1,475][/td][/tr][tr][td=1,1,285]Cyclophosphamide
[/td][td=1,1,475]50 mg/m2 PO 4 days a week or every other day for 8 weeks
[/td][/tr][tr][td=1,1,285]Vincristine
[/td][td=1,1,475]0.7 mg/m2 IV once a week for 8 weeks
[/td][/tr][tr][td=1,1,285]Prednisone
[/td][td=1,1,475]40-50 mg/m2 q24h PO for seven days; then 20-25 mg/m2 PO every other day for seven weeks; in cats use 5 mg q12h for rest of cats life
[/td][/tr][tr][td=1,1,285][b]Adriamycin Protocol[/b]
[/td][td=1,1,475][/td][/tr][tr][td=1,1,285]Adriamycin (doxorubicin)
[/td][td=1,1,475]30 mg/m2 IV every 3 weeks for dogs or 20 mg/m2 for cats (do not exceed 240 mg/m2 total); OR 1 mg/kg IV every 3 weeks for small dogs and cats
[/td][/tr][tr][td=1,1,285][b]L-Asp-VCAP Protocol[/b]
[/td][td=1,1,475][/td][/tr][tr][td=1,1,285]L-asparaginase
[/td][td=1,1,475]10,000 IU/kg IP on day one of therapy
[/td][/tr][tr][td=1,1,285]Vincristine
[/td][td=1,1,475]0.7 mg/m2 IV every week for 4 weeks, then every 3 weeks
[/td][/tr][tr][td=1,1,285]Cyclophosphamide
[/td][td=1,1,475]250 mg/m2 PO on week 7, 13, 16, and 22 of therapy
[/td][/tr][tr][td=1,1,285]Adriamycin
[/td][td=1,1,475]30 mg/m2 on week 10 and 19
[/td][/tr][tr][td=1,1,285]Prednisone
[/td][td=1,1,475]40-50 mg/m2 q24h PO for seven days; then 20-25 mg/m2 PO every other day for seven weeks; in cats use 5 mg q12h for rest of cats life
[/td][/tr][/table][/size]

minibabyqq 2007-1-3 10:40 PM

轉貼自4682

[color=Magenta][size=5][b]藥物和肝臟病 [/b][/size][/color]

