Alimentary Tract Diseases Flashcards
What is regurgitation?
- Expulsion of undigested food/liquid from oesophagus/larynx
- Passive process (no abdominal contractions)
- Often shortly after eating
- May lead to malnutrition, weight loss and aspirating pneumonia
What are some possible causes of regurgitation relating to oesophageal disease?
- Megaoesophagus (oesophagus becomes flaccid, weak and dilated)
- Foreign body
- Oesophagitis
- Oesophageal stricture (narrowing usually caused by ingesting foreign material, eg toy/rope)
- Persistent right aortic arch (Abnormal rerouting of the blood vessels in the aorta
- Hiatal hernia (Forms at opening in diaphragm where oesophagus joins stomach)
- Neoplasia (various types of abnormal growths/tumours)
What are some other causes of regurgitation (not relating to oesophageal disease)?
- Neuromuscular (myasthenia gravis)
- Myopathies
- Neuropathies
- Central nervous system disease
- Lactating bitch
- Infectious (rabies, botulism)
What diagnostics can be done for a patient presenting with regurgitation?
- Blood samples (haematology and biochemistry)
- Plain and barium swallow radiographs (water soluble contrast preferred)
- Endoscopy
What treatments can be done for regurgitation?
Treat underlying cause:
- Megaoesophagus = conservative management
- Oesophagitis = antiinflammatories and antacids (omeprazole & antihistamines)
- Foreign bodies = removal
- Oesopageal strictures = ballooning
- PRAA/hiatal hernia/neoplasia = surgery
What nursing care can be done for a regurgitating patient?
- Monitor hydration and vitals
- Monitor and record weight
- Observe regurgitation and record
- Observe signs of aspiration pneumonia
- Small volumes of concentrated diet
- Pastural feeding (let gravity assist movement = high feeding)
- Fluids and electrolytes
What is vomiting?
- Active process
- involves expulsion of contents from the stomach and/or upper small intestine
- Involves contraction of abdominal muscles
- Signs of nausea may be seen before emesis (eg hyper salivation, lip licking, abdominal pain, behaviour changes, eating grass)
- Common clinical sign of many conditions as it is a protective mechanism
- Can be classed as acute or chronic
- Dehydration may occur depending on frequency and volumes involved
- May also lead to electrolyte imbalances
What are some possible causes of vomiting and some examples?
Primary GI Disease
- Adverse reaction to food
- GI infection
- Parasitism
- Gastric ulceration
- Gastric neoplasia
- Gastric foreign body
- Gastrointestinal ischaemia (decreased blood flow to GI tract)
- Gastrointestinal obstruction
Secondary causes
- Motion sickness
- Causes of sepsis (pyometra)
- Renal disease (due to uraemia)
- Disease of pancreas/liver
- Pain, fear, psychogenic
What diagnostics can be done for a vomiting patient?
- Detailed clinical history
- Observation and clinical exam of patient
- Blood tests
- Abdominal X-rays and/or ultrasound
- Barium swallow radiographs
- Gastroscopy
- Exploratory laparotomy
- Biopsy
What treatment and nursing care can be done with a vomiting patient?
- Isolate and barrier nurse
- Treat underlying cause
- Replace fluids and electrolytes
- Period of starving (if uncomplicated acute V+ starve for 24 hours)
- Dietary modification
- Anti-emetics
- Gastric protectants and antacids
- Analgesia
- Clean/groom patient
- Monitor vomiting, weight and hydration status
What is GDV?
Gastric Dilation-Volvulus
What clinical signs may be seen with a GDV patient?
- Collapse
- Severe hypovolaemic shock
- Unproductive wretching
- Distended stomach
- Tachycardia and possibly arrhythmias
- Pale MMs and slow CRT
- Restlessness
- Hypersalivation and tachypnoea
How is GDV diagnosed?
Right lateral X-ray (abdominal)
What treatment and nursing care can be done for a GDV patient?
- Immediate decompression (large bore stomach tube through centre of roll of tape in mouth), percutaneous trocarisation = immediate release of gas and fluid
- Aggressive shock fluid therapy
- IV AB’s
- Treatment/monitoring of cardiac arrhythmias
- Corrective surgery (gastropexy)
Post op:
- Starve for 12 hours and slowly introduce oral liquids (bland, easily digestible)
- Monitor for signs of shock
What is pancreatitis caused by?
