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Blackwell’s Five-Minute Veterinary Consult: Canine and Feline Sixth Edition Blackwell’s Five-Minute Veterinary Consult Canine and Feline Sixth Edition Edited by Larry P. Tilley, DVM Diplomate, American College of Veterinary Internal Medicine (Small Animal Internal Medicine) President, VetMed Consultants, Inc. Santa Fe, New Mexico USA Francis W. K. Smith, Jr., DVM Diplomate, American College of Veterinary Internal Medicine (Small Animal Internal Medicine & Cardiology) Vice-President, VetMed Consultants Lexington, Massachusetts Clinical Assistant Professor, Department of Medicine Cummings School of Veterinary Medicine, Tufts University North Grafton, Massachusetts Thiseditionfirstpublished2016©2016byJohnWiley&Sons,Inc FirstEdition1997©LippincottWilliams&Wilkins SecondEdition2000©LippincottWilliams&Wilkins Thirdedition2004©LippincottWilliams&Wilkins FourthEdition,©2007BlackwellPublishingProfessional Fiftheditionfirstpublished2011byJohnWiley&Sons,Inc Editorialoffices: 1606GoldenAspenDrive,Suites103and104,Ames,Iowa50010,USA TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK 9600GarsingtonRoad,Oxford,OX42DQ,UK Fordetailsofourglobaleditorialoffices,forcustomerservicesandforinformationabouthowto applyforpermissiontoreusethecopyrightmaterialinthisbookpleaseseeourwebsiteat www.wiley.com/wiley-blackwell. Authorizationtophotocopyitemsforinternalorpersonaluse,ortheinternalorpersonaluseof specificclients,isgrantedbyBlackwellPublishing,providedthatthebasefeeispaiddirectlyto theCopyrightClearanceCenter,222RosewoodDrive,Danvers,MA01923.Forthose organizationsthathavebeengrantedaphotocopylicensebyCCC,aseparatesystemofpayments hasbeenarranged.ThefeecodesforusersoftheTransactionalReportingServiceare ISBN-13:978-1-1188-8157-697-8/2016. Designationsusedbycompaniestodistinguishtheirproductsareoftenclaimedastrademarks. Allbrandnamesandproductnamesusedinthisbookaretradenames,servicemarks,trademarks orregisteredtrademarksoftheirrespectiveowners.Thepublisherisnotassociatedwithany productorvendormentionedinthisbook. Thecontentsofthisworkareintendedtofurthergeneralscientificresearch,understanding,and discussiononlyandarenotintendedandshouldnotberelieduponasrecommendingor promotingaspecificmethod,diagnosis,ortreatmentbyhealthsciencepractitionersforany particularpatient.Thepublisherandtheauthormakenorepresentationsorwarrantieswith respecttotheaccuracyorcompletenessofthecontentsofthisworkandspecificallydisclaimall warranties,includingwithoutlimitationanyimpliedwarrantiesoffitnessforaparticularpurpose. Inviewofongoingresearch,equipmentmodifications,changesingovernmentalregulations,and theconstantflowofinformationrelatingtotheuseofmedicines,equipment,anddevices,the readerisurgedtoreviewandevaluatetheinformationprovidedinthepackageinsertor instructionsforeachmedicine,equipment,ordevicefor,amongotherthings,anychangesinthe instructionsorindicationofusageandforaddedwarningsandprecautions.Readersshould consultwithaspecialistwhereappropriate.ThefactthatanorganizationorWebsiteisreferredto inthisworkasacitationand/orapotentialsourceoffurtherinformationdoesnotmeanthatthe authororthepublisherendorsestheinformationtheorganizationorWebsitemayprovideor recommendationsitmaymake.Further,readersshouldbeawarethatInternetWebsiteslistedin thisworkmayhavechangedordisappearedbetweenwhenthisworkwaswrittenandwhenitis read.Nowarrantymaybecreatedorextendedbyanypromotionalstatementsforthiswork. Neitherthepublishernortheauthorshallbeliableforanydamagesarisingherefrom. LibraryofCongressCataloging-in-PublicationData Blackwell’sfive-minuteveterinaryconsult.Canineandfeline/editedbyLarryPatrickTilley, FrancisW.K.Smith,Jr.