Drugs and Liver Disease   


肝臟是許多藥物新陳代謝主要站點因此臨床工作者關注確實執行藥物安全對患者與肝疾病。肝疾病可能修改藥物的生物相容性和性格並且影響藥物的藥物學作用。例如, 重大肝官能不良可能減少反潰瘍藥物omeprazole 的第一通行證作用, 增加系統地可利用的藥物和延長行動的它的期間。肝臟病也許並且影響pro-drugs 新陳代謝譬如cyclophosphamide 入活躍代謝產物。
藥物的改進的作用在有肝臟病病人主要歸結於被減少的藥物新陳代謝。幸運地, glucuronidation, 油脂可溶解藥物代謝在狗的一個共同的方法, 看來是相對地未受影響的由肝疾病。依靠反之肝血流、蛋白質捆綁, 和內在肝清除藥物的肝排除被肝清除和肝提取影響。為某種藥物譬如心得安, 肝排除的率被肝血流影響但他們是厚臉皮的對變化在肝新陳代謝上。lignocaine 清除由粗劣的肝灌注並且延長(即, 在心力衰竭, 在震動, 和以心得安管理) 。
為其它藥物, 譬如苯甲二氮卓、phenylbutazone 、prednisolone 、茶鹼和腸潰藥, 變化在肝新陳代謝上但不是變化在肝血流上將影響肝排除。但是, 為許多藥物, 肝疾病的作用在藥物性格複雜和難預言。
不幸地, 在獸醫實驗室醫學, 沒有可能使用預言巨大變化在藥物上肝清除肝臟官能不良的令人滿意的索引。總之, 當執行由肝臟廣泛地代謝譬如benzodiazepines 、NSAIDs 和opioids 對有肝臟病病人劑量間隔時間的藥物應該被延長。的有一個狹窄的治療索引) 的用途對巴比土酸鹽和幾種細胞毒素的藥物(譬如cyclophosphamide 、dacarbazine 、thiotepa 和l.asparaginase 應該被避免在有肝臟病病人。
為有高的血漿蛋白質捆綁和被肝臟主要地清除的藥物, 肝臟病會被預計增加藥物的發行的容量和減少藥物清除。但是, 被減少的蛋白質束縛由於被減少的白蛋白水平與相關先進的肝疾病也許實際上增加肝清除和因此補嘗被減少的肝新陳代謝(如果這發生□) 。增加的清液球蛋白水平也許發生在激動肝疾病或當肝網狀內皮組織的系統減弱。在這些情況, 增加的蛋白質捆綁可能發生為某種基本的藥物譬如lignocaine 由於深刻階段蛋白質的增加的生產。
主要被消滅在膽汁藥物的藥量應該被減少在有重大膽固醇沉著病病人特別如果藥物有一個狹窄的治療窗口(即, digitoxin) 。雖然只大約15% digoxin 代謝在肝臟, 膽管的結紮術增加它的半衰期從平均26 個小時到35 個小時在實驗性狗。
應該潛在地積累在肝疾病, 也許導致毒力的抗菌藥物, 包括氯胺苯醇、lincosamides 、大環內酯、metronidazole 、磺胺和四圜素。
被報告直接地導致肝毒力在狗的藥物包括primidone 、phenobarbitone (很少), rifampin, 和三氮二烯伍圓antifungals 譬如ketoconazole 。Lignocaine 腸外地被執行因為它由肝臟廣泛地代謝對毒性代謝產物如果口頭給。
是否對某些藥物的用途應該被避免在動物中經驗肝臟官能不良是有爭議的。最後, 它取決於是否那種藥物導致毒力以集中緊挨治療集中(即, 那些藥物以一個低治療索引) 並且是否其它可利用的藥物是適當的選擇。
具體藥物被使用在肝臟病的管理
Ursodeoxycholic 酸(Ursodiol)
臨床應用。 Ursodeoxycholic 酸是自然發生的膽汁酸被發現在中國黑熊的膽汁。黑熊膽汁被使用了許多年由東部醫學的實習者和是商業被綜合和可利用的至於使用作為一個hepatoprotective 代理在日本從30 年代。從70 年代, ursodeoxycholic 酸被使用了在西部人的醫學為膽結石的溶解。最近, ursodeoxycholic 酸被使用了在慢性肝疾病的管理在人譬如主要膽汁肝病、膽汁疾病次要對囊狀纖維變性, 非酒精steatohepatitis 、先天慢性肝炎、自動免疫的肝炎、主要硬化膽管炎, 和酒精肝炎。但是, 它的治療效力在這些混亂牢固地未建立。
在獸醫方面, ursodeoxycholic 酸被使用了在狗的管理與慢性肝炎和貓以lymphocytic plasmacytic 膽管炎。它認為是最有利的在膽汁毒力充當一個重要角色在持續的病理學裡的混亂。ursodeoxycholic 酸效力在獸醫患者確定地未建立雖然逸事報告建議它也許有某一好處在有慢性激動hepatobiliary 疾病病人。它也許是某一好處在減慢疾病進步特別是如果使用在疾病的早期。一些作者推薦ursodeoxycholic 酸治療為所有貓與extrahepatic 膽汁阻礙被消滅了的cholangiohepatitis 。
行動機制。 Ursodeoxycholic 酸減少小腸吸收和壓制膽固醇肝綜合和存貯。這應該減少膽汁的膽固醇飽和和膽固醇包含的gall 石頭的因此允許可溶化。它有少許作用在鈣化的膽結石或在radiolucent 膽汁顏料石頭和療法是只成功的在患者與一個功能膽囊。Ursodeoxycholic 酸, 相對地親水膽汁酸, 並且應該保護肝臟免受疏水膽汁酸的殘損的作用, 被保留在cholestatic 混亂。hepatoprotective 作用可以然而, 是較少在貓和狗比在人因為主要流通的膽汁酸在狗和貓是taurocholate 。這比主要流通的膽汁酸親水和較不hepatotoxic 在人。ursodeoxycholic 酸的免疫調節的作用由B 淋巴細胞應該介入被減少的免疫球蛋白生產, 被減少的interleukin-1 和interleukin-2 生產由T 淋巴細胞, hepatocyte 細胞表面膜HLA 組I 分子被減少的hepatocyte 糖皮質激素的感受器官的表示和可能刺激。
藥量率。狗和貓: 10.15 mg/kg q24h 或分開的和指定的q12h 。它建議, ursodeoxycholic 酸被執行3.4 月在之後患者應該被再評價為在hepatocellular 病理學生物化學的標誌的改善。如果有是改善, 治療繼續, 但如果有是沒有改善或進步, 或者治療應該被終止或另外的療法譬如glucocorticoids 或秋水僊素增加。
不利影響。 Ursodeoxycholic 酸看上去由狗和貓很好容忍; 嘔吐和腹瀉很少被報告。有一些關心在人的患者, 牛磺酸取盡也許由慢性治療增強與ursodeoxycholic 酸。這也許是重要在是強制牛磺酸conjugators 的貓。在牛磺酸取盡的這潛力也許被惡化在增加了牛磺酸被共軛的膽汁酸的泌尿排泄的一些貓以hepatobiliary 疾病。狗是較不可能成為牛磺酸由這個機制耗盡因為他們能轉移到氨基乙酸結合。Ursodeoxycholic 酸不應該被使用在患者與額外肝膽汁阻礙、膽汁fistulas 、膽汁或胰腺炎。
秋水僊素
臨床應用。秋水僊素被使用在痛風的管理在人提供症狀深刻安心並且預防。在獸醫方面, 它被使用了在amyloidosis 和慢性肝纖維變性的管理。受控臨床試驗缺乏但有是逸事證據從幾個專題研究秋水僊素也許改進肝功能和減慢肝纖維變性進步。
行動機制。 膠原分泌物從lipocytes 要求microtubles, 彙編由秋水僊素禁止, 因此干涉膠原的transcellular 運動。藥物增量collegenase 活動和也許因此促進現有的膠原的退化。它有抗發炎作用由禁止白血球migration.this 也許壓制fibrogenesis 。它也許並且有一個直接hepatoprotective 作用由穩定hepatocyte 膜。
藥量率。 藥量在狗被外推了從人的文學。它的用途在貓未被報告。秋水僊素被銷售與probenicid 的組合在某一countries.this 組合應該被避免作為probenecid 可能導致噁心, 嘔吐, 和慵倦。藥量: 0.025.0.03 mg/kg/day
不利影響。 由於有限的獸醫經驗與秋水僊素, 一點為人所知關於它潛在的毒力在狗和貓。
在人, 治療窗口為秋水僊素是相當狹窄的以毒性作用發生在唯一小藥劑過量以後。
噁心, 嘔吐和腹瀉被報告了在狗。
骨髓鎮壓發生□在人在長時期的用途之後。
Myopathy 和周邊神經病很少被報告了在人
嚴厲地方激怒發生如果藥物perivascularly 疏忽地被執行得。Thrombophlebitis 並且被報告了。
秋水僊素contraindicated 在有嚴肅腎臟, GI 或心臟病疾病病人, 應該小心地被使用在有較不這些器官嚴厲疾病病人。
秋水僊素是致畸物在老鼠和倉鼠; 因此, 它不應該被使用在懷孕患者除非好處勝過風險。
秋水僊素也許減少精子發生。
安全對護理出生不滿一月的嬰兒是未知的, 照原樣不為人所知是否它排泄在牛奶裡。
NSAIDs, 特別是phenylbutazone 增量thrombocytopenia 、白血球減少症或骨髓鎮壓風險當使用在秋水僊素的同時
許多antineoplastic 和其它潛在地骨髓壓制藥物也許導致疊加性myelosuppression 當使用在秋水僊素的同時。
青黴胺
青黴胺不是青黴素退化產品但有抗菌活動。1953 年它第一次被隔絕了從一名病人的尿有接受青黴素的肝臟病
臨床應用。 青黴胺是被使用在獸醫方面在銅存貯治療hepatopathy 的monothiol 結為螯合物的代理(即, Bedlington 狗), 主角毒力, 和胱氨酸urolithiasis 。它並且被使用了在類風濕病的關節炎的管理在人。
行動機制。 青黴胺結為螯合物幾種金屬包括銅、主角、鋼, 和水銀, 形成renally 排泄的穩定的水溶複合體。它與胱氨酸化工並且結合形成穩定, 可溶解, 欣然排泄的複合體。雖然通常需要幾個月對幾年為肝銅水平對減退, 臨床改善經常看在Bedlington 狗在唯一幾個星期建議藥物有其它有利作用不同於銅取盡之後。青黴胺導致肝metallothionein, 也許束縛和隔離銅以無毒形式。它也許並且有antifibrotic 作用當它禁止lysyl oxidase, 酵素必要為膠原綜合和直接地束縛對膠原原纖維, 防止cross-linking 入穩定的膠原纖維。但是, 它的效力作為一個antifibrotic 代理在人是半信半疑的並且它未被評估在獸醫方面。青黴胺也許有免疫調節的作用和被展示減少IgM 類風濕病的因素在人以類風濕病的關節炎。但是, 行動它的機制在這種疾病依然是不定。
劑量和公式化。 為管理銅伴生hepatopathy, 10.15 mg/kg q12h PO 藥量被給在一個空的胃。但是, 如果GIT 不利影響是老練的, 這些也許被減少如果它被給用食物, 雖然吸收也許被減少。供選擇地, 減少藥量和逐漸加強充分的藥量。
有害反應:
GIT 不利影響是共同造成噁心和嘔吐。更小的藥量根據一個更加頻繁的依據也許緩和不利影響。供選擇地, 藥物可能被給用食物雖然這將減少吸收。
其它不利影響少有地被觀察或很少有:
  熱病。
  Lymphadenopathy 。
  皮膚過敏症反應。
  免疫複雜glomerulonephropathy 。
白血球減少症、發育不全的貧血症和中性粒細胞缺乏症被報告了在人

