Block 4 Flashcards
How many teeth do dogs have?
42
How many teeth do cats have?
30
What is the canine tooth?
04
What is the carnesial on the maxillary?
08
What is the carnesial on the mandible?
09
What is normal probe depth in dog?
1-3mm
What is normal probe depth in cats?
0.5-1mm
How many molars does a cat have?
1 in each arcade
What teeth are cats missing on the mandible?
05 and 06 of the premolar
What does PD stand for?
Periodontal disease
What is PD stage 0
No disease
What is PD stage 1
Gingivitis (reversible)
What is PD stage 2
Periodontitis present, attachment <25% loss (unlikely reversible without dedicated owner)
What is PD stage 3
25-50% loss
What is PD stage 5
> 50% loss
What is open vs closed root planing?
Scraping away the bacteria underneath the gingiva
Open: Making a flap to get lower
Closed: Smaller pockets that can be done without a flap
What antibiotic can be added to slow progression of PD 2 and PD 3?
Doxirobe
What is M1-3?
Mobility
What is M1
0.2mm-0.5mm
What is M2
0.5-1mm
What is M3
> 1mm
What is F1-3?
Furcation
What is F1
<50% under crown
What is F2
> 50%
What is F3
Can push a probe all the way through the furcation
What are the 7 scenarios that you remove a tooth?
PD4, M3, F3, abscess, fracture, resorptive lesion, crowding, trauma
What is type 1 resorptive lesion?
Roots still present
Whole tooth extraction
What is type 2 resorptive lesion
No root left
Crown amputation
What is type 3 resorptive lesion?
Mix of both types of lesions
What is an uncomplicated fracture?
No pulp exposure
What is a complicated crown fracture?
Pulp fracture
What is a risk for fractures?
Infection of the pulp
What normally causes oral nasal fistulas after canine extraction?
Too much tension on suture
What does calicivirus cause?
Tongue ulceration
Where is the #1 place for a oral nasal fistula to occur on a dog?
Underneath canine tooth after extraction
What opioids can you use for standing equine dentals?
Butorphanol or morphine
What number is the wolf tooth?
05 or first premolar
Do you need to trim back gingival hyperplasia to reduce bacterial pockets?
Yes!
Does a blind woof tooth need to be extracted?
Absolutely!
What is the first tooth that you can see in a horse’s mouth in the back area?
06
Should you extract a lower wolf tooth?
Yes
Does a normally formed wolf tooth need to be extracted?
Not necessarily
What does a diastama cause?
Fermentation leading to an acidic environment causing an anaerobic bacterial infection
When do you extract the wolf tooth?
After it is erupted, not necessarily at castration
SAFER BEFORE 18 MONTHS
What is the most common cause of equine periodontal disease?
Diastema
What is a transverse ridge?
Like a small mountain in the tooth
Is the wolf tooth the same as the canine?
NO!!
What is a ramp?
Up slope on the bottom 11s
ALWAYS EXTRACT BLIND WOLF TEETH
What is a hook?
Top tooth down, usually 06
What do you do about a hook?
Grind down 2-3mm at a time, dont want to expose pulp
What must you do to a step?
Take it down
What does the secondary bacterial infection caused by the diastema cause?
Sinusitis
How to treat EOTRH?
Removal of teeth
Can you create a deworming protocol without seeing the farm first?
Nope
What does EOTRH?
Equine odontoclastic tooth resorption and hypercementosis
***** ON EXAM: What is the GI parasite control plan for a dog or cat during first year of life?
2, 4, 6, and 8 weeks, then monthly and fecal recheck (2x or more)
Do you deworm at fixed intervals?
No!
Should you tailor strongyle control to the active transmission season?
YES!
Where is anthelmintic resistance worst in?
Southern US
What is refugia?
Parasites that have not been exposed to dewormers
Should you use fecal egg counts to diagnose clinical disease in horses?
NO!
Does refugia work for all parasites?
NO!
What parasites do we consider refugia a part of our management plan?
Food animals or horses only
Which hosts should we do efficacy tests on?
Ones that actually are treated on? (dogs for a dog disease)
What is the most common reason for oral maxillofacial surgery?
Trauma
How do you tell if a drug is effective against parasitic infection?
Fecal egg count reduction test
What would the removal of one half of the rostral mandible be called?
Rostral mandibulectomy
Where can you go to find reliable recommendations in companion animals?
CapCVet
Where does fenbendazole work?
In the intestine
During mandibular surgery, they use different terminology than dentistry
They consider each side of the mandible as an individual bone
What would the removal of one hand of both sides of the mandible be called?
Bilateral mandibulectomy
Where is the caudal inferior alveolar block located?
Near the caudal part of the ramus. inside of the jaw
What are the margins for removal of neoplasia on mandibulectomy?
1cm
What is the most common complication with mandibulectomy?
Mandibular drift
What is tight lip syndrome?
Rostral edge of lip tissue pulled over mandibular dental arcade
What does tight lip syndrome inhibit?
Mandibular growth
What is tight lip syndrome described most in/
Shar-peis
What are important complications of maxillectomy?
Oronasal fistula
How long does it take dogs to start eating after surgery?
48hrs
How long will it take the majority of dogs to adapt?
2 weeks
If a cat is having a hard time eating, what can be done?
Feeding tube
Can you remove the whole tongue in dogs? Cats?
Dog: yes
Cat: No
What types of cleft palate are there?
Hard palate only
Combo
Soft palate only
Is treatment of cleft palate always necessary?
Not if not clinical!
How do you diagnose a cleft palate?
Sedated oral exam
Remove any debris trapped in the cleft
What can be a sequela of cleft palate?
Aspiration pneumonia
Cleft palate can be a multi staged surgery
When is the best time to treat cleft palates?
Early (3-4 months age)
What is the artery that needs to be protected in cleft palate surgery?
Palatine artery
What is important post-op in cleft palate surgery?
Nothing hard PO for 4 weeks, including toys
What is the most common salivary gland for disease?
Sublingual
What is magic mouth wash made up of?
