Prva pomoć - bolestan ljubimac, što da radim?

[Het]

Hvala
(budem pitala drugi put hehe)

[porga]

Het kaže:

Jel ti se da malo opsirnije oko toga, jako me zanima jer imam NJO, nije joj nista sad ali korisnih informacija nikad dosta za 'nedaj boze' situacije.

Hvala.

Perianal Fistula

BASIC INFORMATION

DEFINITION

A chronic, inflammatory disease of the tissues surrounding the anus of dogs. The lesions are painful, ulcerative, and sometimes deep and have draining tracts adjacent to the anus. The anus itself is not usually involved.

SYNONYM(S)

Anal furunculosis

EPIDEMIOLOGY

SPECIES, AGE, SEX: Dogs, usually >5 years old; males may be overrepresented.

GENETICS AND BREED PREDISPOSITION: German shepherds and possibly Irish setters are predisposed.

RISK FACTORS: Possibly broad-based tail, low tail carriage, and increased density of apocrine sweat glands in the perianal region.

ASSOCIATED CONDITIONS AND DISORDERS: Possibly caused by a food allergy; manifested as pruritus and/or signs of colitis.

CLINICAL PRESENTATION

HISTORY, CHIEF COMPLAINT: Initially, owners may notice a foul odor or observe that the dog licks its perianal region excessively. As the lesions progress, the dog may have dyschezia, hematochezia, tenesmus, and fecal incontinence; the dog may engage in self-mutilation. In severe cases, inappetence, lethargy, and weight loss are possible.

PHYSICAL EXAM FINDINGS: In mild to moderate cases, physical examination abnormalities are confined to the perianal region. In more severe cases, the dog may also be in poor body condition. Examination of the perianal region may be very difficult in these animals due to pain, and sedation is often necessary. Visual and rectal examinations are indicated:

* Visually, the lesions appear as multiple, ulcerated, draining tracts that may be superficial or extend deeply into the perianal tissues. The lesions may extend 360 degrees around the anus as well as involve the ventrum of the tail base.
* Upon rectal palpation, rectal strictures, loss of anal tone, anal sac rupture or abscessation, and/or roughened rectal mucosa may also be found.


ETIOLOGY AND PATHOPHYSIOLOGY


* An immunologic basis is suspected based on clinical improvement with immunosuppressive drugs as well as a few pathologic studies identifying sterile, chronic inflammatory changes.
* Secondary bacterial infection is common, often due to fecal microflora or skin contaminants.

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS


* Perianal neoplasia (anal sac adenocarcinoma)
* Anal sac abscessation/rupture
* Trauma (bite wounds)
* Perianal hernia (early phase of fistula, prior to ulcerated lesions)


INITIAL DATABASE


* Complete blood count (CBC), serum chemistry panel, and urinalysis: often within normal limits
* Abdominal radiographs: may show evidence of constipation


ADVANCED OR CONFIRMATORY TESTING


* Contrast radiography may be needed to better delineate the lesion in cases with rectal stricture because a colonoscopy may not be possible if the stricture is profound
* Colonoscopy/proctoscopy: may reveal inflammatory colitis (lymphoplasmacytic), rectal stricture


TREATMENT

THERAPEUTIC GOAL(S)


* Reduction in number and size of fistulae
* Control of infection
* Treatment of colitis, rectal stricture if present


ACUTE GENERAL TREATMENT


* Under sedation or general anesthesia: clipping of hair, removal of feces and debris, and cleansing of surrounding tissues.
* Enemas and stool softeners may be needed if constipation is present.