The liver is the major site of metabolism of many drugs hence the clinician is rightly concerned about the safety of administering drugs to patients with hepatic disease. Hepatic disease can alter the bioavailability and disposition of a drug as well as influence the pharmacological effects of the drug. For example, significant hepatic dysfunction can reduce the first pass effect of the anti-ulcer drug omeprazole, increasing the systemically available drug and prolonging its duration of action. Liver disease may also affect the metabolism of pro-drugs such as cyclophosphamide into active metabolites.
The enhanced effect of drugs in patients with liver disease is primarily due to decreased drug metabolism. Fortunately, glucuronidation, a common method by which lipid soluble drugs are metabolised in dogs, appears to be relatively unaffected by hepatic disease. Hepatic elimination of drugs is influenced by hepatic clearance and hepatic extraction that are in turn dependant on hepatic blood flow, protein binding, and intrinsic hepatic clearance. For some drugs such as propranolol, the rate of hepatic elimination is influenced by hepatic blood flow but they are insensitive to changes in hepatic metabolism. Clearance of lignocaine is also prolonged by poor hepatic perfusion (e.g., in heart failure, in shock, and with propranolol administration).
For other drugs, such as diazepam, phenylbutazone, prednisolone, theophylline and cimetidine, changes in hepatic metabolism but not changes in hepatic blood flow will affect hepatic elimination. However, for many drugs, the effects of hepatic disease on drug disposition are complex and difficult to predict.
Unfortunately, in veterinary laboratory medicine, there are no satisfactory indices of liver dysfunction that can be used to predict the magnitude of changes in hepatic clearance of drugs. In general, when administering drugs that are extensively metabolised by the liver such as benzodiazepines, NSAIDs and opioids to patients with liver disease the dosage interval should be prolonged. Use of barbiturates and several cytotoxic drugs (which have a narrow therapeutic index) such as cyclophosphamide, dacarbazine, thiotepa and l𠿟sparaginase should be avoided in patients with liver disease.
For drugs that have high plasma protein binding and are predominantly cleared by the liver, liver disease would be expected to increase the volume of distribution of the drug and decrease drug clearance. However, reduced protein binding due to reduced albumin levels associated with advanced hepatic disease may actually increase hepatic clearance and therefore compensate for reduced hepatic metabolism (if this is occurring). Increased serum globulin levels may occur in inflammatory hepatic disease or when the hepatic reticuloendothelial system is compromised. In these circumstances, increased protein binding can occur for some basic drugs such as lignocaine due to increased production of acute-phase proteins.
The dose of drugs that are primarily eliminated in bile should be reduced in patients with significant cholestasis particularly if the drug has a narrow therapeutic window (e.g., digitoxin). Although only about 15% of digoxin is metabolized in the liver, bile duct ligation increases its half-life from an average of 26 hours to 35 hours in experimental dogs.
Antimicrobial drugs that are believed to potentially accumulate in hepatic disease and may cause toxicity, include chloramphenicol, lincosamides, macrolides, metronidazole, sulphonamides and tetracyclines.
Drugs that have been reported to directly cause hepatic toxicity in dogs include primidone, phenobarbitone (rarely), rifampin, and triazole antifungals such as ketoconazole. Lignocaine is administered parenterally because it is extensively metabolized by the liver to toxic metabolites if given orally.
Whether the use of certain drugs should be avoided in animals experiencing liver dysfunction is controversial. Ultimately, it depends on whether that drug leads to toxicity at concentrations close to therapeutic concentrations (i.e., those drugs with a low therapeutic index) and whether other available drugs are suitable alternatives.
Specific drugs used in the management of liver disease
Ursodeoxycholic acid (Ursodiol)
Clinical applications. Ursodeoxycholic acid is a naturally occurring bile acid found in the bile of the Chinese black bear. Black bear bile has been used for many years by practitioners of Eastern medicine and has been commercially synthesised and available for use as a hepatoprotective agent in Japan since the 1930s. Since the 1970s, ursodeoxycholic acid has been used in Western human medicine for dissolution of gallstones. More recently, ursodeoxycholic acid has been used in the management of chronic hepatic diseases in humans such as primary biliary cirrhosis, biliary disease secondary to cystic fibrosis, nonalcoholic steatohepatitis, idiopathic chronic hepatitis, autoimmune hepatitis, primary sclerosing cholangitis, and alcoholic hepatitis. However, its therapeutic efficacy in some of these disorders has not been firmly established.
In veterinary medicine, ursodeoxycholic acid has been used in the management of dogs with chronic hepatitis and cats with lymphocytic plasmacytic cholangitis. It is believed to be most beneficial in disorders where bile toxicity plays an important role in the ongoing pathology. The efficacy of ursodeoxycholic acid in veterinary patients has not been definitely established although anecdotal reports suggest it may have some benefit in patients with chronic inflammatory hepatobiliary disease. It may be of some benefit in slowing disease progression especially if used at an early stage of the disease. Some authors recommend ursodeoxycholic acid treatment for all cats with cholangiohepatitis where extrahepatic biliary obstruction has been eliminated.
Mechanism of action. Ursodeoxycholic acid decreases intestinal absorption and suppresses hepatic synthesis and storage of cholesterol. This is believed to reduce cholesterol saturation of bile and thereby allowing solubilization of cholesterol-containing gall stones. It has little effect on calcified gallstones or on radiolucent bile pigment stones and therapy is only successful in patients with a functional gall bladder. Ursodeoxycholic acid, a relatively hydrophilic bile acid, is also believed to protect the liver from the damaging effects of hydrophobic bile acids, which are retained in cholestatic disorders. The hepatoprotective effect may however, be less in cats and dogs than in humans as the major circulating bile acid in dogs and cats is taurocholate. This is more hydrophilic and less hepatotoxic than the major circulating bile acids in humans. The immunomodulatory effects of ursodeoxycholic acid are believed to involve decreased immunoglobulin production by B lymphocytes, decreased interleukin-1 and interleukin-2 production by T lymphocytes, decreased expression of hepatocyte cell surface membrane HLA class I molecules and possibly stimulation of the hepatocyte glucocorticoid receptor.
Dose rate.Dogs and cats: 10?5 mg/kg q24h or divided and given q12h. It is recommended that ursodeoxycholic acid be administered for 3? months after which the patient should be reassessed for improvement in biochemical markers of hepatocellular pathology. If there has been improvement, treatment is continued, but if there has been no improvement or progression, either treatment should be terminated or additional therapies such as glucocorticoids or colchicine added.
Adverse effects. Ursodeoxycholic acid appears to be well tolerated by dogs and cats; vomiting and diarrhoea are reported rarely. There is some concern in human patients that taurine depletion may be potentiated by chronic treatment with ursodeoxycholic acid. This may be important in cats that are obligate taurine conjugators. This potential for taurine depletion may be exacerbated in some cats with hepatobiliary disease that have increased urinary excretion of taurine-conjugated bile acids. Dogs are less likely to become taurine depleted by this mechanism as they can shift to glycine conjugation. Ursodeoxycholic acid should not be used in patients with extra-hepatic biliary obstruction, biliary fistulas, cholecystitis or pancreatitis.
Colchicine
Clinical applications.Colchicine is used in the management of gout in humans providing acute relief of symptoms as well as prophylaxis. In veterinary medicine, it has been used in the management of amyloidosis and chronic hepatic fibrosis. Controlled clinical trials are lacking but there has been anecdotal evidence from a few case studies that colchicine may improve liver function and slow the progression of hepatic fibrosis.
Mechanism of action. Collagen secretion from lipocytes requires microtubles, the assembly of which is inhibited by colchicines, thereby interfering with the transcellular movement of collagen. The drug increases collegenase activity and therefore may promote degradation of existing collagen. It has anti-inflammatory effects by inhibiting leukocyte migration鍟his may suppress fibrogenesis. It may also have a direct hepatoprotective effect by stabilising hepatocyte membranes.
Dose rate. Doses in dogs have been extrapolated from the human literature. Its use in the cat has not been reported. Colchicine is marketed in combination with probenicid in some countries鍟his combination should be avoided as probenecid can cause nausea, vomiting, and lethargy.?Dose: 0.025?.03 mg/kg/day
Adverse effects. Because of the limited veterinary experience with colchicine, little is known about its potential toxicity in dogs and cats.
In humans, the therapeutic window for colchicine is quite narrow with toxic effects occurring after only small overdoses.
Nausea, vomiting and diarrhoea have been reported in dogs.
Bone marrow suppression has occurred in humans after prolonged use.
Myopathy and peripheral neuropathy has been reported rarely in humans
Severe local irritation occurs if the drug is inadvertently administered perivascularly. Thrombophlebitis has also been reported.
Colchicine is contraindicated in patients with serious renal, GI or cardiac disease and should be used with caution in patients with less severe disease of these organs.
Colchicine is teratogenic in mice and hamsters; therefore, it should not be used in pregnant patients unless the benefits outweigh the risks.

minibabyqq 2007-1-3 10:43 PM

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[color=Magenta][size=5][b]溶血貧血症診斷[/b][/size][/color]