Lidocaine, Maalox (aluminum), benadryl
What is the most common disease of the salivary gland?
Sialadenitis (inflammation of gland)
In a parotid sialocele surgery, what must be avoided
Facial nerve
What is the most common type of sialocele?
Cervical sialocele
What is the second most common type of sialocele?
Sublingual/RanulaI
How to you cure a cervical sialocele?
Removal of BOTH mandibular and sublingual salivary gland
Something about lingual nerve
Why must mandibular and sublingual glands be removed?
They share the same duct
Does how much protein matter?
Less of how much, more of the type of protein
What is like the #1 takeaway from a lot of Rudinsky’s lectures?
Dont jump to a liver diet
What should you keep in mind about protein content in growing animals?
Higher protein in kidney diet, worry more about where the protein is coming from
What are 7 things that make up a “typical” liver diet?
Reduced/modified protein
Reduced copper content
Increased zinc
Decreased sodium
Increased soluble fiber protein
L-carnitine fortified
Anti-oxidant enriched
What liver diseases are copper and zinc content specific for?
Copper hepatopathies
What does increased copper cause/
Oxidative stress
What does increased zinc do?
Zinc reduces the intestinal absorption of copper
What is the metabolism of copper?
Absorbed in intestine
Stored in liver
Secreted in bile
What should zinc supplementation not be combined with?
d-penicillamine
Decreases effect of both
What is the reason for decreased sodium content?
Avoids contributing to formation of portal hypertension and ascites
Reasons to modify protein?
Hepatic encephalopathy
Reason to decrease sodium?
Ascites/portal hypertension
Reason to reduce copper and increase zinc?
Copper hepatopathy
Why enrich with anti-oxidants?
Allergies
Reason to increase soluble fiber?
Hepatic encephalopathy
Why fortify with L-carnitine?
Increased L-carnitine to potentially aid in fatty acid oxidation
What is the threshold for copper hepatopathy?
400 (800 is bad)
What is a useful copper chelator?
Penicillamine
What supplement can give to a copper hepatopathy dog?
Zinc
What are the top 4 things to do for a copper hepatopathy dog?
Low copper diet
Copper chelator (penicillamine)
Zinc supplement
Anti-oxidant diet
What are 2 low copper proteins?
Eggs
White meat
What is a low copper diary product?
Cottage cheese
Where can you go to find copper concentration?
USDA website
What does a portosystemic shunt cause?
Heptaoencephalopathy (HE)
What is high in HE?
ammonia
What is medical therapy for portosystemic shunt?
Lactulose
Antibiotics
Anti-epileptic
Do you reduce protein in a PSS animal?
Not unless symptomatic
How do you treat lymphocytic disease?
Immunosupression
**Are elevate liver enzymes an indication for the use of a liver diet?
NO!!
What is copper needed for?
Normal METABOLISM
What does high amounts of copper cause?
Oxidative stress
What 2 molecules carry copper?
Albumin
Transcuprein
How is copper excreted?
through bile
What are the 5 treatments to copper hepatopathy?
Low copper diet
Copper chelation
Decrease inflammation
Zinc supplement
Anti-oxidant
*Typical Liver Diet
*Modified protein content
*Reduced copper content
*Increased zinc
*Decreased sodium
*Increased fiber
*L-carnitine
*Anti-oxidant
What is copper chelation?
Medications utilized to increase mobilization of copper out of body
Beside penecillamine, what is the other copper chelator that can be used?
Tridentine hydrochloride
Can zinc supplement and copper chelator be combined?
NO!!
What is a copper specific anti-oxidant?
Vitamin E
What is a classic anti-oxidant to be used with Cu hepatopathies?
Denamarin
Should you use colchicine?
No!!
What are the 2 reasons not to use it?
- Documented to cause decreased copper excretion
- High side effect profile
What is a nutraceutical?
food that has pharmaceutical benefit
What is s-adensyl-methionine (SAMe)
glutathione donor (aka an anti-oxidant donor)
Where is glutathione found (GSH)
Synthesized and found in almost every cell type
(Hepatocytes have higher levels)
What is something that you can prescribe to every liver patient?
Glutathione (GSH)
What is glutathione?
I think it is an antioxidant
What is another heptatoprotectant that can be prescribed?
N-acetylcysteine
What does cysteine do?
Increases glutathione levels
Where is cysteine best characterized?
Acetaminophen toxicity
What is a better home treatment for a hepatoprotectant than the IV acetylcystein?
S-adenosylmethionine (SAMe)
What are 2 brands of SAMe?
Denamarin
Denosyl
What is silymarin?
Milk Thistle
What is silymarin (milk thistle) specifically known to inhibit the uptake of?
Amanita mushrooms
What does silymarin specifically affect?
P450 metabolism
What is ursodiol?
Bile acid of chinese black bear
What does ursodiol cause?
Stimulates bile flow
What type of disease is ursodiol (bear bile) most useful in?
Liver cirrhosis (inability for bile to leave)
What are the 2 reasons to not use hepatoprotectants?
Tolerance
Finances
With necroinflammatory disease, what should you use?
SAMe +/- ursodiol
Which cholestatic disease, what should you use?
Ursodiol +/- SAMe
What is the first line of defense against immunomodulatory chronic hepatitis?
Corticosteroids there are others if the side effects are too high
What are the top 4 drugs for immunomodulatory chronic hepatitis?
Corticosteroids
Azathioprine
Mycophenalate
Cyclosporine
What are the top 2 drugs in cats for immunomodulatory chronic hepatitis?
corticosteroids
Cyclosporine
What is an iatrogenic side effect of prednisone (corticosteroid)?
Iatrogenic hyperadrenocorticism
What are the 3 types of hepatic encephalopathy?
Type A - Acute liver failure associated
Type B - PSS associated
Type C - Chronic liver disease associated
What are the 4 components to treatment of hepatic encephalopathy?
Correct precipitating event
Modify dietary protein
Decrease ammonia absorption
Modify microbiome
Does ammonia or ammonium cross diffuse better?
