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is usually accompanied with an increase in the size of the pancreas. Unfortunately, size change does not always mean that there is pancreatic pathology. The canine prostate size is variable. Its size increases with age and is small in neutered males. Although there are studies indicating prostate size estimation using ultrasound
is reliable, it is still very subjective as differentiating between normal and diseased prostate is difficult.
The volume of the gallbladder and urinary bladder varies in both dogs and cats. Some of them appear large but have no clinical significance. The wall of the gallbladder should appear as a thin echogenic line in normal dogs and cats. Thickening and the presence
of a measurable gallbladder wall most likely indicates edema or inflammation of the wall. The diameter of
the common bile duct in dogs and cats is < 3mm and
< 4mm respectively. Dilation of the common bile duct most likely indicates obstruction. The urinary bladder wall should be < 2.3 mm for dogs and < 1.7 mm for cats. Increased urinary bladder wall thickness should be interpreted with other changes and history. Thickness
of the gastrointestinal tract in normal dogs and cats
has been reported. Generally, the gastric thickness of dogs and cats should be less than 5mm and 3.6 mm respectively. The thickness of the small intestines in cats is more consistent and mostly < 2.5 mm. As for dogs, the thickness of the small intestines varies depending on the body size. However, it should be less than 6 mm for the duodenum and 5 mm for jejunum. The thickness of the wall of the colon is 2-3 mm in dogs and 1.4-2.5 mm in cats. Increased wall thickness without disruption of the five layer appearance of the gastrointestinal tract is usually due to inflammatory bowel disease except when there is increased thickness of the muscularis layer, which may indicate lymphosarcoma. A normal adrenal gland size has been reported in dogs. The maximal diameter of the adrenal gland has been found to be the most reliable indicator of its size. As a general rule, a diameter of 7.4 mm has been suggested to be used as the upper limits of normal. Unfortunately, overlapping
in size between normal dogs and those with adrenal gland abnormality exist. Approximately 25% of dogs with pituitary dependent hyperadrenocorticism (PDH) do not have adrenal gland enlargement, and about 20% of dogs without any evidence of adrenal diseases had adrenal size more than the proposed upper limits of 7.4 mm. Enlargement of the canine adrenal glands is suggestive of PDH, neoplasia or nodular hyperplasia. In many instances, abnormalities of the adrenal glands lead to an increase in size alone without any nodules or masses. In cats, a study using 10 normal adult cats showed that the normal size to be 4.3 ±0.3 mm.
As a general rule, size measured should be interpreted with care, and should always correlate with clinical signs.
WSV18-0074
NURSES (HILLS)
CARDIOPULMONARY RESUSCITATION PRACTICAL FOR NURSES
J. Hatcher1
1Provet AIRC, Airc, Brisbane, Australia
UPDATE ON CARDIOPULMONARY RESUSCITATION (CPR)
Jo Hatcher Cert IV VN, TAE, Dip VN, AVN
Brisbane Australia jhatcher@provet.com.au
In CPR time is of the essence and therefore it is important that all staff know what to do, how to do it
and where everything is that is required in treating the patient. It is also important that staff know what is normal and what is abnormal in the patient. The emergency cart must be well stocked and checked regularly to ensure drugs and equipment is maintained. The definition of Cardiac Arrest is an abrupt cessation of spontaneous and effective ventilation and systemic perfusion (circulation) which leads to inadequate oxygen delivery to tissues.
In 2012 The Reassessment Campaign on Veterinary Resuscitation (RECOVER) was designed to systematically evaluate the evidence on the clinical practice of veterinary CPR with 2 overarching goals. First to devise clinical guidelines on how to best treat CPR in dogs and cats, and second to identify important knowledge gaps in veterinary CPR that need to be filled in order to improve the quality of recommendations, and thus the quality of patient care in the future. An Advisory board of experts in the field as well as over 80 Veterinarians were consulted throughout the process.
One of the findings in the guidelines was that delaying the start of CPR has shown significant reductions in survival to discharge and the neurological status of
the patient. Agonal breaths can be misinterpreted as spontaneous breathing. In human studies less than 2% of patients on whom CPR is started when not completely confirmed are actually harmed as commonly the patients respond to the stimulation associated with CPR. If there is any doubt CPR should be started immediately.
Preparing for CPR
An organised, cohesive, knowledgeable and well trained team will lead to better outcomes in CPR. It was recognised that the factors that can affect the outcome of CPR are environmental and personnel factors. Environmental factors that may impact performance include well-designed, straightforward checklists; algorithm charts; cognitive aids; and well-stocked, easy to access, organized crash carts.
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