Diagnosis of Hemolytic Anemias   


紅血球正常生活間距平均為大約100.120 天在狗和70.78 天在貓。加速的紅血球破壞是主要機制在溶血混亂和充當在許多其它共同的貧血症的較小角色。
紅血球破壞也許發生或額外或intravascularly 。血管外的hemolysis 是主要形式和假設是衰老的紅血球的破壞方式在健康動物。血管外的破壞提到erythrophagocytosis 由脾臟、肝臟, 和骨髓的巨噬細胞。
在貧血症旁邊的一般標誌譬如pallor 和弱點, hemolysis 的典型標誌是黃疸和pigmenturia 。黃疸首先被讚賞在黏膜(齒齬和sclera) 當清液膽紅素水平超出2 mg/dl, 但是皮膚變得治療黃疸用只以更高的膽紅素含量。hemolysis 的更加溫和和慢性形式不可以同黃疸聯繫在一起。Pigmenturia 由hemolysis 造成也許歸結於hyperbilirubinuria 和hemoglobinuria 。看來不是一恆定發現的Hyperbilirubinuria 堅持在狗以溶血混亂, 但是在貓。Hemoglobinuria 和hemoglobinemia 是血管內的hemolysis 標記特點和經常表明更加嚴厲的混亂。因而, 溶血貧血症是再生和macrocytic-hypochromic, 雖然在非常早期和在一些複雜的被獲取的形式erythroid 反應也許是窮的。紅血球的過份破壞也許發生或由於一個內在瑕疵在細胞或由於外在因素的行動在正常紅血球。內在瑕疵一般被繼承並且外在部分被獲取。
被繼承的紅血球瑕疵
幾個遺傳性紅血球瑕疵被描述了在狗並且貓和新資訊有湧現的過去十年。繼承方式是autosomal 隱性為所有被描述的紅血球瑕疵, 除似貓的porphyria 之外, 被繼承作為一個統治特徵。他們代表一個大異種小組混亂並且大多數相對地很少發生。但是, 通過近親繁殖實踐(普遍的陛下, 線養殖) 某些紅血球瑕疵變得共同在某些養殖。除非受影響的養殖相關緊密地, 疾病由同樣基因的不同的變化可能造成。多數紅血球瑕疵導致帶領從溫和補償威脅生命的溶血貧血症的溶血混亂。準確實驗室試驗現在有時間為許多紅血球瑕疵查出受影響並且載體動物。遺傳性紅血球混亂被分類了入三個小組:
1 。   Heme 瑕疵(porphyria) 並且hemoglobinopathies 。
2 。   膜反常性包括stomatocytosis 和增加的滲透的脆弱。
3 。   Erythroenzymopathies 譬如Phosphofructokinase (PFK) 並且丙酮酸鹽Kinase (PK) 缺乏。
免疫斡旋的溶血貧血症
免疫斡旋的溶血貧血症(IMHA) 出現當一個免疫反應目標直接或間接紅血球和溶血貧血症接著而來, 和起因於一次故障在免疫自已容忍。紅血球的免疫破壞被IgG 或IgM 抗體捆綁和補全創始對紅血球表面。在主要IMHA, 指使起因無法被辨認, 因而同義詞先天IMHA 或自動免疫的溶血貧血症。相反, 次要IMHA 同一個部下的情況聯繫在一起或由代理觸發。另外, alloimmune 溶血貧血症譬如似貓的出生isoerythrolysis 和溶血滲流反應由anti-erythrocytic alloantibodies 造成。IMHA 是溶血貧血症的最共同的原因在狗。基因素質被建議在也許代表40% 所有狗的美國斗雞家Spaniels 。在其它似犬養殖, 素質是較不好提供和也許地理上變化。和以其它免疫混亂, 母狗出現輕微地事先安排好, 既使當spayed 。在IMHA 的最近研究中, 一臺部下的疾病過程或觸發器能被辨認包括藥物和感染, 造形術並且其它免疫混亂。在babesiosis 和hemobartonellosis, hemolysis 看上去由免疫過程誇大。許多慢性傳染包括膿腫、discospondylitis 、pyometra, 和腎盂腎炎可能導致次要免疫混亂包括IMHA 。一個世俗協會在IMHA 之間接種和起始並且被建議了。因為這種交互作用同修改過的和被殺死的疫苗聯繫在一起反對共同的傳染病從不同的製造商, 可能看起來, 疫苗也許觸發或提高一個悶燃的免疫過程而不是是根本原因。IMHA 的更高的速率在更加溫暖的月期間從5月通過8月報告了在一些研究中, 但不是其他人, 也許並且建議感染起因包括滴答作響出生混亂。這季節性也許地理上變化。IMHA 的協會以其它免疫混亂, 包括甲狀腺機能不足和免疫斡旋的thrombocytopenia (ITP), 借支持對一個一般免疫干擾的假說。如果IMHA 和ITP 一致地發生, 這為人所知當Evans. 綜合症狀。
IMHA 的臨床標誌
IMHA 也許提出在任一年齡, 但最共同地遇到在年輕成人對中年狗。臨床歷史一般是簡要和隱晦的。一個部下的情況也許被辨認。嘔吐或腹瀉情節也許在貧血症(慵倦、弱點、鍛煉不寬容, pallor) 並且hemolysis 之前(pigmenturia, icterus 的) 典型的標誌。一些動物也許熱性, 據推測歸結於紅血球病勢漸退或一個部下的疾病過程。其他人開發呼吸困難表明肺問題或作為部下的疾病或作為IMHA 的thromboembolic 複雜化。體格檢查也許共同地並且顯露溫和的脾大和, 較少, 溫和的hepatomegaly 和lymphadenopathy, 再建議IMHA 的次要起因。此外, 標誌可歸屬對他們部下的疾病也許佔優勢, 但是IMHA 的慢性或週期性標誌建議一個主要形式。
定期實驗室試驗結果
貧血症可能是溫和的對生活威脅並且血流比容計也許險峻地滴下在介紹以後由於活躍hemolysis 。雖然再生macrocytic-hypochromic 貧血症會被期望, 多達IMHA 所有案件的三分之一是non-regenerative 在介紹。疾病路線也許是太深刻的, 不允許時刻為對登上的一個再生反應。供選擇地, 抗體也許被指揮反對erythroid 前體或IMHA 疾病過程也許改變骨髓的小環境和因此削弱紅血球生成。無效的紅血球生成和erythrophagocytosis 的證據也許被發現在骨髓的cytologic 考試中aspirate 。紅血球的Autoagglutination 和spherocytosis 是典型的研究結果在血液汙跡。
在erythroid 反常性旁邊, 白血球增多經常是存在, 可能超出100,000/μl 主要由於一成熟neutrophilia 。由於高白細胞計數一般不遇到以貧血症, 這可能反射獨特的激動和cytokine 反應具體為IMHA, 但伴隨傳染和類固醇導致的白血球增多應該並且被考慮。因而, erythroid 和myeloid 細胞增生也許是存在在骨髓。此外, thrombocytopenia 由於伴隨ITP (Evans. 綜合症狀) 或DIC 也許發生。
清液分析一般顯露hyperbilirubinemia; 上述10 mg/dl 的清液膽紅素含量同一種嚴重預測聯繫在一起。但是, 清液膽紅素價值也許輕微地只被增加在慢性案件, 據推測由於高度高效率和加速的膽紅素新陳代謝。因而, 高清液膽紅素價值也許還表明一伴隨hepatopathy 。實際上, 狗與IMHA 經常增加了清液肝臟酵素在類固醇療法以前。Hyperbilirubinuria 被期望和以其他溶血貧血症; 在貓, 任一程度bilirubinuria 被認為重要, 但是巨額膽紅素一般是存在在狗尿。那裡也許並且是一細菌膀胱炎的證據, 也許表明部下的傳染病或也許發生次要地由於immunoderegulation 或免疫抑制的療法。
各種各樣的想像研究也許被表明顯露部下的疾病IMHA 的過程, 譬如瘤形成, 和複雜化。thromboemboli 的證據也許被查出在胸口射線照相和胃腸超聲波並且在導尿管站點。
診斷實驗室試驗結果
IMHA 診斷必須展示紅血球的加速的免疫破壞。因而, 在提供溶血貧血症旁邊, 查尋在抗體或補全或兩個被指揮反對紅血球必需, 即, 一個或更多以下三個標記之後必須是存在到達IMHA 一個明確的診斷:
1 。   明顯的spherocytosis 。
2 。   真實的autoagglutination 。
3 。   正面直接Coombs. 測試。
Spherocytosis
Spherocytes 是看上去microcytic 沒有中央pallor 的球狀紅血球。他們起因於或部份吞噬作用或病勢漸退和是剛性和極端易碎的在紅血球滲透的脆弱測試。由於spherocytes 丟失了一些膜, 他們沒有任何儲備擴展在低壓的解答。很大數量的spherocytes 是存在在狗中的大約三分之二與IMHA, 但小數字也許也看以hypophosphatemia 、鋅醉, 和microangiopathic hemolysis 。
Autoagglutination
Anti-erythrocytic IgM 和, 大量地, IgG 抗體也許導致直接autoagglutination 。Autoagglutination 也許是可看見的對肉眼當血液(在低血流比容計) 是在EDTA 管或被安置在一個載玻片(宏觀膠合) 或也許變得明顯當小叢紅血球在被弄髒的血液汙跡或在鹽弄濕登上(微觀膠合) 。Autoagglutination 必須是卓越的從紅血球堆積在彼此頂部的rouleaux 形成。為未經說明的原因, 似犬紅血球有一個傾向空泛地凝集在血漿面前在更冷的溫度。混合一滴血液與一下落鹽不能破壞這個膠合的空泛的形式。它, 因此, 重要確定是否膠合堅持在被命名了真實的autoagglutination 的saline 洗滌物以後。這由增加完成三次生理學鹽解答來血液管在上層清液以後重覆的離心法和撤除包括血漿。
直接Coombs 。測試
直接Coombs. 測試, 亦稱直接antiglobulin 測試, 被使用查出抗體並且/或者補全在紅血球表面當反紅血球抗體力量或集中太降低(subagglutinating 的滴定量) 以至於不能導致自發autoagglutination 。所謂的incomplete. 抗體在紅血球, 與特定種類的antiglobulins 一起反對IgG 、IgM 和C3b (Coombs 試劑), 允許抗體跨接和從而上漆的紅血球膠合並且/或者病勢漸退。分開的IgG 、IgM 和C3b, 並且多價Coombs. 試劑, 是可利用的為狗和貓。他們增加以各種各樣的集中在洗滌patient.s 紅血球以後免於血漿。混合物一般被孵化在37.C, 和然後被分離, 並且上層清液和藥丸分析對於hemolysis 和膠合, 各自地。直接Coombs. 測試的表現在更冷的溫度(4.C 和20.C) 很少被表明, 因為冷的凝集素和hemolysins 很少是足夠強的和激活在幾乎正常的體溫(30.C) 很少導致疾病。冷的凝集素和hemolysins 臨床重要一般是IgM 抗體在非常高滴定量以到達30.C. 的熱量高度由於同樣紅血球洗滌物做法至於為真實的autoagglutination 測試和Coombs. 反應的終點紅血球被使用在直接Coombs. 測試膠合和病勢漸退, 真實的autoagglutination 阻止一個直接Coombs. 測試的表現。
正面直接Coombs. 測試結果被報告作為+1 到+4 或以導致膠合並且/或者病勢漸退Coombs. 試劑的稀釋的形式。Coombs. 反應的力量不一定預言hemolysis 嚴肅。為了到達IMHA 一個明確的診斷, 直接Coombs. 測試應該是正面的, 然而, 這不歧視在主要和次要IMHA 之間。狗以消極Coombs. 測試結果應該被複評為其它溶血貧血症的起因。但是, 狗的一個小比例也許有IMHA, 儘管一種消極Coombs. 測試結果。假消極Coombs. 測試結果也許發生由於一定的抗體和許多技術原因的不足的數量(不適當的試劑或稀釋) 。消極結果也看在疾病是釋免, 然而, 幾天免疫抑制的療法可能不會扭轉測試結果的動物中。實際上, 被對待的動物也許長期仍然有正面Coombs. 測試結果在溶血貧血症以後被解決。假正面Coombs. 測試結果只很少發生, 即, 在不相容的滲流以後或由於技術問題。
傳染伴生的Hemolysis
溶血貧血症也許顯現出在對幾個寄生, 細菌和病毒代理的暴露由於傳染的代理或它的產品的直接行動在紅血球。少量rickettsial 和原生動物的有機體是能直接地傳染紅血球和導致嚴厲溶血貧血症。其它傳染物質也許間接地導致與其它主要臨床標誌一起一個溶血組分。因而, 任一傳染也許觸發體液抗體的生產反對主人紅血球, 並且與一個被激活的補全和吞噬細胞的系統一起, 紅血球破壞的率也許明顯加速。此外, 在細菌(即, 螺旋體、紡錘狀細菌屬、鏈球菌, 葡萄球菌) 敗血症期間, 具體hemolysins 可能被生產和結果在溶血貧血症。
化學製品和物理導致的溶血貧血症
許多化合物包括化學藥劑、藥物、和食物組分和添加劑可能導致對紅血球的氧化損傷導致溶血貧血症。許多這些代理是芳香有機化合物衍生物。在某些情況下, 化學製品作為一個氧化代理, 但經常, 化合物或它的代謝產物與氧氣相處融洽形成自由基和過氧化物。Extracellularly 被生產的氧化劑膜受傷, 但是氧化劑細胞內引起了攻擊血紅蛋白並且膜結構。因而, 一個唯一代理也許給予紅血球傷害, 從而hemolysis 和被減少的氧氣交付對組織由一或所有三:
1 。   heme 鋼的氧化作用造成methemoglobin 生產。
2 。   血紅蛋白的氧化變性導致Heinz 身體形成。
3 。   膜損傷導致被削弱的deformability 和離子運輸。
嚴厲hypophosphatemia 導致hemolysis 在狗和貓同糖尿病mellitus 聯繫在一起、肝lipidosis, 和主要hyperparathyroidism 並且以enteral 和腸外hyperalimentation (飢餓refeeding 綜合症狀) 並且phosphate-binding 抗酸劑的口服。在胰島素期間, (ketoacidotic) 糖尿病動物的流體和重碳酸鹽治療, 磷酸鹽價值在血漿險峻地declines 。Hypophosphatemia 發生由於細胞內磷酸鹽轉移、改進的腎臟損失, 和磷酸鹽的被減少的小腸吸收。除myopathy 和心臟病和神經學官能不良之外, 深刻溶血貧血症, 為一種迅速下落在PCV 和溫和的血管內的病勢漸退和Heinz 身體形成描繪被觀察在動物中與hypophosphatemia 。在臨床實踐hemolysis 發生以< 2.5 mg/dl 的磷酸鹽價值。hypophosphatemia 導致的貧血症的發病原理可能與被減少的erythrocytic deformability 和增加的滲透的脆弱有關並且感受性對氧化傷害。
那導致細胞破碎和內部並且血管外的hemolysis 情況的大品種也許造成對紅血球的物理損傷。在水醉的情況下由於近淹沒在淡水裡, 紅血球接受低壓的紅血球病勢漸退相似與膨脹和病勢漸退在 體外 滲透的脆弱測試。中風和嚴厲燒傷能給予熱量傷害對紅血球。心臟瓣膜疾病並且心血管植入管和靜脈內導尿管可能導致對紅血球的機械損傷儘量dirofilariasis, 特別以caval 綜合症狀的形式。另外, 其它內皮細胞的損傷由脈管炎造成、hemangiosarcoma 和其它腫瘤、各種各樣的脾臟疾病或扭力, 和肝臟病可能傷害紅血球。溶血尿毒症的綜合症狀為急性腎衰竭、小片活化作用導致thrombocytopenia 和血栓形成, 和microangiopathic 溶血貧血症描繪最近被描述了在狗。同樣, 傳播的血管內的凝固同破碎hemolysis 聯繫在一起。microangiopathic hemolysis 診斷, 經常是臨床症狀不顯的和很少只導致公開血管內的溶血貧血症, 由辨認做觸發的情況和schistocytes (shizocytes 的) 描述特性。這些紅血球片段出現在血液汙跡像小, 殘廢, 經常三角或盔甲形狀的結構。Schistocytes 是重要在小數字, 無法由粗劣的血液汙跡準備製造。