CHRONIC TREATMENT


* Immunosuppression is the initial therapy of choice:
o Cyclosporine: 80-90% success rate; expensive in larger dogs. Starting dose, using emulsion form (Atopica, Neoral): 3-5 mg/kg PO q 12h, adjusted to maintain whole blood trough cyclosporine levels 400-600 ng/ml. Adding ketoconazole (10 mg/kg PO q 24h) allows a reduction in cyclosporine dose to 1 mg/kg PO q 12h, with similar serum levels.
o Azathioprine (2 mg/kg PO q 24h, for 2 to 4 weeks, then tapered) may be an effective alternative.
o Prednisone alone (effective in ≤33% of animals): 2 mg/kg PO q 24h, for 2 to 4 weeks as needed for lesion improvement, then gradual taper to 0.5 mg/kg q 48h.
o Tacrolimus 0.1% topical, applied q 12-24h: resolution of lesions in 50% of dogs.
* Antimicrobials (e.g., cephalexin 22 mg/kg PO q 8-12h) are used as adjunct therapy for perianal dermatitis.
* Dietary therapy has been used in conjunction with immunosuppression. Novel antigen diets have been recommended becuase there is a suspected association with food hypersensitivity. Most important, animals should avoid high-fiber (bulking) diets, and owners should feed highly digestible diets that will result in a softer, smaller stool.
* Stool softeners (e.g., lactulose 0.25-0.5 ml/kg PO q 12h, titrated to stool consistency) as necessary to allow for easier defection.
* Surgery: if medical management does not resolve lesions to an acceptable degree. Use of an Nd:YAG laser and cryotherapy have been reported. Surgical procedures that may be needed include anal sacculectomy, removal of skin overlying the tracts, debridement of diseased tissue, and rectal pull-through for rectal strictures.
* Balloon dilation of rectal strictures is recommended as first line of therapy because surgical removal of strictures may result in recurrence of strictures or fecal incontence.


DRUG INTERACTIONS

Ketoconazole decreases the catabolism of cyclosporine and is given for this purpose

POSSIBLE COMPLICATIONS

* Recurrence of fistulae with discontinuation of immunosuppressive drugs
* Rectal stricture and constipation secondary to chronic inflammation
* Fecal incontinence secondary to chronicity or surgery


RECOMMENDED MONITORING


* Follow-up examinations of the perianal region every 2 weeks
* Whole blood trough cyclosporine levels
* CBC (risk of cytopenias if azathioprine is being used)


PROGNOSIS AND OUTCOME


* Fair to good prognosis with early treatment
* Long-term prognosis may be guarded with more severe lesions and the need for indefinite medical therapy


PEARLS & CONSIDERATIONS

COMMENTS

Most dogs will respond to medical management but may also require long-term therapy to maintain remission.

CLIENT EDUCATION

Advise clients on the clinical signs and lesions that warrant early intervention if lesions recur

SUGGESTED READING

Ellison GW, Bellah JR, Stubbs WP, van Gilder J: Treatment of perianal fistulas with Nd:YAG laser-Results in twenty cases. Vet Surg 24:140-147, 1995.

Harkin KR, Walshaw R, Mullaney TP: Association of perianal fistula and colitis in the German shepherd dog: Response to high-dose prednisone and dietary therapy. J Am Anim Hosp Assoc 32:515-520, 1996.

Mathews KA, Sukhiani HR: Randomized controlled trial of cyclosporine for treatment of perianal fistulas in dogs. J Am Vet Med Assoc 211:1249-1253, 1997.

Misseghers BS, Binnington AG, Mathews KA: Clinical observations of the treatment of canine perianal fistulas with topical tacrolimus in 10 dogs. Can Vet J 41:623-627, 2000.

Patricelli AJ, Hardie RJ, McAnulty JF: Cyclosporine and ketoconazole for the treatment of perianal fistulas in dogs. J Am Vet Med Assoc 220:1009-1016, 2002.

Tisdall PLC, Hunt GB, Beck JA, Malik R: Management of perianal fistulae in five dogs using azathioprine and metronidazole prior to surgery. Aust Vet J 77:374-378, 1999.

AUTHOR: LISA E. MOORE

EDITOR: DEBRA L. ZORAN

[porga]

PERIANAL FISTULA

About the Diagnosis

Perianal fistula is a disease of the tissues surrounding the anus. With perianal fistula, one or several draining tracts (open sores) develop in the skin directly around the anus. The sores are very painful and can be foul smelling. The condition tends to get progressively worse in affected dogs. German shepherds and Irish setters are the most frequently affected breeds, although the condition can occur in retrievers and spaniels as well. These breeds have broad-based tails or low tail carriage, and this body conformation is believed to contribute to the development of the disease. The main cause appears to be an autoimmune destruction of tissue in this area-the body's own immune system mistakenly identifies normal tissue as foreign and proceeds to attack and destroy it. In this case, the normal tissues surrounding the anus are misidentified and partially destroyed. Allergy to certain ingredients in foods may also play a role in development of perianal fistulas.