Ammonia
What is the most common precipatiting factor HE?
Infection
What can oner restriction of protein have on HE?
Can make it worse!
Is organ meet a good protein?
No, very encephalopathic
What are 2 ways to reduce circulating ammonia?
Nonabsorbable disaccharides (alter colonic pH)
Oral antibiotics (to reduce ammonia-producing bacteria)
What is a non absorbable disaccharide that can be given?
Lactulose
What does lactulose do?
In the colon, lactulose is metabolized by gut bacteria into organic acids (like lactic acid and acetic acid), which acidify the intestinal environment.
The acidic pH helps convert ammonia (NH₃) into ammonium (NH₄⁺), a form less readily absorbed into the bloodstream, thus reducing ammonia levels.
What are 3 ways that the microbiome can be influenced of HE patient?
Antibiotic
Probiotic
Prebiotic
What does the C stand for?
Coagulopathy
What is lactulose categorized into?
Prebiotic
What is the acronym for liver disease complications?
CANINE
What are 3 antibiotics used with HE?
(MAN)
Metronidazole
Amoxicillin
Neomycin
Rifaximin but really expensive
What does the N stand for
Ncephalopathy
What does the A stand for
anemia
What does the I stand for?
Intestinal and gastric ulcers
What does the N stand for?
Ndotoxemia and infection
What does the E stand for?
effusion
What is the downside to omeprazole?
Liver metabolism
What is a good H2 blocker?
Famotidine
What are 3 acid suppressors for GI ulcers?
H2 blockers
Proton pump inhibitors
Omeprazole
What mechanism causes endotoxemia and infection?
Impaired kupffer cell function
What causes intra hepatic portal hypertension?
Cirrhosis
What type of H2 blocker should be avoided?
P450 inhibitors
Why does portal hypertension occur?
Increased pressure due to cirrhosis
What are 2 causes of post-hepatic portal hypertension?
Right heart failure
Pericardial effusion
What are 4 consequences of portal hypertension?
Ascites
Acquired PSS
Hepatomegaly
Gastric ulcers
What are 4 management strategies for ascites and edema?
Sodium restriction
Diuretics
Colloids
Abdominocentesis
Why does portal hypertension cause gastric ulcers?
Decreased blood flow makes the stomach more friable
What is an acquired shunt secondary to?
Pulmonary hypertension
What dog breeds get extra hepatic shunting vessels?
Cats, small dogs
What dog breeds get intrahepatic shunting vessels?
Large breed
What is a clinical sign of PSS especially in cats?
Hypersalivation
What is a clinical sign of PSS?
Urate stones
What are the 2 locations that the liver gets blood?
80% portal blood
20% Arterial blood
What is seen in RBCs of PSS cases?
Microcytic (small) RBCs
What may be seen in urinalysis of PSS cases?
Ammonium crystals
What are 2 primary liver function tests?
Serum bile acids
Blood ammonia levels
Given a PSS, what type of clearance increases?
Renal clearance over intestinal clearance
Serum bile acids increase with _______ types of liver disease
ALL
Hepatocellular dysfunction
Cholestasis
PSS
What is a more specific test for PSS?
Blood ammonia
What are the 3 medical managements for congenital PSS?
Protein-restricted diet
Lactulose, antibiotics
Correct precipitating events
What is the stainless steel ring that is used for constricting PSS?
Ameroid constrictor
What is the schedule of ameroid constricting?
Rapid phase - 14d
Gradual - Up to 60d
How is hepatic microvascular dysplasia differentiated from PSS?
Protein C
What type of PSS can a aneroid constrictor be used on?
Extrahepatic PSS
What is an asymptomatic reason for increased SBA?
Hepatic microvascular dysplasia
Can you treat hepatic microvascular dysplasia?
No
What do all surgical shunt corrections need to be pre-treated with?
Anti-epileptic
If dogs have a high protein C activity, >70% what does that likely mean?
MVD (but DOES NOT differentiate)
What is the best technique for determining fecal load?
Fecal flotation
If protein C is <70%, what does that mean?
It is PSS
What are the 3 consequences of PSS?
Hepatic encephalopathy
Urate urolithiasis
Hepatic atrophy
What is the least toxic anthelmintic?
Benzimidazoles
What do you need to change between large and small animals with fecal floats?
There is a different media
What is MOA of benzimidazoles?
Binds to beta-tubulin, disrupts microtubules to kill parasites
Why does the MOA work in parasites?
Their higher concentration of beta tubulins
What has the fasted rate of absorption of the benzimidazoles?
Liquid
What has the best concentration of the benzimidazoles?
Pellets
Where do benzimidazoles primarily work?
Within the gut
What is an issue with imidazothiazoles?
Narrow margin of safety
What does levamisole not work on?
Cestodes or trematodes
What is the mechanism of action of imidazothiazoles?
Cholinergic agonist at synaptic acetylcholine receptors on nematode muscle cells
What is the main difference between levamisole and pyrantel?
Levamisole has a narrow margin of safety
What is a cestodicide?
Praziquantel
What are cestodicides effective against?
Cestodes
What is the outcome of chronic fascioliasis?
Biliary hyperplasia and fibrosis
What is fascioliasis?
A zoonotic fluke
What is the life cycle of fascioliasis?
Immature fluke penetrates bowel wall and migrates to liver in 4 days
How long does it take for fascioliasis to mature?
8-12 weeks
What does acute fascioliasis cause?
Liver failure with jaundice
Clostridial disease
Once the fascioliasis is mature, what happens?
Penetrates bile duct leading to chronic fascioliasis
What is a bad, common sequela post-choke?
Aspiration pneumonia
What are macrocyclic lactones effective against?
BOTH endo and ectoparasites
How can you treat adult flukes?
Albendazole and benzensulfonamides
What macrocytic lactones are used most commonly world wide?
Avermectins and milbemycins
What do macrocytic lactones not work against?
Tapes and flukes
What is a drug that kills both endo and ectoparasites?
Endectocides
What is a common symptom of choke?