Self-digestion (autolysis) of pancreas by the digestive enzymes
What diagnostics can be done for a suspected pancreatic patient?
- Clinical signs
- Ultrasound
- Blood tests (biochemistry = increased lipase and amylase, snap-test to confirm abnormal levels, canine or feline pancreatic lipase = outside lab for exact values)
What treatment and nursing care can be done for a patient with acute pacreatitis?
- Monitor vital signs
- Nil per os until vomiting stops (VS direction), avoid sight and smell of food
- TLC/groom/clean
- IVFT +/- electrolytes
- Analgesia
- Low-fat diet
- Anti-emetics
- Surgery (if bile duct obstruction)
- Weight control and exercise
What treatment and nursing care can be done for a patient with chronic pancreatitis?
- Long-term dietary management
- Feed small amounts often of low/reduced fat diet
- Enzyme diet supplement with food
- Monitor faecal output
- Groom and clean patient
- Monitor weight
- Surgery (if tumour/bile duct obstruction)
What are the possible causes of acute diarrhoea?
- Dietary change/allergies
- Infection
- Parasites
- Neoplasia
- IBD
- Intussusception (part of intestine slides into an adjacent part of the intestine)
What are the possible causes of chronic diarrhoea?
- Long term dietary intolerance
- Neoplasia
- FBs
- Liver disease
What diagnostics can be done for a patient with diarrhoea?
- Clinical history
- Clinical examination
- Biochemistry and haematology
- Faecal analysis
- Contrast radiographs
- Ultrasound
- Endoscope
- Ex-lap
- Biopsy
What treatment and nursing care can be done for a patient with diarrhoea?
- Isolate and barrier nurse
- Fast/easily digested food (small and frequent)
- Medication under direction of VS
- Managing feeding tube (if present)
- IVFT +/- electrolytes
- Analgesia
- Clean patient
- Monitor clinical signs, weight and hydration status
- Observe and record diarrhoea type and frequency
- Regular walks for toileting
- Establish underlying cause
What are some possible causes for constipation?
- Dietary
- Colonic
- Orthopaedic
What are some clinical signs of constipation/impaction?
- Absence of faeces
- Tenesmus (straining)
- Very hard small faeces +/- fresh blood
- Vomiting
- Abdominal distension
What diagnostics can be done for a patient with suspected constipation/impaction?
- Physical examination (including rectal)
- X-rays
- Ultrasound
- Proctoscopy
What treatment and nursing care can be done for a patient with constipation?
- Enemas under VS direction
- IVFT
- Monitor vital signs
- Dietary changes
- Faecal softeners
- Bulking agents
- Surgical correction
- Clean/groom patient
- Encourage to eat
What is intussusception?
- Intestines telescope in on themselves
- Most often seen in young animals, especially if they have diarrhoea
What are the clinical signs of intussusception?
- Subdued
- Decreased appetite/anorexia
- V+ and D+
What is the diagnostics and treatment of intussusception?
Diagnostics:
- Ultrasound
- Sometimes palpable on examination
Treatment:
-Surgery (enterectomy = removal of a length of intestine due to loss of blood supply to area)
What are some possible causes of obstruction in cats and dogs?
Cats:
- Fish bones
- String
- Fishhooks
- Hair balls
- Rubber toys
Dogs:
- Sticks
- Bones
- Balls
- Stones
- Peach stones/corn cob
What is ileus?
Disruption of the normal propulsive ability of the intestine
What are some possible causes of ileus?
- Obstruction (associated with high glucose)
- Stress and/or pain
- Dental disease
- Inappropriate diet
- Infections
- Parasite burden
What are the diagnostics for a possible ileus?
- Ultrasound
- X-rays
- Glucose reading
What are the treatments and nursing care requirements for a patient with ileus?
- Removal of obstruction (if present)
- Prokinetics (eg metoclopramide)
- Small and frequent meals (easily digestible diet)
- Exercise
- Abdominal massage
- Grooming (may help if fur obstruction)
- Rabbits: feed caecotrophs from healthy rabbits
What is anal furunculosis?
- Inflammatory disease often associated with chronic bowel disease
- Almost exclusively to GSDs
What are the clinical signs and management of anal furunculosis?
Clinical signs:
- Pain
- Dyschezia
- Constipation
Management:
- Immunosuppressive drug therapy
- Occasionally excision of anal sacs