Early in the disease the only symptom may be persistent licking of the anal area. Other signs include straining to defecate, blood on the stools, discharge from the anal area, and constipation. The condition often is painful, such that the dog will usually not allow the tail to be lifted. A severely affected dog may be in such pain that it develops poor appetite, weight loss, and behavioral changes (e.g., aggression).

Because of the discomfort associated with the condition, your pet may need to be sedated for a thorough examination of the area. Diagnosis is made on the basis of the presence of specific lesions called draining tracts (deep sores) in the skin near the anus. Conditions with a similar appearance such as dog fight wounds, anal sac abscesses, and perianal tumors will be considered and evaluated your veterinarian. This sometimes requires a biopsy procedure for the submission of tissue for microscopic examination by a pathologist.

Living with the Diagnosis

Perianal fistulas are a chronic condition that can often be improved but rarely permanently eliminated. Treatment with medications (oral pills, wound care, etc.) may successfully control the condition, and lifelong treatment usually is necessary. Although surgery can improve this condition as well (removal of the affected tissue), the condition can reoccur after surgical treatment. It is also important to monitor affected dogs' vital functions, especially defecation. Some dogs with severe perianal fistulas that do not respond well to treatment are prone to developing problems with fecal incontinence or stricture (narrowing) of the anus. Considering the possibility of such complications but also the possibility of excellent control and an otherwise normal life, the long-term outlook for patients with perianal fistulas is guarded, and individual response to treatment varies substantially from one dog to the other.

TREATMENT

Treatment using medications only (no surgery) can control many cases of perianal fistula. First the area is thoroughly cleaned by your veterinarian while the dog is under anesthesia. Antibiotics often are prescribed to control an infection if one is present in the draining tract lesions. Orally-administered immunosuppressive drugs are used for controlling the underlying, immune-mediated basis of the disease. In addition, since a food allergy may be involved, a hypoallergenic diet should be fed, and specific types and ingredients should be reviewed with your veterinarian. Hypoallergenic diets on the market are not all hypoallergenic for all individuals, so selecting one is a careful issue that needs to be covered in detail during the veterinarian office visit to avoid choosing the wrong diet.

In severe cases or if the dog does not respond to medications and routine care, one of several surgical procedures can be used in an attempt to remove all diseased tissue. Possible complications of surgery are fecal incontinence due to damage to the muscles surrounding the anus, anal stricture due to scarring around the anus, and reoccurrence of the condition. In general, surgical approaches are falling out of favor as the benefits of immune-suppressive therapy become more and more clearly identified.

DOs

* Give all medications exactly as directed.
* Ask your veterinarian detailed information about how to properly wash your dog's hind end. This simple but critical aspect of treatment should not be painful to the dog or stressful to you. Points to be covered include what to use as a wash solution, what to use as a rinse, how often to do it, and what signs to watch for as reasons to stop.


DON'Ts


* If your dog has perianal fistulas, don't handle his/her tail if doing so seems painful.
* Don't expect a short course of treatment. Some dogs with perianal fistulas require ongoing treatment for the rest of their lives, whereas others have complete improvement and only occasionally experience relapses.


When to Call Your Veterinarian


* If your dog has not defecated in 24 hours or more. The pain of defecation in dogs with severe perianal fistula is such that they can become constipated, which leads to even greater pain when trying to pass stool. Therefore, if normal stools are not being passed, check for constipation.
* If your dog feels poorly (decreased appetite, sluggishness/lethargy, etc.). These symptoms can occur from complications of perianal fistulas (such as infection) or may be related to medication problems, requiring an adjustment.


Signs to Watch For


* Persistent licking of the anal area.
* Foul odor from the tail area.
* Straining to defecate.
* Fresh blood in the stools or dripping from under the tail.
* Reluctance to allow lifting of the tail due to pain.


Routine Follow-Up


* Dogs treated either with medications or surgery should be examined periodically to monitor the condition. Dogs taking immunosuppressive drugs need periodic monitoring for possible side effects of the medications.

__________________________________________________ ______________

Tekst je iz ove knjige.

[purpurna kiša]

i mojim malim mačičima su jako krmeljile oči i nosići su im bili uljepljeni i kihali su (ne svi). probali smo ispiranjem kamilicom, vodom, mlijekom, nekim kapima iz pet shopa, ali ništa nije dugotrajno pomagalo. na kraju je veterinar ustanovio da imaju herpes virus koji često napada male mace i koji se, ako se ne liječi, može pretvoriti u upalu pluća. isprao im je dobro okice i nosiće fiziološkom otopinom, dao - injekcije i stavljamo im kapi u oči. već su sutradan bili puno bolje, a sad tako lijepo bistro gledaju.

