Alimentary-exam 3 Flashcards
1
Q
What is the difference between segmentation and peristalsis?
A
Segmentation is rhythmic contraction of circular muscle- mixes the enzymes and nutrients, allows adequate time for digestion/absorption
Peristalsis- longitudinal wave of constriction that moves ingesta in the aborad direction
2
Q
You don’t see diarrhea, can you rule out intestinal disease?
A
No. Small intestinal disease is frequently quite severe before diarrhea occurs
3
Q
What is the definition of diarrhea?
A
an increase in frequency, fluid content, or volume of feces
4
Q
What percentage of absorptive function in the GI tract happens in the small intestine?
A
80%
5
Q
With osmotic diarrhea, do you have to worry about loss of electrolytes?
A
Generally not so much.
6
Q
What other problem can osmotic diarrhea lead to?
A
Dysbiosis
7
Q
What are three clinical causes of osmotic diarrhea?
A
EPI, SI lymphoma, IBD
8
Q
What is secretory diarrhea generally caused by? Name four clinical causes?
A
caused by an increase in mediators such as endogenous hormones or cytokines.
Specifically- Salmonella, E. coli, Campylobacter, or IBD
9
Q
Where is integrity of the tight junction between enterocytes the loosest?
A
At the crypts where fluid secretion occurs
10
Q
Why is exudative diarrhea clinically important?
A
Leads to increased risk of bacterial translocation and sepsis
11
Q
What are three clinical causes of exudative diarrhea?
A
Inflammatory disease, neoplasia, Lymphangiectasia
12
Q
What is the general cause of exudative diarrhea?
A
altered permeability from structural damage to the gut wall.
13
Q
What does blood in the feces typically equal?
A
compromised gut function
14
Q
What is the primary function of the colon?
A
To absorb water/electrolytes from the intestinal contents
15
Q
What general causes of diarrhea would you think of in a neonate or juvenile patient?
A
Infectious
-Infectious, obstructive, nutritional
16
Q
What are some characteristics of small bowel diarrhea?
A
normal to increased volume, urgency is uncommon, tenesmus is absent, weight loss can be severe, vomitting is common (esp in cats)
17
Q
What are some characteristics of large bowel diarrhea?
A
Normal to decreased volume, mucus common, tenesmus and dyschezia common, weight loss and vomitting are uncommon
18
Q
Is a general fecal culture a good idea?
A
No, it is a waste of money, most have an organism in mind that you want to target.
19
Q
When would you see decreased cobalamin and folate?
A
with ileal malabsorptive disease
20
Q
What is the main goal with survey radiographs?
A
to determine if the condition is surgical or non-surgical. they do NOT rule out significant disease
21
Q
What kind of things can you evaluate on survey radiographs?
A
foreign body, abdominal fluid, organomegally, free gas, mass lesion, ileus
22
Q
What is a good general deworming protocol? When should you use it?
A
fenbendazole for five days. Use on pretty much every patient
23
Q
What is the MINIMUM amount of time you should do a food trial to see if that is the cause of your diarrhea?
A
3 weeks. NPO except prescribed food and water- no treats, flavored meds, etc.
24
Q
What is the most common location of intussesception in dogs? In cats?
A
In dogs= ileocolic junction or jejunojejunum
In cats= jejunojejunal
25
In what age of animal is intussesception more common?
26
What is the cause for most intussesceptions?
Idiopathic, maybe neoplasia or IBD in older cats
27
Would you expect rapid gas and fluid accumulation with high or low GI obstruction?
High
| low has more slow accumualtion
28
What signs would fluid and gas accumlation associated with obstruction cause?
Dehydration, electrolyte and acid-base imbalances (hyopchloremic metabolic alkaloisi and hypokalmeia). Hypovolemic shock can occur in 48-72 hrs.
29
What signs would a patient with an obstruction might have?
Anorexia, abdominal pain, depression, vomiting. Can lead to dehydration, collapse, and death.
