Najd\u00f4le\u017eitej\u0161ie je vyhodnoti\u0165 klinick\u00fa odpove\u010f; ak sa nezlep\u0161\u00ed, m\u00f4\u017ee by\u0165 potrebn\u00e9 vy\u0161\u0161ie d\u00e1vkovanie.
\nNajm\u00e4 ke\u010f sa ma\u010dke dar\u00ed dobre, je najlep\u0161ie pravidelne vykon\u00e1va\u0165 krvn\u00e9 testy, ale berte na vedomie, \u017ee to m\u00f4\u017ee by\u0165 stresuj\u00face a n\u00e1kladn\u00e9 n\u00e1v\u0161tevy kliniky.
\nMonitorovanie lie\u010dby FIP: v t\u00fdchto pr\u00edpadoch by malo sta\u010di\u0165 na pos\u00fadenie odpovede. Je vhodn\u00e9 vyzva\u0165 majite\u013eov ma\u010diek, aby si doma v\u00e1\u017eili svoje zvierat\u00e1 pomocou cenovo dostupn\u00fdch detsk\u00fdch v\u00e1h a zaznamen\u00e1vali si ich hlad, spr\u00e1vanie, r\u00fdchlos\u0165 d\u00fdchania a \u010fal\u0161ie d\u00f4le\u017eit\u00e9 faktory do denn\u00edka. Nasleduj\u00face rady sa m\u00f4\u017eu upravi\u0165 v z\u00e1vislosti od reakcie ma\u010dky na lie\u010dbu: – O\u010dak\u00e1va sa, \u017ee normotermia a spr\u00e1vanie sa zlep\u0161ia do 48 hod\u00edn. V tomto okamihu by ste mali z\u00edska\u0165 \u00fastne aktu\u00e1lne inform\u00e1cie o v\u00fdvoji ma\u010dky a o tom, ako \u013eahko ju mo\u017eno lie\u010di\u0165. – Po dvoch t\u00fd\u017ed\u0148och je d\u00f4le\u017eit\u00e9 zhodnoti\u0165 hmotnos\u0165, spr\u00e1vanie a v\u00fdtok (vn\u00fatropodnikov\u00e9 skenovanie, meranie obvodu brucha). M\u00f4\u017ee sa vyhodnoti\u0165 aj bioch\u00e9mia a hematol\u00f3gia s\u00e9ra, pri\u010dom sa pod\u013ea potreby vykonaj\u00fa \u00fapravy vzh\u013eadom na finan\u010dn\u00e9 obmedzenia (napr. porozm\u00fd\u0161\u013eajte, \u010di by sa ako \u00fa\u010dinn\u00fd a r\u00fdchly \u00favodn\u00fd skr\u00edning na ur\u010denie, \u010di je potrebn\u00e9 \u010fal\u0161ie testovanie, nemohli pou\u017ei\u0165 celkov\u00e9 bielkoviny, PCV a hodnotenie farby plazmy meran\u00e9 pomocou rozto\u010denej mikrozkumavky s hematokritom). Normaliz\u00e1cia s\u00e9rov\u00e9ho AGP (ak bol zv\u00fd\u0161en\u00fd pred lie\u010dbou) m\u00f4\u017ee by\u0165 u\u017eito\u010dn\u00e1 pri predpovedan\u00ed remisie; – Ma\u010dka by sa mala op\u00e4tovne pos\u00fadi\u0165 a vy\u0161\u0161ie uveden\u00e9 testy by sa mali vykona\u0165 po \u0161iestich t\u00fd\u017ed\u0148och. – Po 12 t\u00fd\u017ed\u0148och by mala ma\u010dka absolvova\u0165 vy\u0161etrenia a v ide\u00e1lnom pr\u00edpade by mali by\u0165 v\u0161etky hodnotenia pred ukon\u010den\u00edm lie\u010dby norm\u00e1lne. Niekedy sa zaznamen\u00e1va mierna chronick\u00e1 hyperglobulin\u00e9mia