[Cobalt Chick]

[QUOTE=Pingvich;15469332]Neki vetovi kažu ne, neki da. Uglavnom, da ne kompliciramo i ne riskiramo, pola litre fiziološke je 12 kuna i traje 100 godina.
Da, postoji Tobrex kapi, ali meni se to ne sviđa - ukapaš, maca trepne i kap je vani. Meni je mast bila puno bolja.

Fiziološka kad se otvori traje 8 dana,a nakon toga nije više sterilna. Za kamilicu mi jemoj vet rekao ne, jer u nekim slučajevima može pojačati upalu

[lapdog]

Imam i ja isti problem.
Sinoć sam dobila na čuvanje 6 komada, jako malih, nađenih negdje odbačenih. Za sad im čistim oči blazinjicom namočenom u mlakoj vodi, da im skinem krmelje, i baš sam otprašila dragog u ljekarnu po mast.
Imam pitanje... Većina ima tako krmeljave, blago upaljene oči, ali nemaju svi, a kod ovih što imaju je u pitanju po jedno oko. Da im mažem samo to jedno, samo njima ili da na svih primjenim postupak, na sve okice, ako je ta "upalica" prenosiva da spiječim da se širi?

[b'elana]

lapdog kaže:

Imam i ja isti problem.
Sinoć sam dobila na čuvanje 6 komada, jako malih, nađenih negdje odbačenih. Za sad im čistim oči blazinjicom namočenom u mlakoj vodi, da im skinem krmelje, i baš sam otprašila dragog u ljekarnu po mast.
Imam pitanje... Većina ima tako krmeljave, blago upaljene oči, ali nemaju svi, a kod ovih što imaju je u pitanju po jedno oko. Da im mažem samo to jedno, samo njima ili da na svih primjenim postupak, na sve okice, ako je ta "upalica" prenosiva da spiječim da se širi?

Jako je prenosivo.

[lapdog]

A blago meni... Ništa, znači, mažem svih 12 očiju i pazim da nisu krmeljave? Svu ostalu brigu imaju, imam iskustva i totalno sam luda za malenima. Evo, radi mi radijator u kupaoni...

Ja se potrudim koliko god mogu oko njih, a dalje šta im bog da...

[lapdog]

Nakon 3x mazanja mašću i čišćenja okica, sve je u redu. Nakon cijele noći okice su bistre, širom otvorene, nema krmelja. Vjerojatno je ovo bio tek početak nekakve upale, pa je brza reakcija spriječila gore stanje. Mazat ću im još koji dan, za svaki slučaj, i vjerujem da je to to. Jupi!

[Pingvich]

Cobalt Chick kaže:

Fiziološka kad se otvori traje 8 dana,a nakon toga nije više sterilna. Za kamilicu mi jemoj vet rekao ne, jer u nekim slučajevima može pojačati upalu

Nije sterilna ni vatica sa kojom se čisti, pa što. Ne znači to da je prljava ili da je fiziološka 'pokvarena'.

[hellie]

kad kažu da fiziološka nije više sterilna misli se da se počnu bakterije množit. isto kao i kapi za oči nakon mjesec dana od otvaranja više nisu za upotrebu jer se bakterije počnu razvijati.
vatice bi trebale biti sterilne ako su u originalnom pakiranju ili prebačene u sterilnu posudu. najbolje bi bilo da maci zalije malo više oči sa fiziološkom i da onda samo suhom vaticom obriše višak. naravno da voda ne bi curila po svuda trebalo bi maci staviti vaticu malo ispod oka i naliti obilato fiziološkom i onda potapkati krmelje.
ali fiziološka ionaklo samo služi da se odlijepe krmelje i očiste ostaci kreme a sama krema je riješila upalu pa i nije tako strašno bitno da se pretrgne od sterilnosti.