–Sixthedition. p.;cm. Five-minuteveterinaryconsult.Canineandfeline Canineandfeline Includesbibliographicalreferencesandindex. ISBN978-1-118-88157-6(cloth) 1.Dogs–Diseases–Handbooks,manuals,etc. 2.Cats–Diseases–Handbooks,manuals,etc. I.Tilley,LawrenceP.,editor. II.Smith,FrancisW.K.,Jr.,editor. III.Title:Five-minute veterinaryconsult.Canineandfeline.IV.Title:Canineandfeline. [DNLM:1.DogDiseases–diagnosis–Handbooks. 2.Cat Diseases–diagnosis–Handbooks. 3.CatDiseases–therapy–Handbooks. 4.Dog Diseases–therapy–Handbooks. 5.VeterinaryMedicine–methods–Handbooks. SF991] SF991.B5342016 636.7′0896–dc23 2015022706 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsin printmaynotbeavailableinelectronicbooks. Setin9/10ptGaramondProbyAptaraInc.,NewDelhi,India 1 2016 TomywifeJeri,mysonKyle,andgrandsonTucker TomylatemotherDorothy,whoinstilledvaluesinmybrotherSteveandmyselfthathave helpedusthroughoutlife Tofamilyandanimalswhorepresentthepurityoflife. LarryP.Tilley Tomywife,May,myson,Ben,andmydaughter,Jade,whoareaconstantsourceofinspira- tion,loveandjoy.Tomylatefather,Frank,whowasmyperfectrolemodel.ToKaylee(dog) andCentie(cat)whoremindmeeachdaytomaketimetoplay. FrancisW.K.Smith,Jr. Preface Keepingabreastofadvancesinveterinaryinternalmedicineisextremelydifficult,especiallyfor the busy general practitioner. To keep current with all the veterinary journals while practicing medicineisimpossible.Theveterinarianinpracticecanbeoverwhelmedbyallofthefindingsand conclusionsof thousands of studiesconductedby veterinary specialists. Blackwell’s Five-Minute VeterinaryConsultisdesignedtoprovidethebusyveterinarypractitionerandstudentofveterinary medicinewithconcisepracticalreviewsofalmostallthediseasesandclinicalproblemsindogsand cats.Ourgoalincreatingthistextbookwasalsotoprovideup-to-dateinformationinaneasy-to- useformat.Emphasisisplacedondiagnosisandtreatmentofproblemsanddiseaseslikelytobe seenbyveterinarians. Ourfondestdreamwasrealizedwhenthefirstfiveeditionsofthisbookwerechosenasacompre- hensivereferencesourceforcanineandfelinemedicinebyveterinarystudents,practicingveteri- narians,andboard-certifiedspecialists.Theformathasproveneasytouseandverypopularwith busypractitioners.Thescopeofthebookandthenumberofconsultingeditorsandauthorshave beenexpanded.WehavealsoincreasedthenumberofauthorsfromoutsideNorthAmerica,to providethebestadviceintheworld.Thenumberoftopicshasbeenincreased,andeverytopic hasbeenupdatedtoprovideyouwiththemostcurrentinformationpossibleinatextbook.The appendixeshavealsobeenexpandedtoincludemoreusefultables,andtheDrugFormularyhas beenupdatedandexpanded.Newmedicationshavealsobeenadded. Several good veterinary internal medicine textbooks are available. The uniqueness and value of Blackwell’sFive-MinuteVeterinaryConsultasaquickreferenceistheconsistencyofpresentation, thebreadthofcoverage,thecontributionoflargenumbersofexperts,andthetimelypreparation ofthemanuscript.Theformatofeverytopicisidentical,makingiteasytofindinformation.An extensivelistoftopicheadingsensurescompletecoverageofeachtopic. Asthetitleimplies,oneobjectiveofthisbookistomakeinformationquicklyavailable.Tothis end,wehaveorganizedtopicsalphabeticallyfromAtoZ.Mosttopicscanbefoundwithoutusing the index. A table of contents broken out by organ system and a detailed index are provided. Largevolumesofusefulinformationaresummarizedinchartsintheappendixes.Alsoincludedin theappendixesareanextensiveanddetaileddrugformulary,toxicologytables,endocrinetesting protocols,normallaboratoryvalues,newgeneticepilepsyclassificationtable,painmanagement tables,informationpagewithimportantresourcesforveterinarians,andconversiontables. Wearedelightedandprivilegedtohavehadtheassistanceofnumerousexpertsinveterinaryinter- nalmedicinefromaroundtheworld.Morethan300veterinaryspecialistscontributedtothistext, allowing eachchapter to be writtenby an experton the subject.In addition to providing out- standinginformation,thislargepoolofexpertsallowedustopublishthismajortextinatimely manner. Manylargetextbookstakeseveralyearstowrite,makingsomeoftheinformationoutdatedby