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Samples should be collected aseptically from anatomic sites likely to contain pathogens buy aricept 10 mg low cost. Samples should be taken during the acute phase of the disease rather than the chronic stage order aricept 10mg on line. Any pertinent background information and differ- ential diagnoses should be provided. Samples submitted for bacteriology, virology, chlamy- dia isolation or necropsy require special considera- tion. Most samples for bacteriologic screening should be kept moist in an appropriate transport medium, re- frigerated but not frozen and sent immediately with cold packs. Chlamydia isolation may be more suc- cessful if tissues are frozen and shipped with dry ice, rather than refrigerated immediately and then shipped on regular ice. Fecal samples or cloacal swabs in specific chlamydia transport medium may be submitted for antemortem diagnosis. Refrigerants must be sealed in leak-proof plastic bags, and dry ice should be packed to allow for the carbon dioxide to escape after sublimation, without contaminating the samples. Refrigerants should constitute about 50 percent of the weight of the contents of the package. The use of a human drug in food-producing ani- use in avian species, but the Federal Drug Admini- mals may cause adulteration of the food. Avian practitioners should be aware that companion or non-food-producing animals provided the promotion, distribution and use of human drugs all of the following conditions exist: in animals results in violation of the Federal Food, 1. Intended animal use of the human drug is not Drug and Cosmetic Act when: established by labeling, advertising, promotional 1. A drug labeled for human use accompanied by activity or in any other overt manner. There is no approved veterinary drug version of gests a use for animals, for which the product is the human drug available. The human drug does not represent a significant an unsafe new drug under section 512(a) and is risk to the animal when prescribed, dispensed or adulterated under section 501(a)(5) of the Act. The use or intended use of a human drug in animals by a veterinarian causes such drug to be considered a misbranded drug under section 502(f)(1) of the Act. A drug labeled for human use that is promoted, Environmental distributed or otherwise intended for animal use is misbranded under section 502(f)(1) of the Act if Responsibility In addition to medical care for individual pets, avian practitioners also have a responsibility to the global avian population because of their importance in the environment. Many of the species maintained as pets are threatened or endangered in the wild because of habitat destruction and capture for the pet trade. Most leading professional, avicultural and conserva- tion-oriented organizations are actively promoting domestically raised, not wild-caught, birds for pets. Throughout the world there are increased legislative efforts to stop or at least control importation of wild- caught birds. The avian practitioner should promote the purchase of domestically raised birds and keep clients informed of conservation efforts. Occasionally, the avian practitioner must try to de- termine the origin of a bird for medical purposes. The quarantine system is designed strictly to prevent diseases of importance to the poultry in- dustry from entering the United States. These machines have the advantage of providing rapid, inexpensive test Newcastle disease, and a 30-day treatment with results (courtesy of Cathy Johnson-Delaney). Clients should be wary of “bargain” major changes in the system will require time. Infor- birds from the flea market, classified advertisements mation concerning the importation and quarantine or garage sales. The Fish and any pertinent physical information in the medical Wildlife Service is charged with restricting imports record. If the band is removed, the client should keep and exports of many species of birds which may a copy of this record along with the removed band. Assoc Avian Vet, 1991, p tants in inactivating Giardia muris Cont Ed No Am Ed Small Animal through an enhanced owner/bird R2-1. Clin No Amer Sm Anim Prac Emergency Care: A Manual for Emer- Proc Assoc Avian Vet, 1989, pp 454- 21(6):1121-1134, 1991. Clinicians must thoughtfully combine information from the anamne- sis, physical examination and minimum database to advise clients on how to prevent medical problems in a companion bird. An incomplete understanding of the physical, nutri- tional, physiologic and psychologic needs of birds frequently leads to long-term, inadequate care. Because of management faults, finding “nor- mal” birds during a physical examination is, unfortu- nately, rare. Establishing these predisposing factors requires identifying a common pathogenesis for the abnor- malities noted on physical examination. It is when the interconnection between the clinical signs of dis- ease is determined that the true cause of a problem can be clearly defined and corrected.