The normal life span of erythrocytes averages approximately 100?20 days in dogs and 70?8 days in cats. Accelerated erythrocyte destruction is the major mechanism in hemolytic disorders and plays a minor role in many other common anemias.
Erythrocyte destruction may take place either extra- or intravascularly. Extravascular hemolysis is the predominant form and assumed to be the mode of destruction of senescent erythrocytes in healthy animals. Extravascular destruction refers to erythrophagocytosis by macrophages of the spleen, liver, and bone marrow.
Beside the general signs of anemia such as pallor and weakness, characteristic signs of hemolysis are jaundice and pigmenturia. Jaundice is first appreciated on mucous membranes (gingiva and sclera) when the serum bilirubin level exceeds 2 mg/dl, whereas the skin becomes icteric only at higher bilirubin concentrations. Milder and chronic forms of hemolysis may not be associated with jaundice. Pigmenturia caused by hemolysis may be due to hyperbilirubinuria and hemoglobinuria. Hyperbilirubinuria persists in dogs with hemolytic disorders, whereas in cats that appears not to be a constant finding. Hemoglobinuria and hemoglobinemia are hallmark features of intravascular hemolysis and often indicate a more severe disorder. Thus, hemolytic anemias are regenerative and macrocytic-hypochromic, although in the very early stages and in some complicated acquired forms the erythroid response may be poor. Excessive destruction of erythrocytes may occur either because of an intrinsic defect in the cell itself or because of the action of extrinsic factors on normal erythrocytes. Intrinsic defects are generally inherited and the extrinsic ones are acquired.
Inherited Erythrocyte Defects
Several hereditary erythrocyte defects have been described in dogs and cats and much new information has emerged over the past decade. The mode of inheritance is autosomal recessive for all described erythrocyte defects, with the exception of feline porphyria, which is inherited as a dominant trait. They represent a large heterogeneous group of disorders and most of them occur relatively rarely. However, through inbreeding practices (popular sire, line breeding) certain erythrocyte defects have become common in certain breeds. Unless the affected breeds are closely related, the disease is likely caused by different mutations of the same gene. Most erythrocyte defects cause hemolytic disorders that lead from mild compensated to life-threatening hemolytic anemia. Accurate laboratory tests are now available for many erythrocyte defects to detect affected as well as carrier animals. Hereditary erythrocyte disorders have been classified into three groups:
1.   Heme defects (porphyria) and hemoglobinopathies.
2.   Membrane abnormalities including stomatocytosis and increased osmotic fragility.
3.   Erythroenzymopathies such as Phosphofructokinase (PFK) and Pyruvate Kinase (PK) deficiency.
Immune-Mediated Hemolytic Anemia
Immune-mediated hemolytic anemia (IMHA) arises when an immune response targets directly or indirectly erythrocytes and hemolytic anemia ensues, and results from a breakdown in immune self-tolerance. Immune destruction of erythrocytes is initiated by the binding of IgG or IgM antibodies and complement to the surface of erythrocytes. In primary IMHA, no inciting cause can be identified, thus the synonyms idiopathic IMHA or autoimmune hemolytic anemia. In contrast, secondary IMHA is associated with an underlying condition or triggered by an agent. In addition, alloimmune hemolytic anemias such as feline neonatal isoerythrolysis and hemolytic transfusion reactions are caused by anti-erythrocytic alloantibodies. IMHA is the most common reason for hemolytic anemias in dogs. A genetic predisposition is suggested in American Cocker Spaniels that may represent up to 40% of all dogs. In other canine breeds, predisposition is less well documented and may vary geographically. As with other immune disorders, female dogs appear slightly predisposed, even when spayed. In recent studies of IMHA, an underlying disease process or trigger could be identified including drugs and infectious, neoplastic as well as other immune disorders. In babesiosis and hemobartonellosis, hemolysis appears exaggerated by immune processes. Many chronic infections including abscesses, discospondylitis, pyometra, and pyelonephritis can induce secondary immune disorders including IMHA. A temporal association between vaccination and onset of IMHA has also been suggested. As this correlation was associated with modified and killed vaccines against common infectious diseases from different manufacturers, it appears likely that vaccines may trigger or enhance a smoldering immune process rather than be the underlying cause. The higher rate of IMHA during the warmer months from May through August reported in some studies, but not others, may also suggest an infectious cause including tick-born disorders. This seasonality may vary geographically. The association of IMHA with other immune disorders, including hypothyroidism and immune-mediated thrombocytopenia (ITP), lends support to the hypothesis of a general immune disturbance. If IMHA and ITP occur concurrently, this is known as Evans?syndrome.
Clinical Signs of IMHA
IMHA may present at any age, but is most commonly encountered in young adult to middle-aged dogs. The clinical history is generally brief and vague. An underlying condition may be identified. An episode of vomiting or diarrhea may precede the typical signs of anemia (lethargy, weakness, exercise intolerance, pallor) and hemolysis (pigmenturia, icterus). Some animals may be febrile, presumably due to erythrocyte lysis or an underlying disease process. Others develop dyspnea indicating pulmonary problems either as the underlying disease or as a thromboembolic complication of IMHA. Physical examination may also reveal mild splenomegaly and, less commonly, mild hepatomegaly and lymphadenopathy, which again suggest a secondary cause of IMHA. Furthermore, signs attributable to their underlying disease may predominate, whereas chronic or recurrent signs of IMHA suggest a primary form.
Routine Laboratory Test Results
The anemia can be mild to life threatening and the hematocrit may precipitously drop after presentation due to active hemolysis. Although a regenerative macrocytic-hypochromic anemia would be expected, as many as one-third of all cases of IMHA are non-regenerative on presentation. The disease course may have been too acute, not yet allowing time for a regenerative response to mount. Alternatively, antibodies may be directed against erythroid precursors or the IMHA disease process may change the microenvironment of the bone marrow and thereby impair erythropoiesis. Evidence of ineffective erythropoiesis and erythrophagocytosis may be found on cytologic examination of a bone marrow aspirate. Autoagglutination of erythrocytes and spherocytosis are typical findings on blood smears.
Beside erythroid abnormalities, a leukocytosis is often present and can exceed 100,000/μl mostly due to a mature neutrophilia. Because high white blood cell counts are not generally encountered with anemia, this likely reflects a unique inflammatory and cytokine response specific for IMHA, but concomitant infection and steroid-induced leukocytosis should also be considered. Thus, hyperplasia of erythroid and myeloid cells may be present in the bone marrow. Furthermore, thrombocytopenia due to a concomitant ITP (Evans?syndrome) or DIC may occur.