a mierna abdomin\u00e1lna lymfadenomeg\u00e1lia, hoci nes\u00favisia s recid\u00edvou. Ak s\u00fa v\u0161etky ostatn\u00e9 parametre – vr\u00e1tane AGP – norm\u00e1lne, je e\u0161te mo\u017en\u00e9 ukon\u010di\u0165 lie\u010dbu. V pr\u00edpade, \u017ee je dostupn\u00fd a za rozumn\u00fa cenu, je u\u017eito\u010dn\u00e9 ultrazvukov\u00e9 vy\u0161etrenie v mieste starostlivosti (POCUS) na pos\u00fadenie ve\u013ekosti lymfatick\u00fdch uzl\u00edn a\/alebo rozl\u00ed\u0161enia v\u00fdpotku.<\/p>\n
– Po\u010das prv\u00fdch dvoch a\u017e piatich dn\u00ed by ste mali zaznamena\u0165 zmenu n\u00e1lady, chuti do jedla, vymiznutie pyrexie a pr\u00edpadn\u00fd \u00fabytok bru\u0161nej alebo pleur\u00e1lnej tekutiny. – Po\u010das prv\u00fdch dn\u00ed lie\u010dby, t. j. predt\u00fdm, ako liek stihne za\u00fa\u010dinkova\u0165, sa m\u00f4\u017ee objavi\u0165 viac klinick\u00fdch pr\u00edznakov, ktor\u00e9 s\u00fa sp\u00f4soben\u00e9 FIP. Napr\u00edklad, ak je ma\u010dka doma, vyzvite majite\u013ea, aby pos\u00fadil pokojov\u00fa frekvenciu d\u00fdchania a n\u00e1mahu ma\u010dky. M\u00f4\u017ee \u00eds\u0165 aj o tvorbu alebo n\u00e1vrat pleur\u00e1lneho v\u00fdpotku, ktor\u00fd si m\u00f4\u017ee vy\u017eadova\u0165 dren\u00e1\u017e. M\u00f4\u017eu sa vyskytn\u00fa\u0165 aj neurologick\u00e9 pr\u00edznaky alebo pr\u00edznaky uveit\u00eddy (majitelia si napr\u00edklad v\u0161imn\u00fa zmenu farby d\u00fahovky). Zmeny neurologick\u00fdch alebo o\u010dn\u00fdch funkci\u00ed by mali podnieti\u0165 vyhodnotenie d\u00e1vky lieku, aby sa ur\u010dilo, \u010di je potrebn\u00e9 ju zv\u00fd\u0161i\u0165. – V\u00fdtoky zvy\u010dajne vymizn\u00fa do dvoch t\u00fd\u017ed\u0148ov. Ak v\u00fdpotok pretrv\u00e1va aj po dvoch t\u00fd\u017ed\u0148och, zv\u00e1\u017ete zv\u00fd\u0161enie d\u00e1vky (ide\u00e1lne napr\u00edklad o 2 – 3 mg\/mg dvakr\u00e1t denne alebo ka\u017ed\u00fdch 12 hod\u00edn) na vy\u0161\u0161iu \u00farove\u0148, ako sa odpor\u00fa\u010da pre ma\u010dky so samotn\u00fdm v\u00fdpotkom. – M\u00f4\u017ee trva\u0165 nieko\u013eko t\u00fd\u017ed\u0148ov, k\u00fdm sa album\u00edn v s\u00e9re zv\u00fd\u0161i a globul\u00edny klesn\u00fa (t. j. normalizuj\u00fa sa); majte v\u0161ak na pam\u00e4ti, \u017ee globul\u00edny m\u00f4\u017eu spo\u010diatku st\u00fapnu\u0165, ke\u010f sa vstrebe zna\u010dn\u00fd objem v\u00fdpotku. Ke\u010f sa v\u0161etky ostatn\u00e9 parametre vr\u00e1tia do norm\u00e1lu, existuje mo\u017enos\u0165, \u017ee globul\u00edny bud\u00fa na konci lie\u010debn\u00e9ho