On a ventrodorsal terial infections often cause monocytosis that can be radiograph cheap aricept 10mg with visa, the kidneys are superimposed by the demonstrated on a peripheral blood smear order aricept 5 mg without a prescription. This is considered an abnormal finding that occurs frequently in African Grey Parrots. Adult trematodes of Tanaisia some viruses like avian polyomavirus and infectious bragai can be found in collecting ducts of chickens, bronchitis virus in chickens demonstrate a trophism turkeys and pigeons. Other viruses that have been associ- ated with renal lesions include Newcastle disease Noninfectious Diseases virus, paramyxovirus of pigeons, reoviruses, viruses belonging to the leukosis/sarcoma group and herpes- Congenital Defects viruses (eg, Pacheco’s disease virus and pigeon her- Agenesis and hypoplasia of part of the kidneys have pesvirus). Renal Mycotic Infections cysts have also been described and may be congenital Renal infarction as a complication of mycelium inva- in origin (Color 21. Diagnosis can be made with sion of blood vessels secondary to pulmonary mycotic urography and laparoscopy. Abdominal air sac aspergillosis with renal involvement per continuitatem has also Metabolic Disorders been reported (Color 21. In the latter case, is- Hypervitaminosis D and elevated dietary calcium chiatic nerve involvement resulted in unilateral pa- can both cause hypercalcemia and lead to deposition ralysis. Parasitic Infections This condition can be detected radiographically, and Granulomatous nephritis due to Isospora, Crypto- the history may indicate oversupplementation of cal- sporidium, Microsporidium an d Encephalitozoon cium or vitamin D in the diet. Visualization of the kidneys is enhanced by the presence of calcium phosphate crystals. Pneu- monia and consolidation of the left air sacs (arrows) are also present (courtesy of Marjorie McMillan). Suggested causes include excess dietary calcium, low phosphorous and infectious bronchitis virus. Unilateral or bilateral ureteral concrements of calcium urate can lead to postrenal renal failure. A diagnosis may be possible with cloacal palpation, radiography, excretory urography and endoscopy. Hypovitaminosis A can cause metaplasia of the epi- thelium of the ureters and collecting ducts and de- creased secretions of mucus in these structures. Amyloidosis Renal amyloidosis often occurs in Anseriformes in con- junction with amyloidosis of other organs (eg, liver) secondary to chronic inflammation. There is a deposi- tion of amyloid A, a degraded fragment of an acute phase reactant. In ducks, renal amyloidosis can lead to massive proteinuria and nephrotic syndrome due to severe glomerular damage. Prerenal Renal Failure Salt (NaCl) poisoning has been documented in vari- Treatment of prerenal renal failure caused by dehy- ous species. Salt poisoning via drinking water can dration or shock is usually successful; however, the lead to right ventricular failure and ascites. Salt challenge is diagnosing and treating the initial cause poisoning via food leads to acute renal failure with of dehydration. Clinical signs include volume with intravenous fluids will usually restore polydipsia and polyuria, or anuria if urate impaction normal renal function within hours (see Chapter 15). Successful extracor- Neoplasia poreal shock wave lithotripsy for removal of uric acid Budgerigars have a high incidence of primary renal concrements in the urinary tract has been reported tumors, especially adenocarcinoma and nephrobla- in a Magellanic Penguin and may be attempted in stoma (younger birds) (Color 21. Unilateral or bilateral paralysis caused by compression of the ischia- Once a diagnosis of acute (reversible) renal failure is tic nerve is a common clinical sign associated with renal made, immediate and aggressive therapy is indi- malignancies in birds (Color 21. Suggested therapy ment is common when a renal mass causes caudoven- for managing uric acid nephropathy in mammals tral displacement of the ventriculus or ascites. A renal provides some insight into the treatment of birds tumor may be radiographically detectable with or with- with a similar condition but different etiology. Acute out the use of barium sul-phate to differentiate the oliguric renal failure associated with hyperuricemia margins of the gastrointestinal tract. A bilateral the administration of cytotoxic drugs or irradiation, obstruction will rapidly lead to visceral gout. Unilat- whereby the dissolution of a neoplastic mass liber- eral obstructions will lead to atrophy and compensa- ates a heavy load of nucleic acid that must be catabol- tory hypertrophy of the contralateral kidney. The uric acid excre- tion rises suddenly, uric acid precipitates in renal Renal Hemorrhage tubules and acute oliguric renal failure ensues. Con- Renal hemorrhage can be caused iatrogenically dur- tributing factors include excretion of an acid urine ing endoscopy if improper technique is used. Spor- secondary to metabolic acidosis, dehydration and the adic renal hemorrhage in male turkeys and Psittaci- use of uricosuric drugs (adrenocorticosteroids). It can also occur as a taining a high alkaline urine flow by infusing manni- complication of renal pathology (eg, tumor).