[maria2]

Molim hitno da mi napišete svoja iskustva sa izraslinama na prednjim zglobovima. Izraslije su skoro veličine jajeta, meke - kao želatinaste. Zastrašujuće izgleda. Veterinar dao Heparin gel da mažemo kroz desetak dana i da dođemo na kontrolu. Inače veli da to nije bezazleno. Čak govori o mogućoj operaciji, ali ne garantira da nema mogućnosti da se to opet ponovi.
To se navodno često radi na prednjim zglobovima velikih pasa, od težine, pri sjedanju, jer je veliki pritisak na te zglobove. Navodno je to kao nekva nakupina vode. Užasnuta sam od straha. Molim da mi se jave ljudi koji su imali slična iskustva.

[Clearwater]

Kojim prednjim zglobovima? Jer ima njih više... ako je lakat, onda je to higrom lakta; Heparin ti tu neće pomoći.

[Tyndall]

S obzirom da se stalno ponavljaju teme tipa "bolesni mačak/pas/narval/whatever, što da radim" i slično, od sada sve vaše upite stavljate ovdje. Svaki otvoreni thread će biti spojen s ovim.

Naravno, prvi odgovor koji uvijek dobijete je da odete veterinaru.

Ponavljam,

Odite veterinaru!

Još jednom:

Prvo veterinaru, a onda na forum!

Odlično, sad kad smo to riješili možemo nastaviti.

S obzirom da ne mogu spojiti stare teme u ovu jer bi se pomiješali postovi, sve dosadašnje diskusije nastavite ovdje.
Kako to učiniti? Jednostavno, citirajte post iz stare teme koju želite nastaviti i kopirajte ga u odgovor ovdje i onda napišite svoj odgovor.

[Nemruth Dagi]

Imam malu macu staru oko 6 mjeseci. Jučer je počela grčiti prednje šapice te ih stavljati iza glave. Preplašena je ali joj se ne grče mišići na capama, nema pjene na ustima, normalno piški, to je pod kontrolom.
Nakon "napada" koji traje oko 10 sekundi teže, lejujavo hoda ali to traje kratko i brzo normalno prohoda i proskače. Inače se igra, jede, pije vodu...ima sjajno krzno...
Prema simptomima nije epilepsija, niti mačja sida....što je onda

Danas idemo kod veterinara....no zanima da li se netko od vas sreo sa takvim neurološkim simptomima u mačke???

[Clearwater]

Tjeranje?

[Nemruth Dagi]

Clearwater kaže:

Tjeranje?

Ne.

Mače je nađeno na cesti u jako lošem stanju, duplo je manje nego normalna mačka. Ne vjerujem da je to tjeranje...

[1234567]

Nemruth Dagi kaže:

Ne.

Mače je nađeno na cesti u jako lošem stanju, duplo je manje nego normalna mačka. Ne vjerujem da je to tjeranje...

Sta je rekao vet?


Imam i ja jedno pitanje (mada ne spada bas u ovu temu)

Imam macku koja ima 6 mjeseci (napunila prije neki dan) i kod mene u gradu ngdje nema da se kupi mljeko za mecke nego joj dajem obicno.
To mljeko sto joj ga dajem ima 2.8% udjela masti u sebi , ja sam ga do sada mjesao s vodom (pola/pola) , ali vidio sam da moja susjeda daje svojoj jednogodisnjoj macki mljeko od 3.1% ili 3.2% i macki nije nista.
Pa me zanima mogu li i ja svojoj davati mljeko bez mjesanja s vodom ???

p.s.> ovo oko mjesanja mljeka i vode pola/pola preporucila mi je neka veterinarka s nekog foruma kada je moja macka imala 2 mjeseca.

[Tyndall]

Mačke ne smiju piti kravlje mlijeko, ujebat će im probavu. Nikada, nikako.

Ili mlijeko za mačiće (a ako ima 6 mjeseci onda niti to) ili voda. U tvom slučaju, samo i isključivo voda.

Još jednom - Mačke ne smiju piti kravlje mlijeko! Jebeni Walt Disney i "narodna predaja".

[1234567]

Tyndall kaže:

Mačke ne smiju piti kravlje mlijeko, ujebat će im probavu. Nikada, nikako.

Ili mlijeko za mačiće (a ako ima 6 mjeseci onda niti to) ili voda. U tvom slučaju, samo i isključivo voda.

Još jednom - Mačke ne smiju piti kravlje mlijeko! Jebeni Walt Disney i "narodna predaja".

Pa nije to kravlje, nego ono obicno.
(koliko znam to obicno razlicitije od kravljeg)
A probao sam s vodom , on nece ni da cuje za vodu... samo je primirisi i ode.