BILATERAL nasal discharge
What is the MOA of macrocyclic lactones?
Paralytic effects through GABA/glutamate gated Cl- channels
What uncommon clinical sing is seen in a guarded prognosis for choke?
Subcutaneous emphysema
What is an uncommon motility disorder in horses but is over represented in Friesian horses?
Megaesophagus
**What can you NOT use in food animals in the US?
Nitroimidazoles
With an esophageal tube, what should you lavage with?
ONLY WATER
What is the most common esophageal disorder in horses?
Choke
What should you sedate a choke horse with?
Alpha-2 or and opioid
What do you want to make sure happens during treatment of choke?
That there is a low head carriage
What drug do you use to relax the horse’s esophagus during choke?
Buscopan
3 ways you can prevent choke?
Soft, good-quality feed
Slower feeding
Adequate dental care
What is the most common tumor of the esophagus?
Squamous cell carcinoma
What is the volume of an average adult horse’s stomach?
8-12L
What is a dietary modification used after a choke case?
A mash, soak food in H2O
is the squamous or glandular easier to treat?
Squamous is easy to treat, glandular is hard to treat
What should you avoid as analgesia for choke cases?
NSAIDs (ulcer)
What are the types of equine gastric ulcer syndrom?
Equine squamous gastric disease
Equine glandular gastric disease
Why are race horses more at risk of equine squamous gastric disease?
Because the horse is continuously sloshing around the stomach
What is EGUS?
Equine gastric ulcer syndrome
What are 3 gastric mucosal protective factors?
Mucosal blood flow
Mucus (rich in bicarb to help neutralize acid)
Continuous grazing
What are drugs available to reduce pH of stomach
Omeprazole
Why does high concentrate feed increase risk of EGUS?
Products of fermentation are acidic
Is glandular or squamous on the top?
Squamous
Where is the #1 site for ESGD?
Margo plicatus
What can be a cause/exacerbate equine glandular gastric disease?
NSAIDs
What is ptyalism
Excess salivation
What is a diagnosis of EGUS?
Gastroscopy
How long do you treat a foal with EGUS?
28 days
Does aloe vera work?
YES!
What is the limitation to buffers for treatment of gastric ulcers in horses?
Need to be administered every 2 hours
What is DGE in foals?
diffuse gastric erosion
What should be available at all times to a horse with known EGUS?
Roughage (hay, grass)
What “phenomena” is associated with lumpy jaw?
Splendore-Hoeppli
How can you treat actinomycosis?
Penecillin, sodium iodide
***How do you treat a gastric impaction in horses?
Lavage!!! (Diet coke)
What gross looking bug is found in the wall of horse GI?
Gasterophilus intestinalis (ivermectin)
What is a common foreign body on the west coast of cows’ pharynx?
Foxtails
What bacteria is lumpy jaw?
Actinomycosis
What is a parasite that causes choke in bovines?
hypoderma esophagitis
What is actinomycosis
Hard, non-painful swelling of the bone
What bacteria is wooden tongue/
Actinobacillus
What is wooden tongue?
Tongue thickened, hard, protrudes from the mouth
Where do hypoderma lineatum live?
Migrate around esophagus
What is necrotic laryngitis?
Calf diptheria
What age does calf diptheria onset?
3-20m
What bacteria causes calf ciptheria
Fusobacterium necrophorum
Where do hypoderma bovis live?
Along spine
What is necrotic laryngitis?
Acute infection of laryngeal mucosa and cartilage of young cattle
What is the treatment for necrotic laryngitis?
NSAID
Penecillin
Tracheostomy (if needed)
What is the treatment for pyrrolizidine alkaloid toxicity?
Change in feed (highly palatable feed)
NSAIDs
SAMe
Keep out of sunlight - precent photosensitization
Remove from pasture - prevent continued exposure
What is pyrrolizidine alkaloid toxicity?
Toxin from plant consumption
What is treatment for ascending cholangiohepatitis?
Antibiotics
What is treatment of hepatic encephalopathy?
Dextrose
Fluid therapy
Mineral oil (intestinal lube)
Oral antibiotics (reduce ammonia production)
Lactulose
What is Tyzzer’s
Clostridium piliforme
How do you treat Tyzzer’s?
Euthanasia
How can you TRY to treat Tyzzer’s?
Penecillin and tetracycline
Plasma infusion
Fluids + dextrose
What is the overarching goal of treating hepatic encephalopathy in horses?
Antibiotics to reduce ammonia production (metro)
Lactulose (decrease intraluminal pH)
Cathartics (mineral oil, lactulose, sodium sulfate, magnesium sulfate)
What is bilirubin?
Digest heme
What is pre hepatic jaundice?
Hemolytic
What is anisocytosis?
RBC are different sizes
What do different size RBC mean?
It is regenerative
Wehre is bilirubin conjugated?
Liver
Where is the obstruction in intrahepatic jaundice?
Within the liver
Where does conjugated bilirubin go?
Into the intestine
Where is urobilirubin excreted?
Either in intestine or renal
What does extra hepatic jaundice mean?
Liver is likely fine but obstruction in bile duct
Where does conjugated bilirubin go normally?
Out bile duct into urobilirubin
What are causes of hepatic jaundice?
Inflammation
Lipidosis
FIP
Lymphoma
Hepatotoxicity
What causes post-hepatic jaundice?
Pancreatitis
Cholecystitis
Cholelithiasis
Biliary mass
What does a left shift on blood work mean?
Inflammation/infection
What is the most liver specific liver enzyme?
ALT
If no hemolysis is seen on CBC what will there be a lack of?
Low RBC
What is a cholestatic patter?
Increased ALP proportionally to ALT
Normal GGT!
What do the RBC look like in hepatic lipidosis?
Poikilocytosis
How does the liver appear on ultrasound of a lipidotic cat?
Hyperechoic
What are the 3 types of cholangitis?
Neutrophilic
Lymphocytic
Chronic
What is neutrophilic chonagitis?
Ascending biliary bacterial infection (anaerobes, G(-))
What transitions cholangitis to cholangiohepatitis?