30
What is the treatment for intestinal obstruction?
stablize and normalize hydration status, treat shock and electrolyte abnormalities, start antibiotics ASAP. Surgery.
31
Name three metabolic causes of diarrhe
Addisons, hyperthyroidism, EPI
32
Name three viruses that can cause viral enteritis in dogs
Parvo, Coronavirus, distemper
33
How long is parvovirus shed? How long can it persist in the environment?
Shed for 3-14 days.
| Can persist in the environment for 6mo.
34
What is the general treatment for parvo?
Aggressive fluids and antibiotics
35
How do you calculate a fluid deficit?
%dehydrationx BW in kg
36
What type of antibiotics do you want to use in a dog with parvo?
Broad spectrum- ampicillin in combo with enrofloxacin, 3rd gen cephalosporin or aminoglycoside
37
What probiotic should you use for parvo?
VSL#3
38
What are some potential complications of parvovirus?
esophagitis, aspiration, intussusception, sepsis, hypovolemia
39
What is the prognosis for parvo both treated and untreated?
Untreated= 90% mortality
| aggressviely treated= 0-30% mortality
40
What is the vaccination schedule for parvo?
start at 6wks and vaccinate q 3-4 weeks until 12 weeks of age (or 18 weeks in predisposed breeds.- Does not provide complete protection
41
What are the other names for feline parvovirus?
feline panleukopenia and feline distemper
42
What are the clinical signs of feline parvovirus?
anorexia, and pain, vomiting and watery to blood diarrhea
43
What type of WBC abnormality is seen most commonly with feline parvovirus?
absolute neutropenia
44
How do you diagnose feline parvovirus?
You can use the ELISA test used in dogs
45
What types of cells does coronavirus invade?
mature absorptive cells along sides and tips of villi
46
How does coronavirus cause its effects? How serious of a disease is it usually?
- causes Na+ and water secretion and mild malabsorption.
- commonly causes dubclincal infection in dogs
- most severe in puppies 6-12wks of age
47
What is the incubation period for coronavirus? How long is it shed?
Incubation is 1-4 days
Can be shed for months.
-It is highly contagious
48
What are the common clinical signs associated with coronavirus?
mild, self-limiting diarrhea. Anorexia, vomiting and lethargy can occur. Fever is uncommon.
49
How is coronavirus diagnosed?
Usually by clinical signs and elimination of other causes. Definitive dignosis requires electron microscopic exam of feces.
50
Would you expect to see leukopenia with coronavirus?
No, but you would with parvovirus.
51
How is coronavirus generally treated?
witholding food and water for 12-24hr and gradual introduction of low-fat diet. SQ fluids generally sufficient
52
What is the typical signalment you would expect for an animal with Campylobacter?
53
How severe is the disease typically caused by Campylobacter. How would you diagnosis it?
Usually subclinical, diagnosed through culture of fresh feces.
54
What i the most common Campylobacter isolate?
C. jejuni
55
When is treatment indicated for campylobacter?
when animals have severe hemorrhagic muccoid diarrhea
56
Is treatment with antibiotics reccomened for most patients with Salmonellosis?
Not in healthy animals or stable animals with acute diarrhea.
- can promote bacterial resistance and a carrier state.
57
What type of antibiotics are commonly used for salmonellosis?
Fluoroquinolones. Choice should be made based on culture and sensitivity
58
What type of drugs to clostridial diarrheas generally respond well too?
Metronidazole or penicillins
59
How would you diagnose clostridial diarrhea?
cytology, fecal culture or toxin presence, but finding the organism does NOT mean it is the cause of diarrhea
60
What is the severity of clostridial diarrhea, generally?
Rarely cause systemic disease
| -many clinically normal animals have it in feces. Usually causes large intestine diarrhea.
61
At what age do signs of boxer colitis typically arise?
62
What is trichomonad related diarrhea caused by in cats?
Tritrichomonas foetus
63
What are the clinical signs of trichomonad diarrhea?
Primarily large bowel diarrhea.