thetimethebookispublished.Weareindebtedtothemanycontributorsandconsultingeditors whosehardworkallowedustowrite,edit,andpublishthisworkin2years,withmostchapters completedwithinayearofpublication.Ourgoalistorevisethetextevery3years,sothatthe contentswillalwaysbecurrent. Blackwell’s Five-Minute Veterinary Consult : Canine and Feline, Sixth Edition is available in avarietyofdigitalformats.Visitwww.wiley.com/go/5MVCformoreinformation.Thiseditionalso includes client education handouts based on the content of Blackwell’s Five-Minute Veterinary Consult.Thecomplimentaryclienteducationhandoutsareavailableonacompanionwebsiteat www.fiveminutevet.com/canineandfeline featuring more than 352 Client Handouts for you to customizeanduseinpractice.Thesehandoutscanbeeditedtoreflectyourpracticepreferences andthenprintedonyourletterheadtodistributetoyourclients. vi Thebookwillalsobepublishedasane-bookasadownloadableePub/ePDF.Nowveterinarians canquicklyaccessinformationaboutnecessaryclinicalskillsandnewdevelopmentsindiagnosis andtreatmentontheircomputersormobileversions.OurBlackwell’sFive-MinuteVeterinaryCon- sultwebsite,mobileapplicationsofferfast,affordableaccesstomuchoftheaccumulatedwisdom inveterinarymedicinebyuseofasimplesearch-and-retrievalprocess.Thisinteractivecomputer technologybringstotheclinicexaminationroomanddoctor’sofficeaneasy-to-use“dynamictext- book”thatwillmarkedlyimprovethequalityofcontinuingeducationandclinicalpractice. Thesixtheditionofthistextbookconstitutesanimportant,up-to-datemedicalreferencesource for your practice and clinical education. We strived to make it complete yet practical and easy touse.Ourdreamsarerealizedifthistexthelpsyoutoquicklylocateandusethe“momentarily important”informationthatisessentialtothepracticeofhigh-qualityveterinarymedicine.We wouldappreciateyourinputsothatwecanmakefutureeditionsevenmoreuseful.Ifyouwould like to see any changes in content or format, additions, or deletions, please let us know. Send commentstothefollowing: Drs.LarryP.TilleyandFrankW.K.Smith,Jr c/oWiley 1606Golden AspenDr.Suite 104Ames,IA50010 vii Acknowledgments Thecompletionofthistextbookprovidesawelcomeopportunitytorecognizeinwritingthemany individuals who have helped along the way. The editors gratefully acknowledge the consulting editorsandthecontributorswho,bytheirexpertise,havesounmistakablyenhancedthequality ofthistextbook. Wewouldalsoliketoacknowledgeandthankourfamiliesfortheirsupportofthisprojectandthe sacrificestheymadetoallowusthetimetocompletethebook. Inadditiontothankingveterinarianswhohavereferredpatientstous,wewouldliketoexpress our gratitude to each of the veterinary students, interns, and residents whom we have had the privilege of teaching. Their curiosity and intellectual stimulation have enabled us to grow and havepromptedustoundertakethetaskofwritingthisbook. Finally,aspecialacknowledgmentgoestoeveryoneatWiley-Blackwell.Themarketingandsales departmentsalsomustbeacknowledgedforgeneratingsuchaninterestinthisbook.Theyareall meticulousworkersandkindpeoplewhohavemadethefinalstagesofpreparingthisbookboth inspiringandfun.Wewouldalsoliketothankcopy-editorHeatherAddison,andEricaJudisch, ExecutiveEditor.AspecialthankyougoestoMirjanaMisina,EditorialProjectManager,whospent hoursanddayskeepingtrackofallthecontributorsandthedeadlinedatesformanuscripts.This editionwouldnothavetakenplacewithouther.AspecialthankyougoestoKathyCavanagh,who editedtheclienteducationhandoutsavailablewiththistextbookandNaomiBurtnickwhohelped edittheDrugFormulary.Animportantlifegoalofourshasbeenfulfilled:toprovideexpertisein smallanimalinternalmedicineworldwideandtoteachtheprinciplescontainedinthistextbook toveterinariansandstudentseverywhere. LarryP.TilleyandFrankW.K.Smith,Jr viii

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Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.