cyklu st\u00e1le mierne zv\u00fd\u0161en\u00e9. Toto nebolo spojen\u00e9 s recid\u00edvou. – \u00dastup an\u00e9mie a lymfop\u00e9nie m\u00f4\u017ee trva\u0165 a\u017e 10 t\u00fd\u017ed\u0148ov a \u00fa\u010dinn\u00e1 lie\u010dba m\u00f4\u017ee vies\u0165 k lymfocyt\u00f3ze a eozinof\u00edlii. – Zv\u00e4\u010d\u0161en\u00e9 lymfatick\u00e9 uzliny sa zvy\u010dajne zmen\u0161ia v priebehu nieko\u013ek\u00fdch t\u00fd\u017ed\u0148ov, ale pr\u00edle\u017eitostne sa m\u00f4\u017ee sta\u0165, \u017ee ani po ukon\u010den\u00ed lie\u010dby nenadobudn\u00fa svoju norm\u00e1lnu ve\u013ekos\u0165 alebo ultrasonografick\u00fa echogenitu. Ak sa v\u0161ak v\u0161etky ostatn\u00e9 ukazovatele vr\u00e1tili do norm\u00e1lu, zrejme to neznamen\u00e1 relaps FIP; lie\u010dba by sa mala ukon\u010di\u0165 pod\u013ea pl\u00e1nu a pacient m\u00f4\u017ee by\u0165 pozorne sledovan\u00fd. Ak by ste zaznamenali men\u0161\u00ed ako o\u010dak\u00e1van\u00fd pokrok, mo\u017eno budete chcie\u0165 prehodnoti\u0165 diagn\u00f3zu a\/alebo zv\u00fd\u0161i\u0165 d\u00e1vkovanie.<\/p>\n
Po lie\u010dbe, ktor\u00e1 zvy\u010dajne trv\u00e1 12 t\u00fd\u017ed\u0148ov, by majitelia ma\u010diek mali sledova\u0165 ak\u00e9ko\u013evek klinick\u00e9 pr\u00edznaky recid\u00edvy, ako je zn\u00ed\u017eenie chuti do jedla, kol\u00edsanie hmotnosti alebo in\u00e9 pr\u00edznaky. Klinick\u00e9 ukazovatele recid\u00edvy sa m\u00f4\u017eu l\u00ed\u0161i\u0165 od p\u00f4vodn\u00fdch diagnostick\u00fdch pr\u00edznakov (napr\u00edklad neurodif\u00fazne sign\u00e1ly u ma\u010diek s predch\u00e1dzaj\u00facimi v\u00fdtokmi). Ide\u00e1lne je vy\u0161etrenie ma\u010dky pribli\u017ene \u0161tyri t\u00fd\u017edne po ukon\u010den\u00ed lie\u010dby. Ak AGP zostane v norme, jeho monitorovanie by mohlo poskytn\u00fa\u0165 \u00fatechu. D\u00f4le\u017eit\u00e9 je ve\u013emi skoro presk\u00fama\u0165 ak\u00e9ko\u013evek klinick\u00e9 pr\u00edznaky. <\/p>\n
Pre ma\u010dky s FIP m\u00f4\u017eu by\u0165 prospe\u0161n\u00e9 r\u00f4zne formy podpornej starostlivosti. Antivirotik\u00e1 neboli sk\u00faman\u00e9 so \u017eiadnymi konkr\u00e9tnymi doplnkami a pou\u017e\u00edvanie mnoh\u00fdch peror\u00e1lnych liekov nemus\u00ed by\u0165 najlep\u0161ou vo\u013ebou kv\u00f4li probl\u00e9mom s dodr\u017eiavan\u00edm pravidiel zo strany pacienta a s\u00favisiacim v\u00fddavkom. Ma\u010dky, ktor\u00e9 s\u00fa chor\u00e9 a dehydrovan\u00e9, v\u0161ak m\u00f4\u017eu potrebova\u0165 intraven\u00f3znu hydrata\u010dn\u00fa lie\u010dbu. V z\u00e1vislosti od situ\u00e1cie