Necrosis of hepatocytes beyond limiting plate (into liver)
What is triaditis in cats?
Pancreatitis
IBD
Cholangitis
How do you treat neutrophilic cholestatic liver disease in cats?
Antibiotics (ampicillin and metro)
UDCA
SAMe
Vit K (coagulation)
Food
Fluids
What do you treat lymphocytic cholestatic disease?
Prednisone (immunosuppression)
UDCA
SAMe
How to treat hepatic lipidosis?
Feed
UDCA
SAMe
What do you need to do prior to placing feeding tube?
Give Vit K to help with coagulation
What does fluid rehydration look like for hepatic lipidosis cats?
No dextrose
No lactate (no LRS)
CAN GIVE COBALAMIN TO HEPATIC LIPIDOSIS CATS AS SUPPLEMENT
What clotting factors does vitamin K activate?
2, 7, 9, 10
Why is there a vitamin K deficiency in liver disease patients?
Intestinal malabsorption
No bile acids for micelle formation and absorption.
What route do you need to give vitamin K supplementation?
Parenteral (just not PO)
What can be a complication of hepatic lipidosis treatment of cats?
Refeeding syndrome
What is refeeding syndrome?
Severe deficiency of electrolytes and fluid shift during refeeding due to insulin release and cell reuptake of glucose, P, K, Mg, and water
What to avoid refeeding syndrome?
Feed slowly, monitor closely with electrolytes and fluid
What is the affect of glutathione
Hepatoprotectant
Antioxidant
Why do we want antioxidant supplementation?
Liver is bombarded with oxidants to filter
What is the affect of SAMe
Hepatoprotectant
Antioxidant
What is the affect of Ursodiol
Hepatoprotectant
What is an extra hepatic biliary obstruction?
Gallbladder mucocele
What does a mucocele look like on ultrasound?
Kiwi
How can you medically manage mucoceles?
Hepatoprotectants
What are the 3 causes of infectious hepatitis in dogs?
Viral
Leptospirosis
Leishmania
What 2 drugs can be used to decrease inflammation associated with chronic hepatitis?
Corticosteroids
Azathiaprine
What 2 drugs can be used to decrease hepatic copper associated with chronic hepatitis?
Penicillamine
Zinc
What 2 drugs can be used to decrease oxidant injury associated with chronic hepatitis?
SAMe
Vit E
What drug can be used to promote choleresis associated with chronic hepatitis?
Ursodiol
What part of the lab work is increased in Cu associated liver disease?
ALT (hepatocellular injury)
What is the difference between acute liver disease and acute liver failure?
Failure includes hepatic encephalopathy and coagulopathy
What is the number 1 cause of acute liver injury?
Drugs and toxins
What is one of the highest risk drugs of acute liver injury?
Acetaminophen
What is the treatment for acute liver injury?
Supportive care
What are the 5 lobes of the liver (from left to right)?
Left lobe
Quadrate
Right medial
Right lateral
Caudate
What 2 lobes of the liver is the gallbladder located between?
Quadrate and right medial
What are the 2 lobes of the caudate?
Papillary process
Caudate process
What are the 2 afferent vessels entering the liver?
Portal vein
Hepatic artery
What is the efferent drainage of the liver?
Caudal vena cava
What are the 5 ligaments within the liver?
Right and left triangular
Coronary
Hepatorenal
Falciform
Lesser omentum
What is the sphincter around the major duodenal papilla?
Sphincter of Oddi
Since dogs have major and minor duodenal papilla, what pancreatic duct combines with the common bile duct?
Minor pancreatic duct
What are 6 indications for liver surgery?
Portosystemic shunt
Liver torsion
Neoplasia (focal lesion)
Elevated bile acids
Trauma
Hepatopathy
What are 6 indications for extra hepatic biliary surgery?
Pancreatic disease (can block duct)
Neoplasia
Gallbladder mucocele
Cholelithiasis
Bile peritonitis
Biliary obstruction
What are 2 examples of topical hemostatics?
Gelatin (foam)
Cellulose (mesh)
What are ways to take a biopsy of the liver?
TruCut
Laparoscopically
Guillotine
Punch
Lobectomy
What should you avoid when dealing with liver biopsies or surgeries?
NSAIDs
What should be done after hepatic surgeries?
NG tube places for feed
How often do you check weights post liver surgery?
Every 8 hours
What is the #1 cancer of the pancreas?
Insulinoma
Why would you perform surgery in a pancreatitis case?
To confirm diagnosis
Often to treat local complications, not primary disease
When would you consider surgery for pancreatic pseudocysts?
If persistent clinical signs and failure of other techniques
What is the significance of the blood supply to the pancreas?
There is common bloody supply to both the pancreas and duodenum so compromise to it may require resection of duodenum
What is the surgery for rerouting the biliary duct?
Cholecystoenterostomy
What is an important peri-operative concern for insulinoma surgery?
Hypoglycemia
3 Main pancreatic surgeries?
Mass enucleation
Pancreatic biopsy
Partial pancreatectomy
***What limb of the pancreas is preferred if needing a biopsy?
Distal right limb
What is the distal right limb preferred for biopsy?
Readily accessbile
Avoids pancreatic duct
Vascular supply to other organs is preserved
What 2 techniques are there for pancreatic biopsy?
Blunt dissection
Suture fracture
REASONS FOR PANCREATECTOMY: NEOPLASIA, ABSCESS, PSEUDOCYST
UP TO 90% OF PANCREAS CAN BE REMOVED
What is most common complication associated with pancreatic biopsy?
Pancreatitis
Is surgical intervention of insulinoma usually curative?
No (metastasis)
What will damage to pancreatic duct cause?
Exocrine pancreatic insufficiency
What can be a complication associated with glucose regulation of insulinomas?
Can quickly switch from hypoglycemia is hyperglycemia (diabetes mellitus!!!!)
What is a risk factor for constipation to keep in mind?
Electrolyte derangements
(hypokalemia / hypercalemia)
What is most important factor of constipation?