May appear under nourished
May appear normal systemically
64
How do you diagnose trichomonad diarrhea?
with fecal culture or PCR. Direct smear is very insensitive
65
What is the reccomended treatment for T. foetus?
Ronidazole- relapse after stopping treatment is common
| -Infection usually self limiting after 6-36mo
66
What protozoal disease is one of the most common causes of small bowel diarrhea in dogs and cats?
Giardia
67
What type of diarrhea does giardia cause?
Small bowel
68
giardia affects ______ animals more than ____ ones
young more than old
69
Diagnosis of giardia is done how?
zinc sulfate centrifugation test on 3 seperate fecal samples
- ELISA tests also avialable
- direct smear diagnostic in ~40% of cases
70
What is one reason it might be difficult to find giardia in an infected animal?
cysts are shed intermittently
71
What should you do if you suspect giardia but you cannot document it?
Do a therapeutic trial. Important to treat due to zoonotic potential
72
Should you treat an animal with giardia if it doesn't have symptoms?
Yes
73
What drug should you use to treat giardia if you don't have confirmation of diagnosis?
Fenbendazole +/- metronidazole
74
What is a common reason for signs of giardia to not resolve?
Re-infection
75
What is Histoplasma capsulatum? How is it acquired?
It is a dimorphic fungus acquired through inhalation
76
What is the difference between H. capsulatum infection in dogs and cats?
In dogs, small and large bowel infection is common. In cats, cutaneous problems are more common
77
How is diagnosis of H. capsulatum done?
finding the organism in cytologic or histopatholigic samples
| -a urine antigen test is available
78
is serologic testing reliable for H. capsulatum infection?
No- lacks sensitivity and specificity
79
What should you do if cytology of H. capsulatum is non-diagnostic?
biopsy
80
What is the treatment to H. capsulatum?
Itraconazole, Amphotericin B if severe intestinal disease is present because absorption may be affected
81
What is the prognosis for histoplasma?
Fair to poor
82
What parasitic organism is one of the most common causes of acute and chronic large bowel diarrhea in dogs?
Trichuris vulpis
83
What abnormalities can Trichuris vulpis cause?
severe electrolyte disturbances with hyperkalemia and hyponatremia= "pseudo-Addisonian syndrome"
84
What is the age of dogs generally affected with an adverse food reaction?
Young (~3yrs)
85
What other, non-GI sign might tip you off to adverse food reaction?
Dermatologic disease
86
What type of food should you use for a food trial in a food adverse reaction case?
Hydrolyzed protein or limited antigen (hydrolyzed may be better)
87
How is diagnosis of IBD made?
- BIOPSY
- finding GI inflammation without an underlying cause
- Normal abdominal imaging does NOT rule out IBD
88
What type of pathologist should you send you biopsy samples too if you are suspicious of IBD?
One who follows the WASAVA standards
89
What is the treatment for IBD
Diet change, antibiotics, and immunosuppression
90
What additional medicines might be helpful for IBD?
metronidazole or tylosin
91
What vitamins specifically should you keep an eye on with IBD?
Cobalamin and folate
92
If the patient with IBD doesn't have good improvement with corticosterioids, or doesn't tolerage them, what other treatments would you consider?
```
Chlorambucil
Cyclosporine
Azathioprine
with colitis- sulfasalazine
Consider adding probiotics
```
93
What is a neoplastic cause of diarrhea?
Lymphosarcoma
94
What is ARD?
Antibiotic responsive diarrhea- chronic small bowel diarrhea that is responsive to antibiotics
95
What breeeds typically ahve ARD
Young, large breed dogs, particularly German shepherds. Not recognized in cats, but may occur
96
Which antibiotics are used to treat ARD?
tylosin, metronidazole, and oxytetracycline for 4-8wks
97
What is IL?
Intestinal lymphangiectasia- dilated intestinal lymphatis that rupture and leak protein-rich lymph into the lamina and lumen.
98
Which type of IL is more common?
Acquired much more common than congenital
99
What breed is particularly predisposed to IL?