mo\u017eno zv\u00e1\u017ei\u0165 nasleduj\u00face z\u00e1sahy: – Neur\u00e1lne l\u00e9zie, uveit\u00edda, peritone\u00e1lny a pleur\u00e1lny z\u00e1pal a distenzia z m\u00e1s m\u00f4\u017eu u postihnut\u00fdch ma\u010diek sp\u00f4sobi\u0165 nepr\u00edjemn\u00e9 pocity. V r\u00e1mci multimod\u00e1lnej analg\u00e9zie m\u00f4\u017ee by\u0165 prospe\u0161n\u00e1 lie\u010dba opioidmi, ako je buprenorf\u00edn, a in\u00fdmi liekmi, ako s\u00fa NSAID, ak ma\u010dka prij\u00edma potravu a jej ren\u00e1lne parametre a stav hydrat\u00e1cie s\u00fa norm\u00e1lne; – po\u010das prv\u00e9ho obdobia lie\u010dby m\u00f4\u017ee by\u0165 potrebn\u00e1 opakovan\u00e1 dren\u00e1\u017e pleur\u00e1lnych v\u00fdpotkov; – norm\u00e1lna dren\u00e1\u017e bru\u0161n\u00fdch v\u00fdpotkov sa uskuto\u010d\u0148uje len vtedy, ke\u010f tlak ohrozuje d\u00fdchanie; – v\u00fd\u017eiva je rozhoduj\u00faca, preto\u017ee ma\u010dky s FIP \u010dasto str\u00e1caj\u00fa na hmotnosti a menia fyzick\u00fd vzh\u013ead. Vzh\u013eadom na zl\u00fa zn\u00e1\u0161anlivos\u0165 nosov\u00fdch trub\u00edc a mo\u017enos\u0165 depresie m\u00f4\u017eu ma\u010dky s hlbokou anorexiou, ktor\u00e9 nereaguj\u00fa na vy\u0161\u0161ie uveden\u00e9 lieky, profitova\u0165 z umiestnenia ezofagostomickej (O-) trubice. – Okrem toho m\u00f4\u017ee niektor\u00fdm chor\u00fdm ma\u010dk\u00e1m prospie\u0165 kr\u00e1tkodob\u00e9 umiestnenie k\u0155mnych trub\u00edc, ktor\u00e9 m\u00f4\u017eu u\u013eah\u010di\u0165 pod\u00e1vanie liekov. Lieky ako maropitant m\u00f4\u017eu pom\u00f4c\u0165 ma\u010dk\u00e1m c\u00edti\u0165 sa lep\u0161ie, ke\u010f s\u00fa mal\u00e1tne, a stimulova\u0165 ich k prij\u00edmaniu potravy; – v niektor\u00fdch pr\u00edpadoch z\u00e1va\u017enej (a ob\u010das aj hemolytickej) an\u00e9mie sp\u00f4sobenej FIP m\u00f4\u017ee by\u0165 okrem antivirot\u00edk potrebn\u00e1 aj transf\u00fazia krvi; hepatoprotekt\u00edva, ako je S-adenozylmetion\u00edn (SAME) so silyb\u00ednom alebo bez neho, nie s\u00fa vo v\u0161eobecnosti potrebn\u00e9, dokonca ani u ma\u010diek, ktor\u00fdch aktivita enz\u00fdmu ALT je zv\u00fd\u0161en\u00e1; – a kortikosteroidy s\u00fa vo v\u0161eobecnosti kontraindikovan\u00e9 pri lie\u010dbe FIP antivirotikami, aby sa zabr\u00e1nilo ved\u013eaj\u0161\u00edm \u00fa\u010dinkom a imunosupresii. Na druhej strane, ma\u010dky so z\u00e1va\u017en\u00fdmi neurologick\u00fdmi pr\u00edznakmi m\u00f4\u017eu pr\u00edle\u017eitostne potrebova\u0165 kr\u00e1tkodob\u00e9 syst\u00e9mov\u00e9 kortikosteroidy (1 – 5 dn\u00ed) na