Water intake
What are a couple other contributing factors to constipation?
Medications affecting GI motility
Pain
Dont use opioids
What is the hardest/driest score on fecal scoring?
1
What is cisapride?
Medication used to increase GI motility
What is the initial treatment for megacolon?
Manual deobstipation
What is an alternative treatment to megacolon?
NG tube with CRI of Go-Lytely
What needs to be given in addition to Go-Lytely?
Cerenia
Causes nausea!
What is Go-Lytely?
Osmotic laxative solution (PEG)
Does exercise stimulate peristalsis?
yes
What do laxatives do to electrolytes in bowel?
Move fluids into intestine to promote motility
How does fiber increase bowel movement?
Considered a bulk-forming laxative, stimulates intestinal motility
How can lubricant laxatives be given?
Per rectum
What mechanism of laxative does Go-Lytely and Miralax use
Hyperosmotic laxative
What is hyper osmotic laxative?
Transitions fluid across gradient into intestines to promote motility
What drug is most commonly used for colonic motility?
Cisapride
What is proctitis?
Inflammation of rectal mucosa
How to treat proctitis?
Dietary changes, steroids
How do you treat a perineal hernia?
Surgical correction
What causes rectal prolapse?
Chronic tenesmus (straining)
What is the treatment for rectal prolapse?
Manual reduction + purse string
What is treatment for rectoanal stricture?
Balloon dilation
What is perianal fistula?
Gross rectal disease with holes
What dog breed gets perianal fistulas the most?
German shephards
What is the treatment for perianal fistulas?
Oral cyclosporine
Antibiotics if secondary infection
Increase fiber diet
How to treat anal sac abscess?
Clip, clean, flush
Antibiotic therapy
What is cyclosporine?
an immunosuppressive agent
Is constipation and obstipation the same thing?
NO!
What is a true hernia?
Through a natural opening
What is a false opening?
Traumatic/paramedian
Not a natural opening
Where does a hiatal hernia come through?
Esophageal hiatus
What is type 1 hiatal hernias
Intermittent movement of gastroesophageal junction into thoracic cavity
Is a hiatal hernia true and congenital?
Yes
When do you most often see type 1 hernias?
BOAS
What is type 1 hernia?
Sliding hiatal hernia
What is the medical management of hiatal hernia?
Reduce gastric acid secretion and protect esophageal mucosal protection
What can be surgical management of type 1 hiatus with BOAS?
Tie back (unilateral arytenoid lateralization)
Is surgical or medical management chosen first?
Medical management
What are the 3 surgeries for hiatal hernias?
Diaphragmatic hiatal reduction
Esophagopexy
L sided gastropexy
When is surgical management considered?
When medical management fails
What are the 3 phases of gastric acid secretion?
Cephalic
Gastric
Intestinal
What is secreted in gastric phase?
Histamine (stretch receptors)
What is secreted in the cephalic phase and what secretes it?
Acetylcholine
Parasympathetic
What is secreted in intestinal phase?
Gastrin (G cells, peristalsis to intestines)
What inhibits gastrin acid secretion (G cells)
Somatostatin
What cell is involved in gastric phase of gastric acid secretion?
ECL cells
What are 3 receptors that are targeted by antacids?
Histamine - H2 receptor antagonists
Prostaglandin - Misoprostol
ATPase - Proton pump inhibitor
What are some examples of antacids?
Aluminum hydroxide
Calcium carbonate
Magnesium hydroxide
What is the mechanism of action of antacids?
Decrease pepsin, stimulates local prostaglandin
What is the clinical efficacy and use of antacids
Rapid onset but short acting
Insufficient evidence for GUE or GERD
What is an adverse effect of antacids?
Interferes with PO drug absorption
What do the H2 receptors secrete?
Gastric acid
What is the mechanism of action of H2 blockers
Block histamine receptor so no gastric acid can be secreted by the parietal cells
What is the onset/resistance of H2 blockers?
Works 3-13 days before tolerance is built up
What are 3 examples of H2 receptor blockers?
Cimetidine
Ranitidine
Famotidine
Which of the H2 receptor blockers are resistant in dogs and cats?
Ranitidine
Are H2 receptor antagonists or PPIs better?
PPIs
What are 4 PPIs?
Omeprazole
Pantoprazole
Esomeprazole
Lansoprazole
When are PPIs most effective?
When taken shortly before a meal of with a meal
What is the MOA of PPIs?
Targets final pathway by binding the PPI and inhibiting it from releasing hydrogen, thus increasing pH
How often must a PPI be taken?
2x/day
Does administration of both an H2 receptor antagonist and PPI help?
No, may make it WORSE
What is an adverse affect of PPIs?
Intestinal dysbiosis
What is misoprostol?
A prostaglandin analog
Does prostaglandin increase or decrease gastric acid secretion?
Decrease
What are 3 adverse affects of misoprostol?
Abdominal pain
Diarrhea
Abortion
What is misoprostol good for?
Effective at decreasing gastric lesions association with high aspirin dosage
How do you give sucralfate?
Slurry
What does sucralfate do?
Interferese with pepsin (acidic)
When should you not give sucralfate?
To a consipated patient (aluminum)
WHAT IS SOMETHING TO BE REALLY AWARE OF WITH SUCRALFATE?
DECREASED BIOAVAILABILITY WITH MANY DRUGS
What does GUE stand for?
Gastroduodental ulceration and erosion
What is the standard of care for GUE?
PPIs
Is there evidence for prophylactic use of gastroprotectants in dogs and cats with non erosive gastritis?
No
Does hepatic disease cause GUE?
yeah
When should you start gastroprotectants?
With it is associated with GI bleeding
What is SRMD?
Stress-related mucosal damage
What is beneficial to working dogs?
They have SRMD and use of PPIs may benefit to decrease SRMD
Can renal disease cause GUE?
Yes, rarely
Is there evidence to support prophylactic use of gastroprotectants in kidney disease animals (IRIS 1-3)?