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[color=Magenta][size=5][b]溶血貧血症的管理 [/b][/size][/color]


Management of Hemolytic Anemias   


由於IMHA 嚴肅範圍從疏懶對威脅生命的疾病, 療法必須被剪裁為各名患者和依靠一部分, 是否IMHA 主要或次要。部下的情況的觸發的代理或治療的撤除可能使IMHA 在控制之下。因而, 在次要IMHA 案件由於傳染, antiprotozoal, antirickettsial 或抗藥性療法應該被設立。由於部下的隱密傳染潛力和素質對傳染從immunoderegulation 聯繫了IMHA 並且免疫抑制的療法, 抗藥性療法一般被表明。另外, 膿腫的外科更正和傳染其它站點也許被考慮。非本質藥物, 特別那些能潛在地導致免疫反應, 應該立刻被撤出。儘管這些干預, 滲流和免疫抑制的療法是可能必需在次要IMHA 最初的控制。
在低氧症的情況下標誌由於嚴厲貧血症和一個滴下的血流比容計, 被包裝的紅血球滲流是有利的。增加的氧氣運載的容量被提供transfused 細胞也許是充足贍養動物為少數天必需為其它治療形式開始有效。概念, 滲流是特別危害的在動物中與IMHA 由最近回顧展研究過分強調了和不支持。因為anti-erythrocytic 抗體在IMHA 不是alloantibody, 破壞transfused 細胞是沒有更加高級比autologous 紅血球。但是, autoagglutination 也許阻礙, 在RBC 洗滌物以後, 準確血液鍵入的和crossmatching 的測試; 因而, 唯一DEA 1.1 陰性血液應該是transfused 在狗。如果兼容血液不是可利用的, 最近糧食與藥物管理局批准的遲鈍的血紅蛋白解答可能被執行和提供增加的氧氣運載的容量和血漿擴展。相反, 氧氣吸入療法是少許好處, 除非動物遭受肺病譬如肺thromboemboli 。由於充分滲流支持, 動物與IMHA 很少死由於貧血症, 但由於巨大hemolysis 和次要複雜化譬如thromboembolism 和傳染。
主要目標在IMHA 的治療集中於控制免疫反應由減少吞噬作用、補全活化作用, 和anti-erythrocytic 抗體生產。Glucocorticosteroids 是選擇的最初的治療為IMHA 。他們干涉巨噬細胞Fc 感受器官的表示和作用和從而立刻削弱抗體上漆的紅血球清除由巨噬細胞系統。另外, glucocorticosteroids 也許減少程度抗體捆綁和補全活化作用在紅血球, 和在幾星期之後, 減少自身抗體的生產。口頭強體松或prednisolone 在1.2 mg/kg 藥量每日兩次是中流砥柱治療。供選擇地, 口頭或腸外dexamethasone 在0.6 mg/kg 日報equipotent 藥量可能被使用, 但是可能更加有利的。反應由一個被穩定的甚至上升的血流比容計、一適當的reticulocytosis 、較少autoagglutination, 和spherocytosis 反射可能被期望在天之內。因為glucocorticosteroid 療法同知名的副作用聯繫在一起, 最初的藥量將由減少然後逐漸變細數額由三分之一每七到十天。在幾星期之內, 一種低藥量供選擇的天療法也許被到達以最小的類固醇副作用。
在次要IMHA 以部下的疾病的適當的控制, 逐漸變細可能更加迅速地被完成。由於食道潰瘍潛力由類固醇, 治療與misoprostol (4.8 μg/kg q6h PO), 禁止胃酸分泌物的一個綜合性 類似物前列腺素E 1, 腸潰藥(5.10 mg/kg q6-12h PO), 和sucralfate 也許被考慮。儘管明顯補救依照由到達判斷一個正常血流比容計, 特殊動物與主要IMHA 也許繼續有一個正面Coombs. 測試幾星期對幾個月, 能明顯地復發。這樣復發和最初地被使用一樣也許由治療控制, 但每隔一天留下動物在一種強體松療法幾個月的一個更加逐漸的逐漸變細的政權也許被使用。
其它免疫抑制的療法被擔保當強體松失敗, 只有控制疾病在堅持地大劑量, 或起因不能接受的副作用。他們被使用與強體松一起但一般也許獨立地最終被使用。歷史上, 細胞毒素的藥物是一增加。Cyclophosphamide, 一個烷基化的和有力myelosuppressive 代理, 主張了在fulminate 盒IMHA 。但是, 一次最近被隨機化的有限的預期試驗比較強體松對強體松和cyclophosphamide 的組合沒有發現任何cyclophosphamide 的有利作用在IMHA 的深刻管理。回顧展研究與cyclophosphamide 並且/或者azathioprine, 抗代謝物, 是相似地失望的。這些細胞毒素的藥物禁止淋巴細胞和因此壓制反紅血球抗體生產在幾星期之內。這些代理是, 因此, 可能不有效在IMHA 的深刻管理, 但願有一個地方在加工困難和復發的案件長期控制。合理的養生之道為狗也許每隔一天包括或cyclophosphamide 在2 mg/kg 或azathioprine 在2 mg/kg q24h/EOD 。除這些細胞毒素的藥物之外的強的myelosuppressive 作用導致reticulocytopenia 、嗜中性白細胞減少症, 和thrombocytopenia, cyclophosphamide 可能導致一種不育的出血性的膀胱炎和次要瘤形成。因而, 風險對好處比率應該仔細地被考慮當使用這些藥物。
最近, 幾個其它免疫抑制的代理被使用了根據一個有限的依據在契合與強體松並且逸事成功被報告了在狗和人。作為所有這些代理干涉抗體行動並且巨噬細胞作用, 他們能得出更加直接的作用。Cyclosporine, 一個昂貴但有力免疫抑制的代理最常用在防止貪佔rejection 和貪佔對主人疾病在移植患者, 也許是有利的在控制免疫反應在狗與IMHA 。5-10 mg/kg 藥量養生之道q24h 也許最初地被使用, 但血液集中應該階段性地被監測達到一個有效但安全水平。Leflunamide 是在代理相似的組作為cyclosporine 和被使用了在幾個案件以逸事成功。Danazol, 一種雄激素衍生物, 在10 mg/kg 藥量q24h 也許禁止抗體和吞噬作用捆綁。但是, 一項回顧展研究在狗與IMHA 在danazol 效力是失望的; 此外, danazol 是昂貴的, 也許hepatotoxic 。
靜脈內人的免疫球蛋白(IVIG) 也許短期是狗的有用的治療與IMHA, 雖然行動它的方式依然是未解決。IVIG 可能阻攔Fc 感受器官在巨噬細胞, 因此減少IgG 上漆的紅血球Fc 斡旋的吞噬作用, 干涉補全行動, 和壓制抗體生產。人的IVIG 束縛對似犬淋巴細胞和monocytes, 和禁止紅血球吞噬作用。0.5.2 g/kg 的注入IVIG 作為分開的藥量在二連貫天是有利的在一些加工困難的案件依照由一上升的PCV 和reticulocytosis 表明在天之內, 但反應經常是只臨時的。逸事, plasmapheresis 並且被使用了作為一種輔藥療法。
脾切除術也許被考慮在沒有強體松和其它免疫抑制的療法, 必需的長期大劑量療法保留釋免, 或遭受難處理的藥物副作用的IMHA 患者。脾臟是自身抗體生產一個主要站點並且紅血球的隔離和破壞給套上外套按IgG, 但可能不影響IgM 上漆的細胞清除。另外, 脾臟的histologic 考試也許提供一種部下的疾病的證據。對脾切除術的反應依然是被確定在動物中。有立刻開發巨大傳染崗位脾切除術和系統細菌傳染一種輕微的風險隨後。所以, 脾切除術不應該執行與免疫抑制的療法一起除強體松之外。
Thrombemboli 和DIC 是對患者病態和必死很大地貢獻與IMHA 的獨特的嚴肅的複雜化。雖然發病原理依然是未知, venipuncture 、導尿管, 和glucocorticosteroid 療法代表預先處理情況。至今, 研究未提供任一個成功的預防並且/或者管理協議為這些威脅生命的hemostatic 問題在IMHA 。預先處理因素應該, 每當可能, 是組織的有限和充分灌注和oxygenation 應該帶有流體和滲流。通常, 抗凝劑療法被設立在有thromboemboli 一些證據或懷疑之後。肝素在100 IU/kg q6h SC 藥量或由連續的注入是最常用的藥物, 並且新鮮的結冰的血漿(10 mL/kg q12h) 也許被執行重新補充危險地低血漿antithrombin III 集中。其它複雜化可能與藥方有關。
儘管上述治療戰略的適當的實施, 死亡率依然是高; 實際上, 有印象, IMHA 的fulminate 形式今天更加頻繁地遇到。根據類型實踐(主要對三重), 死亡率從20.75% 被報告了。消極預斷顯示是迅速下落在PCV, 高的清液膽紅素水平、non-regenerative 貧血症、血管內的hemolysis 、autoagglutination, 和thromboembolic 複雜化。