Inhibition of apoprotein synthesis by the liver leads to phospholipid accumula- tion in hepatocytes e discount 5 mg aricept. Grossly discount 10mg aricept amex, this individual’s stool has the appearance of “rice-water” because of the presence of flecks of mucus. Cultures of this patient’s stool grow Vibrio cholerae, a curved, gram-negative rod that secretes an enterotoxin consist- ing of a toxic A subunit and a binding B subunit. In an evaluation of an 8-year-old boy who has had recurrent infections since the first year of life, findings include enlargement of the liver and spleen, lymph node inflammation, and a superficial dermatitis resembling eczema. Microscopic examination of a series of peripheral blood smears taken during the course of a staphylococcal infection indicates that the bac- tericidal capacity of the boy’s neutrophils is impaired or absent. To treat her symptoms, you advise her to take indomethacin in the hopes that it will reduce her pain by interfering with the production of a. Which one of the listed statements is the best histologic definition of an abscess? A localized defect that results from the sloughing of necrotic inflammatory tis- sue from the surface of an organ c. A 25-year-old female presents with a history of losing four pregnancies in the past 5 years. She also has a history of recurrent pains in her legs sec- ondary to recurrent thrombosis. Evaluation of a pedigree for a certain abnormality reveals the following information: there are skipped generations with male-to-male transmis- sion; females are affected at the same rate as are males; and the disease is produced in the homozygous state, while heterozygous individuals are car- riers. You obtain a detailed family history from this patient and produce the associated pedigree (dark circles or squares indicate affected individu- als). Which of the following transmission patterns is most consistent with this patient’s family history? A 10-month-old baby is being evaluated for visual problems and motor incoordination. Examination of the child’s fundus reveals a bright “cherry red spot” at the macula. Talking to the family of this visually impaired 10-month-old infant, you find that they are Jewish and their family is from the eastern portion of Europe (Ashkenazi Jews). Based on this specific family history, which one of the following enzymes is most likely to be deficient in this infant? A 4-year-old male with mental retardation, self-mutilation, and hyper- uricemia is likely to have a deficiency of an enzyme involved in the a. A young boy is being evaluated for developmental delay, mild autism, and mental retardation. Physical examination reveals the boy to have large, everted ears and a long face with a large mandible. A biopsy of an enlarged salivary gland from an individual with Sjögren’s syndrome is most likely to histologically reveal an extensive infiltrate of a. An 8-month-old male infant is admitted to the hospital because of a bacterial respiratory infection. The infant responds to appropriate anti- biotic therapy, but is readmitted several weeks later because of severe otitis media. Over the next several months, the infant is admitted to the hospital multiple times for recurrent bacterial infections. During a routine physical examination, a 45-year-old male is found to have microscopic hematuria. This mass is resected and reveals a tumor composed of a uniform population of cells with clear cytoplasm. Based on all of these findings, which of the following best char- acterizes this tumor? Also assume that renal tumors composed of cells with clear cytoplasm that are larger than 2. A 35-year-old male living in a southern region of Africa presents with increasing abdominal pain and jaundice. He has worked as a farmer for many years, and sometimes his grain has become moldy. Physical exami- nation reveals a large mass involving the right side of his liver, and a biopsy specimen from this mass confirms the diagnosis of liver cancer (hepatocel- lular carcinoma). A biopsy of this mass is diagnosed as a moderately differ- entiated squamous cell carcinoma. Workup reveals that no bone metastases are present, but laboratory examination reveals that the man’s serum cal- cium levels are 11.