No
Same thing goes with pancreatitis. Basically dont use gastroprotectants unless there is evidence of GUE
GI bleeding is common with immune thrombocytopenia
How do PPIs help with reflux esophagitis?
Doesn’t decrease amount of pepsin but just increases the pH
Why is IVDD associated with GI issues?
Because of the high use of steroids
Basically, use PPIs with GUE, SRMD, reflux esophagitis otherwise there is no reason to treat prophylacticly treat (hepatic is a maybe)
What does GERD stand for?
Gastroesophageal reflux disorder
What are the 3 options for treatment of GERD?
Acid suppression
Close LES
Promote gastric emptying
What is the best treatment of GERD?
Acid suppression
What are the 2 options for increasing LES tone and promote gastric emptying?
metoclopramide
cisapride
What part of the GI tract does cisapride act on?
The whole thing
What part of the GI tract does metoclopramide act on?
Just the pylorus and proximal duodenum
what are the 2 affects of misoprostol?
Acid suppression and cytoprotective effects
If PPIs are administered for more than 4 weeks, what needs to be done?
Need to taper to prevent a rebound gastric acid hyper secretion
What is sucralfate affective at doing?
Adhering to ulcerated/damaged mucosa
What is the myenteric reflex?
Intestinal contraction behind bolus and relaxation in front
What (again) are the top 2 promotability drug in dogs?
Metoclopramide and cisapride
What is the MOA of metacopramide?
Increase release of acetylcholine which increases contraction of circular muscles
What is an additional benefit of metoclopramide?
Anti-emetic
Can you use metoclopramide in obstructions?
NO!
Can you use metoclopramide in vomiting disorders?
Yeah but make sure it isnt an obstruction
Is cisapride or metoclopramide more potent?
Cisapride
Is cisapride an antiemetic
No
Which pro kinetic acts upon the whole GI tract?
cisapride
What is a last resort pro motility that can be used?
Erythromycin
Does the erythromycin have an antimicrobial effect?
no its at a lower dose than antimicrobial
Does erythromycin have an affect on the colon?
YES!!
Can you use erythromycin on a cat?
NO!!!
What is the MOA of erythromycin?
Binds the motilin receptor
What does MrMRE stand for?
Microbiota related modulation responsive enteropathy
What was commonly prescribed for decades for acute and chronic diarrhea?
Antibiotics
What is the treatment of MrMRE?
Biotic drugs (pre, sym, pro)
Do you withhold food doe acute diarrhea?
No!!!
What should you be aware of when searching for psyllium supplementation?
No xyllazine in formulation
What is her best way to treat diarrhea?
Fiber
What modifications can you potentially give for acute diarrhea?
Highly digestable
Low-fat
Fiber-enriched
What is the best source of fiber?
Psyllium husk
What is a synbiotic?
Synbiotics are mixtures of probiotics (helpful gut bacteria) and prebiotics (non-digestible fibers that help these bacteria grow).
What group had the best time to remission of clinical signs after acute diarrhea?
Psyllium group
What is pectin?
A prebiotic fiber
What does an adsorbent do?
Molecules adhere to surface and eliminate
What is koalin?
Aluminum silicate
What are kaolin-pectin products used for?
Acute diarrhea
What is kaolin considered?
An adsorbent
What species should you be cautious using Pepto Bismol in?
Cats (can use in dogs but not best first line)
Can you use motility modifiers to decrease diarrhea?
Yes but not first line
When a motility modifier is used, what should it be?
Loperamid
Atropine causes ileus!
What are the 5 types of infectious diarrhea?
Bacterial
Viral
Protozoal
Fungal
Parasitic
What are a couple antibiotic options for parvo?
Metro
Ampicillin
***What are the 5 treatment options for parvovirus
IV fluids
Anti-emetics
Antibiotic
Fecal transplant
Nutritional support
What do you need to address in IV fluids?
Potassium chloride and hypoglycemia
What is a new treatment for parvo?
Canine parvovirus monoclonal antibody (CPMA)
What is an antibiotic option for outpatient parvo?
Cefovecin
How does CPMA work?
binds virus and doesn’t allow entry into cell
How long does a parvo pup need to be isolated?
1 week
What is FIP mutated from?
Feline coronavirus
What rate does coronavirus mutate into FIP?
10%
New product may make FIP treatable
What is the product that makes FIP treatable?
GS-441524 (GS-44)
How is GS-44 given?
Oral preferred but also injectable
How effective is GS-44
Nearly 100%
What is a side effect of GS-44?
Urolithiasis of stone made from the drug
What are the 3 protozoal enteritis?
Giardia
Tritrichomonas
Coccidiosis
Does all giardia need treated?
Nope
What is treatment for giardia (3 things)
Fenbendazole
Metro
High fiber diet
Does the giardia vaccine work?
Unlikely
How does tritrichomonas present?
Chronic waxing-waning large bowel diarrhea
What off label treatment has been reportable working for tritrichomonas?
Ronidazole
What is #1 bacterial cause of diarrhea in cats and dogs?
Histo
What are the 2 options to treat histo?
Itraconazole
Fluconazole (both azoles)
What are 2 side effects of treating histo?
GI upset
Hepatotoxicity
What does itraconazole require?
Needs to be given with food
***WHAT IS SUPER IMPORTANT ABOUT WHERE YOU GET ITRACONAZOLE?
MUST BE NAME BRAND OR GENERIC
(not compounded)
What is a different treatment if you can’t give an azole for histo?
Amphotericin B
What are most bacterial etiologies for acute diarrhea?
Self-limiting
What is the only acceptable bacterial enteritis to use antibiotics with?
E. coli
What is best treatment of E coli?
Enroflaxacin (Baytril)
What diet do you provide if it is just mild esophagitis?
Smaller, fat restricted meals
How do you treat a moderate to severe esophagitis on top of PPIs?
Prokinetics too
After esophageal foreign body, what do you need to treat for?
Stricture
How can you treat an esophageal stricture?
Balloon dilation (needed multiple times about every 5 days and average is 3 times)
What is a B tube?