Because the severity of IMHA ranges from indolent to life-threatening disease, therapy has to be tailored for each patient and depends in part, on whether the IMHA is primary or secondary. Removal of the triggering agent or treatment of the underlying condition can bring the IMHA under control. Thus, in cases of secondary IMHA due to infection, antiprotozoal, antirickettsial or antibiotic therapy should be instituted. Because of the potential of underlying occult infection and the predisposition to infection from immunoderegulation associated with IMHA and immunosuppressive therapy, antibiotic therapy is generally indicated. In addition, surgical correction of abscesses and other sites of infections may be considered. Non-essential drugs, particularly those that could potentially cause an immune reaction, should be withdrawn immediately. Despite these interventions, transfusion and immunosuppressive therapy are still likely required in the initial control of secondary IMHA.
In case of signs of hypoxia due to severe anemia and a dropping hematocrit, packed red blood cell transfusions are beneficial. The increased oxygen-carrying capacity provided by transfused cells may be sufficient to maintain the animal for the few days required for other treatment modalities to become effective. The notion that transfusions are especially hazardous in animals with IMHA has been overemphasized and is not supported by recent retrospective studies. As the anti-erythrocytic antibody in IMHA is not an alloantibody, the destruction of transfused cells is no higher than autologous erythrocytes. However, autoagglutination may hamper, even after RBC washing, accurate blood typing and crossmatching tests; thus, only DEA 1.1 negative blood should be transfused in dogs. If compatible blood is not available, the recently FDA-approved bovine hemoglobin solution can be administered and provides increased oxygen-carrying capacity and plasma expansion. In contrast, oxygen inhalation therapy is of little benefit, unless the animal is suffering from pulmonary disease such as pulmonary thromboemboli. Thanks to adequate transfusion support, animals with IMHA rarely die because of anemia, but because of overwhelming hemolysis and secondary complications such as thromboembolism and infection.
The main goal in the treatment of IMHA focuses on controlling the immune response by reducing phagocytosis, complement activation, and anti-erythrocytic antibody production. Glucocorticosteroids are the initial treatment of choice for IMHA. They interfere with both the expression and function of macrophage Fc receptors and thereby immediately impair the clearance of antibody-coated erythrocytes by the macrophage system. In addition, glucocorticosteroids may reduce the degree of antibody binding and complement activation on erythrocytes, and only after weeks, diminish the production of autoantibodies. Oral prednisone or prednisolone at a dose of 1? mg/kg twice daily is the mainstay treatment. Alternatively, oral or parenteral dexamethasone at an equipotent dose of 0.6 mg/kg daily can be used, but is likely not more beneficial. A response reflected by a stabilized or even rising hematocrit, an appropriate reticulocytosis, less autoagglutination, and spherocytosis can be expected within days. As glucocorticosteroid therapy is associated with well-known side effects, the initial dose will then be tapered by reducing the amount by one-third every seven to ten days. Within weeks, a low dose alternative day therapy may be reached with minimal steroid side effects.
In secondary IMHA with appropriate control of the underlying disease, the tapering can be accomplished more rapidly. Because of the potential of gastrointestinal ulceration by steroids, treatment with misoprostol (4? μg/kg q6h PO), a synthetic analog of prostaglandin E1 that inhibits gastric acid secretion, cimetidine (5?0 mg/kg q6-12h PO), and sucralfate may be considered. Despite an apparent recovery as judged by reaching a normal hematocrit, particularly animals with primary IMHA may continue to have a positive Coombs?test for weeks to months and could obviously relapse. Such relapses may be controlled by the same treatment as initially used, but a more gradual tapering regime may be used which leaves the animal on an every other day prednisone therapy for months.
Other immunosuppressive therapy is warranted when prednisone fails, only controls the disease at persistently high doses, or causes unacceptable side effects. They are generally used together with prednisone but may eventually be used independently. Historically, cytotoxic drugs were the first to be added. Cyclophosphamide, an alkylating and potent myelosuppressive agent, has been advocated in cases of fulminate IMHA. However, a recent randomized limited prospective trial comparing prednisone versus a combination of prednisone and cyclophosphamide did not find any beneficial effects of cyclophosphamide in the acute management of IMHA. Retrospective studies with cyclophosphamide and/or azathioprine, an anti-metabolite, were similarly disappointing. These cytotoxic drugs inhibit lymphocytes and thereby suppress the anti-erythrocyte antibody production within weeks. These agents are, therefore, likely not effective in the acute management of IMHA, but may have a place in the long-term control of refractory and relapsing cases. A reasonable regimen for dogs might include either cyclophosphamide at 2 mg/kg every other day or azathioprine at 2 mg/kg q24h/EOD. In addition to the strong myelosuppressive effects of these cytotoxic drugs leading to reticulocytopenia, neutropenia, and thrombocytopenia, cyclophosphamide can induce a sterile hemorrhagic cystitis and secondary neoplasia. Thus, the risk versus benefit ratio should be carefully considered when using these drugs.
Recently, several other immunosuppressive agents have been used on a limited basis in conjunction with prednisone and anecdotal success has been reported in dogs and humans. As all of these agents interfere with antibody action and macrophage function, they can elicit more immediate effects. Cyclosporine, an expensive but potent immunosuppressive agent most commonly used in preventing graft rejection and graft vs. host disease in transplant patients, may be beneficial in controlling the immune response in dogs with IMHA. A dose regimen of 5-10 mg/kg q24h may be used initially, but blood concentrations should be periodically monitored to achieve an effective but safe level. Leflunamide is in a similar class of agents as cyclosporine and has been used in a few cases with anecdotal success. Danazol, an androgen derivative, at a dose of 10 mg/kg q24h may inhibit binding of antibodies and phagocytosis. However, a retrospective study in dogs with IMHA on the efficacy of danazol was disappointing; furthermore, danazol is expensive and may be hepatotoxic.
Intravenous human immunoglobulin (IVIG) may be helpful in the short-term treatment of dogs with IMHA, although its mode of action remains unresolved. IVIG can block Fc receptors on macrophages, thereby reducing Fc-mediated phagocytosis of IgG-coated erythrocytes, interfere with complement action, and suppress antibody production. Human IVIG binds to canine lymphocytes and monocytes, and inhibits erythrocyte phagocytosis. A infusion of 0.5? g/kg IVIG as divided dose on two consecutive days has been beneficial in some refractory cases as indicated by a rising PCV and reticulocytosis within days, but the response has often been only temporary. Anecdotally, plasmapheresis has also been used as an adjuvant therapy.
Splenectomy may be considered in IMHA patients who failed prednisone and other immunosuppressive therapy, required long-term high dose therapy to remain in remission, or who suffered intractable drug side effects. The spleen is a major site of autoantibody production as well as sequestration and destruction of erythrocytes coated with IgG, but likely does not affect the clearance of IgM-coated cells. In addition, histologic examination of the spleen may provide evidence of an underlying disease. The response to splenectomy remains to be determined in animals. There is a slight risk of developing overwhelming infections immediately post-splenectomy and systemic bacterial infections subsequently. Therefore, splenectomy should not be performed along with immunosuppressive therapy other than prednisone.
Thrombemboli and DIC are unique serious complications that greatly contribute to the morbidity and mortality of patients with IMHA. Although the pathogenesis remains unknown, venipuncture, catheters, and glucocorticosteroid therapy represent predisposing conditions. Thus far, no study has documented any successful prevention and/or management protocol for these life-threatening hemostatic problems in IMHA. Predisposing factors should, whenever possible, be limited and adequate perfusion and oxygenation of tissue should be provided with fluids and transfusions. Generally, anticoagulant therapy is instituted only after there is some evidence or suspicion of thromboemboli. Heparin at a dose of 100 IU/kg q6h SC or by continuous infusion is the most commonly used drug, and fresh frozen plasma (10 mL/kg q12h) may be administered to replenish dangerously low plasma antithrombin III concentrations. Other complications are likely related to drug therapy.
Despite appropriate implementation of the above therapeutic strategies, the mortality rate remains high; in fact, there is an impression that the fulminate form of IMHA is more frequently encountered today. Depending on the type of practice (primary to tertiary), mortality rates from 20?5% have been reported. Negative prognostic indicators are rapid drop in PCV, high serum bilirubin levels, non-regenerative anemia, intravascular hemolysis, autoagglutination, and thromboembolic complications.
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