Yorkies
100
What causes acquired IL?
mechanical lymphatic obstruction due to chronic inflammatory, infectious or neoplastic causes or can be idiopathic.
101
Does a dog with IL have to have diarrhea?
No. Other sings are edema due to hypoalbuminemia and emaciation due to malabsorption
102
What are the common laboratory abnormalities associated with IL?
```
Lymphopenia
Panhypoproteinemia
Hypocholesterolemia
Hypocalcemia and hypomagnesemia
Possible cobalamin and folate deficiencies
```
103
How is IL diagnosed?
biopsy
104
What is the treatment for IL?
Fat restriced diet, anti-inflammatory dose of pred may help
105
What is HGE?
Hemorrhagic gastroenteritis of dogs- peracute, necrotizing hemorrhagic enteritis
106
What clinical signs is HGE assocaited with?
severe vomitting, bloody diarrhea "raspberry jam", and rapid dehydration with marked hemoconcentration and hypoproteinemia
107
What is the typical signalment for a dog with HGE?
Young, small breed dog.
| But can be diagnosed in anyone
108
What is the treatment for HGE?
The same as for parvovirus
109
Why or why shouldn't you use antibiotics in cases of HGE.
You should use antibioctis because of high risk of bacterial translocation. Protection against all types, but especially anaerobes is important.
110
What type of antibiotics might you want to use in a case of HGE?
IV metronidazole and a penicillin
111
Which type of megacolon is more common?
Acquired is much more common
112
What are some causes of megacolon?
any disease that obstructs the normal passage of feces, causing chronic constipation.
Idiopathic is is common in cats
113
What are the clinical signs of megacolon?
recurrent episodes of constipation of increasing severity
| PE- depression, dehydration, unthriftyness and emaciation
114
What is phase I of the deglutition reflex?
Oropharyngeal phase
1. Oral (voluntray)
2. Pharyngeal
3. Pharyngoesophageal (UES relaxation
115
What is phase II of the deglutition reflex?
Esopageal phase
- primary peristalsis
- secondary peristalsis
116
What is phase III of the deglutition reflex?
Gastroesophageal phase
- LES relaxation
- tonically active but relaxes when swallowing
117
What is the definition of "deglutition"?
The transport of food and liquids from the oral cavity to the stomach
118
What is the only voluntary phase of swallowing?
the oral phase (the first part of the oropharyngeal phase)
119
What is the purpose of the soft palate elevating when you swallow?
keeps food from going into your nose
120
What number is the hypoglossal nerve?
12
121
What things need to be coordinated for the oropharyngeal phase of swallowing to work?
tongue, teeth (for prehension), hard palate, mandible, salivary glands, CN I, II, V, XII, and cerebral cortex
122
What does anisognathic mean?
Dogs and cats have a smaller mandible than maxilla- needed for ripping and tearing food
123
the oral phase of swallowing?
prehension
- mastication
- formation of a food bolus
124
What are the three parts of the pharynx?
nasopharynx (resp), oropharynx (digestive), laryngopahrynx (gate keeper to guide food or air to appropriate location)
125
Where is the nasopharynx?
Dorsal to the hard palate
126
Where is the oropharynx?
dorsal to the tongue and ventral to the soft palate (contains the epiglottis)
127
What happens in the pharyngeal phase of swallowing?
bolus is propelled from oropharynx to upper esophageal sphincter
128
What state are the pharyngeal openings in during the pharyngeal phase of swallowing?
They are closed to prevent aspiration
129
What cranial nerves are involved in the pharyngeal phase of swallowing?
V, VII, IX, X, XII, and the medulla oblongata
130
What are the hallmarks oforopharyngeal disease?
Dysphagia, ptyalism, gagging, reluctance to eat, dysphonia, dropping food, immediate "regurg"
131
What is the hallmark of the pharyngoesophageal phase?
the upper esophageal sphincter will relax
132
If an animal has regurgitation, what type of dysphagia do you know it has?