zn\u00ed\u017eenie z\u00e1palu. Ma\u010dky s uveit\u00eddou m\u00f4\u017eu ma\u0165 tie\u017e prospech z lok\u00e1lnych kortikosteroidov. Imunomediovan\u00e1 hemolytick\u00e1 an\u00e9mia (IMHA) je zriedkav\u00fdm ved\u013eaj\u0161\u00edm \u00fa\u010dinkom imunitnej plexopatie ma\u010diek (FIP), ktor\u00fd si \u010dasto vy\u017eaduje syst\u00e9mov\u00fa kortikosteroidn\u00fa lie\u010dbu po\u010das dlh\u0161ieho obdobia spolu s antiv\u00edrusovou lie\u010dbou, aby sa zmiernila an\u00e9mia. Zv\u00e1\u017ete pod\u00e1vanie NSAID ma\u010dk\u00e1m, ktor\u00e9 dost\u00e1vaj\u00fa terapiu FIP, ak je protiz\u00e1palov\u00fd liek nevyhnutn\u00fd (za predpokladu, \u017ee ma\u010dka prij\u00edma potravu a jej ren\u00e1lne a hydrata\u010dn\u00e9 parametre s\u00fa norm\u00e1lne). <\/p>\n
<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
Na \u010do by som mal d\u00e1va\u0165 pozor pri lie\u010dbe FIP? Najd\u00f4le\u017eitej\u0161ie je vyhodnoti\u0165 klinick\u00fa odpove\u010f; ak sa nezlep\u0161\u00ed, m\u00f4\u017ee by\u0165 potrebn\u00e9 vy\u0161\u0161ie d\u00e1vkovanie. Najm\u00e4 ke\u010f sa ma\u010dke dar\u00ed dobre, je najlep\u0161ie pravidelne vykon\u00e1va\u0165 krvn\u00e9 testy, ale berte na vedomie, \u017ee to m\u00f4\u017ee by\u0165 stresuj\u00face a n\u00e1kladn\u00e9 n\u00e1v\u0161tevy kliniky. Monitorovanie lie\u010dby FIP: v t\u00fdchto pr\u00edpadoch by […]<\/p>\n","protected":false},"author":1,"featured_media":28576,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_glsr_average":0,"_glsr_ranking":0,"_glsr_reviews":0,"footnotes":""},"categories":[1169],"tags":[],"_links":{"self":[{"href":"https:\/\/fipmed.co\/sk\/wp-json\/wp\/v2\/pages\/28574"}],"collection":[{"href":"https:\/\/fipmed.co\/sk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/fipmed.co\/sk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/fipmed.co\/sk\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/fipmed.co\/sk\/wp-json\/wp\/v2\/comments?post=28574"}],"version-history":[{"count":0,"href":"https:\/\/fipmed.co\/sk\/wp-json\/wp\/v2\/pages\/28574\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/fipmed.co\/sk\/wp-json\/wp\/v2\/media\/28576"}],"wp:attachment":[{"href":"https:\/\/fipmed.co\/sk\/wp-json\/wp\/v2\/media?parent=28574"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/fipmed.co\/sk\/wp-json\/wp\/v2\/categories?post=28574"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/fipmed.co\/sk\/wp-json\/wp\/v2\/tags?post=28574"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}