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176 Claw Disorders

Possible Complications PEARLS & CONSIDERATIONS • Use hepatotoxic drugs with caution and
HE, septicemia, hemorrhage/coagulopathy, Comments monitor during use (e.g., phenobarbital).
VetBooks.ir Recommended Monitoring • Hepatic fibrosis and cirrhotic changes Technician Tips
disseminated intravascular coagulation
indicate a progressive, terminal condition
• Pursuing a liver biopsy (histopathology;
Body weight, abdominal girth, liver enzymes,
until the patient is in an advanced stage of
gallbladder aspiration (cytology and culture)
albumin, BUN, and bile acids should be that is often not recognized or apparent copper, zinc, and iron quantification) and
monitored on a monthly basis. disease. An underlying cause is not often may identify treatable abnormalities (e.g.,
identified, making specific therapy impos- copper accumulation)
PROGNOSIS & OUTCOME sible. A histopathologic diagnosis is essential • Although clotting times are not directly
in cases of suspected hepatic fibrosis/cirrhosis. correlated to post-biopsy bleeding, most
• In one report, 94% of dogs with hepatic • Even with severe cirrhotic/fibrosing liver clinicians will measure clotting parameters
fibrosis/cirrhosis were dead within 1 week disease, patients may have little active liver in preparation for a biopsy procedure.
of diagnosis. inflammation and therefore can have normal
• Dogs with idiopathic hepatic fibrosis/cirrhosis or near-normal serum liver enzyme activities. Client Education
have been reported to survive for up to 6 ○ Bile acids (especially postprandial) are Even extremely small amounts of meat protein
years, and intensive therapy may extend much more sensitive for assessment of (e.g., one small meat-based treat) may precipi-
survival, although the prognosis is usually hepatic function. tate severe signs of HE in susceptible patients.
very poor with advanced disease.
• Histopathologic findings may be helpful as Prevention SUGGESTED READING
a prognostic indicator. • Early testing of animals with breed predis- Favier RP, et al: A retrospective study of oral pred-
• Patients that are anorectic, demonstrate positions (e.g., Bedlington terriers; genetic nisolone treatment in canine chronic hepatitis. Vet
clinical signs of HE, have coagulopathy test available) may lead to early intervention. Q 33:113-120, 2013.
(prolonged PT, aPTT, or thrombocytopenia), • Avoid oversupplementation with copper- AUTHOR: Craig B. Webb, DVM, PhD, DACVIM
ascites, hypoglobulinemia, or histologically containing products and high-copper diets EDITOR: Keith P. Richter, DVM, MSEL, DACVIM
severe changes (cirrhosis, advanced fibrosis) in predisposed breeds.
usually have a poor prognosis.

Claw Disorders Bonus Material
Online

BASIC INFORMATION • Subungual melanomas: in older dogs; rare (lung-digit syndrome), pulmonary SCC,
in cats cutaneous SCC with metastasis
Definition • Onychomycosis: Malassezia infection
In dogs and cats, the term claw is more common but dermatophytosis rare in dogs Clinical Presentation
appropriate than nail. and cats HISTORY, CHIEF COMPLAINT
• Onychodystrophy: claw malformation Pruritus of affected digit(s), signs of pain/
• Onychogryphosis: hypertrophic claw with GENETICS, BREED PREDISPOSITION lameness, misshaped claws, claw sloughing,
abnormal curvature • SLO: often noted in German shepherds, or a swollen toe or a mass seen during claw
• Onycholysis: separation of claw from Gordon setters, miniature poodles, schnau- trim. A single paw or multiple paws can be
underlying corium zers, and rottweilers involved. The claw disorder can be part of a
• Onychomadesis: sloughing of claw • Subungual SCC: seen in large breeds (75% more generalized skin condition.
• Onychomycosis: fungal infection of claw of cases) and in breeds with a black coat
• Onychorrhexis: brittle claws tending to split (66% of cases), such as in the black Labrador PHYSICAL EXAM FINDINGS
or break retriever and black poodle • Bacterial claw infections
• Paronychia: inflammation of soft tissue ○ One or many affected digits
around claw RISK FACTORS ○ Paronychia, toe swelling, purulent dis-
• Symmetric lupoid onychodystrophy/onychitis Non-neoplastic claw disorders: immunosup- charge, possible separation of claw, and
(SLO): lupus-like condition that causes pression, feline leukemia virus (FeLV) infection, pain
sloughing (onychomadesis) and subsequent vascular insult, trauma, improper trimming/ ○ Regional lymphadenopathy, with fever
onychodystrophy of multiple claws on all care of claws, diabetes mellitus and possible osteomyelitis
paws ○ Other clinical signs of immunocompro-
ASSOCIATED DISORDERS mising conditions
Epidemiology • In cats and dogs: hyperadrenocorticism, • Onychomycosis
SPECIES, AGE, SEX diabetes mellitus, hypothyroidism, der- ○ Dermatophytic claw infections result in
Most claw conditions have no specific age matomyositis, arteriovenous fistula, cold- paronychia with minimal pain, irritation,
or sex predispositions other than those listed agglutinin disease, drug reaction, vaccine or pruritus. Typically, only one or two
here: reaction, vasculitis, trauma, leishmaniasis, affected digits with friable and misshapen
• SLO: in dogs 3-8 years old; rare in cats food allergy claws are seen on the same paw. Usually
• Subungual squamous cell carcinoma (SCC): • In cats only: hyperthyroidism, primary accompanied by focal or multifocal skin
in older dogs pulmonary bronchiolar adenocarcinoma lesions

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