Esophageal- but there may also be other problems
133
What structures can be involved in "oropharyngeal disorders"?
oral cavity, pharynx, salivary glands
134
What are the two classes of oropharyngeal dysphagia. Which is more common
Anatomic- way more common
Functional
-If you don't identify it through physical exam and rads, you can say its funtional
135
What is the function of the esophagus?
to provide uninterrupted and unidirectional flow of food into the stomach
136
What are the three segements of the esophagus?
Cervial (extra-thoracic)
Thoracic (body)
Abdominal
137
What is different about the feline esophagus?
It has smooth muscle in the lower 1/3 (canine is all striated muscle)
138
What is the visceral afferent sensory nerve to the esophagus?
The vagus
139
What three anatomic structures contribute to the LES?
Gastric smooth muscle
Diaphragm
Gastric oblique fibers
140
What does parasympathetic innervation to the LES cause it to do?
relax
141
If you suspect esophageal dysmotility, what areas in particular should you palpate?
the cervical esophagus and the salivary glands
142
Can you generally identify an anatomical cause of esophageal dysmotility on PE?
Usually no, need some more advanced techniques
143
What are some causes of megaesophagus
```
Immune mediated- SLE, polymyosistis, dermatomyosistis
Endocrine-Addisons
Inflammatory-GERD
Neuromuscular-myasthenia
Dysautonomia
```
144
What is the major complication you worry about with megaesophagus?
Aspiration pneumonia
145
What are the four portions of the stomach?
Cardia
Fundus
Body
Pyloric antrum
146
What doe the stomach do?
initiates digestion of proteins and fats and absortion of vitamins and minerals (esp B12)
147
What is the job of the fundus?
"relative relaxation" during swallowing
| -stretches out to let you eat a lot
148
What is the function of the body of the stomach?
Reservoir, mixes
149
What is the function of the antrum of the stomach?
Grinding/churning, more frequent, vigorous mixing
150
What "syndrome" can animals with no antrum have?
a "dumping syndrome"
151
What is the function of the pylorus?
"sieve" function- delays gastric emptying and minimizes reflux
152
What six things contribute to gastric emptying
Water- liquids exit way faster
Nutrient composition- carbs and protiens empty more rapidly than fat
Osmolarity- osmorecectors in proximal duodenum inhibit gastric emptying by swelling. Tells body "I need more time"
pH- duodenal and jejunal receptors slow emptying of low pH foods
Temp- cold and hot things empty slower
Pyloric resistance and pressure differential
153
Where do the acid producing cells of the stomach live?
in the proximal part of the stomach
154
What type of cells would you find in the caudal part of the stomach?
"Pyloric glands":
mucus
G cells-gastrin (helps to produce acid)
D cells- somatostatin
155
What is the main function of the parietal cell?
to produce HCl
| -an active, energy dependent process
156
What are the three main secretogos (stimulants) for HCl production?
Histamine
Gastrin (from G cell)
Acetylcholine (from nerves)
157
How does the body regulate acid secretion in the stomach?
When the pH drops below 3, your body releases somatostatin (SST) from D cells, feeds back and inhibits the secretogogs
158
Name four potential causes of GI ulceration
Impared mucosal bloodflow- GDV, chirrhosis
Decreased PG production- NSAIDs
Damaged epithelium-GI neoplasia
Increased gastric acid- gastrinoma
159
What are the signs of gastric disease?
```
Vomiting is most common
-hyporexia (esp if painful)
-weight loss
Hematemesis
Melena
Abdominal distension and pain
```
160
What four things can feed into the vomiting center?
Abdominal cortex
Vestibular apparatus
Chemoreceptor trigger zone (floor of fourth ventricle)
Cerebral cortex
161
Where is the vomiting center?
```
Medulla oblongata
(so is the swallowing center)
```
162
Name one cause of vomiting that would cause vomiting through the CTZ
Apomorphine
| -also uremia or other blood borne toxins
163
What is the difference between the vestibular apparatus causing vomiting in dogs and cats?
Cats go straight to the vomiting center, dogs go through the CTZ