Its an indwelling balloon dilation that allows owners to dilate the balloon at home to help fix a stricture
What is an option for refractory cases of esophagus stricture?
A stent
What is a vascular ring anomaly that causes esophageal obstruction?
Persistent right aortic arch (PRAA)
How do you treat persistent right aortic arch?
Surgically
Wha tis the second most common cause of megaesophagus (behind myasthenia graves)
Addison’s (hypoadrenocorticism)
What is the treatment for megaesophagus?
Treat underlying cuase
What is treatment of chronic gastritis?
Hypoallergenic diets or hydrolyzed diets
What is a bacterial cause of chronic gastritis?
Helicobacter
Does helicobacter always cause gastritis?
No! Sometime normal microflora
How to treat helicobacter?
Antbx
What is physaloptera?
Nematode - Stomach worm
How to treat physaloptera?
Fenbendazole
How do you treat chronic gastritis from bilious vomiting syndrome?
Late night meal
What do you want to avoid to avoid gastric ulcers?
Concurrent NSAIDS and Steroids
How do you treat hairballs?
Key to treatment is prevention… Manage coat with diets, daily grooming, gastric lubricants, promotability
Which radiograph should you take to differentiate food bloat from GDV
Right lateral
What is treatment of food bloat?
IV fluids and pain management
Is acute gastritis usually self-resolving?
Yes
Why do NSAIDs cause ulcers?
They inhibit the production of prostaglandin which is part of the wall
What is functional gastric motility disorder considered?
A diagnosis of exclusion
What are the 3 key signs of GDV?
Non-productive retching, abdominal distention, and tachycardia
How long will food bloat take to resolve?
24-48hrs
What are the 4 vomiting centers?
Cerebral cortex
Vestibular
Abdominal Viscera
Chemoreceptor trigger zone
What are the receptors of the vomtijgn center?
5-HT3
NK1
Alpha
What are the receptors of the viscera?
5HT3 (serotonin)
What are the receptors of the CRTZ?
D2 (dopamine) and Norepinpehine (alpha2)
What are the receptors of the vestibular apparatus?
Cat: Acetylcholine (M1)
Dog Histamine (H1)
What fluids do you want to give with metabolic acidosis?
LRS
What fluids do you want to give with metabolic alkalosis?
Sodium chloride
What is the drug name of cerenia?
Maropitant
What blocks the NK1 (substance P)
Maropitant
What blocks the 5-HT3 (Serotonin)
Ondansetron
What blocks the D2 (dopamine)
Metaclopramide
What blocks the alpha 2 (norepinephrine)
Chlorpromazine
What blocks the H1 (histamine)
Diphenhydramine
What induces vomiting (agonist) of dopamine in dogs?
Apomorphine
What induces vomiting (agonist) of alpha2 - norepinephrine in cats?
Xylazine or dexmedetomidine
What induces vomiting (agonist) of histamine?
Hydromorphone (dog)
What are 3 common causes of chronic diarrhea?
Parasites
Exocrine pancreatic insufficiency
Addison’s
How do you treat EPI?
Pancreatic enzymes
Is a specific diet needed in EPI?
No
What are the 3 steps for chronic diarrhea?
Diet
Microbiota
Immunomodulation
Are all food reactions from food allergies?
NO!
What are most common food allergens?
Beef, dairy, chicken, wheat, fish
What are hydrolyzed diets?
Reduced protein size -> reduced allergenicity
What are options for food trial/treatments?
Limited antigen
Highly digestable
Low fat
Fiber enriched
Home cooked
Which disease are low-fat diets especially effective in?
PLE from lymphagectasia
What is something that will be noticed when you start feeding a more digestible diet?
Less pooping
What needs to be supplemented in diets?
Cobalamin
What is insoluble fiber used for?
Bulking agent
What will the poop with insoluble fiber look like?
More and harder poop
What are the 5 immunomodulatory agents that can be used for treatment of intestinal disease?
Pred
Budesonide
Cyclosporine
Chlorambucil
Mycophenloate mofetil
Azathioprine
What is the gastric slip?
Mucosa + submucosa falling away from muscularis and serosa
When is tensile strength at its lowest (aka the lag phase)
3-5 days after surgery
When is the highest risk of dehiscence?
3-5 days post op
What cells produce collagen?
Both fibroblasts and smooth muscles
What do gastric surgical patients usually have with their electrolytes?
Low Na, Cl, K due to stomach acid loss
What 3 things must be done pre op?
Correct dehydration
Correct electrolytes
Fasting
How thick are bites through the stomach?
Full thickness!
What type of blade is used for stomach incision?
11
Should you use your hands within the lumen of the stomach?
No, use tools
Can you double dip on stomach surgery?
No!
What are the 2 options for closure?
single or two layer closure
If using a single layer closure, what are the bites?
Full thickness
If using a two layer closer, what does it look like
Mucosa and submucosa = simple continuous
Muscular and serosa = inverting pattern (cushings)
What NEEDS to be done pre-op for GDV?
Shock dose of fluids
Which side of the dog do you stand on for GDV?
Right hand
What is the pulling/pushing for GDV?
Grab pylorus with right and pull toward ceiling
Push body to the left with left hand
What are the 4 things to evaluate color in GDV surgery?
Color
Thickness
Pulsation
Peristalsis
With an incisional gastropexy, where is the cut made?
In the pyloric antrum
How deep is the cut?
Partial thickness!
Where is the body wall made for incisional gastropexy?
On the RIGHT body wall caudal to 13th rib
What are the 5 types of gastropexys?
Incisional
Belt loop
Circum-costal
Incorporating
Laparoscopic
Are antibiotics needed post op for GDV?
Not normally
What is the largest part of the small intestine?
Jejunum
What artery does most all of the blood supply for intestines come from?
Cranial mesenteric artery
How do you tell the difference between jejunal and colonic vessels?
Jejunal are web-like
Colonic are parallel
Is colonic return of strength slower or faster than small intestine?
Slower
What do you increase pre-op as you move more distally?
Use of antibiotics (more bacteria)
What antibiotic is good to be used in both stomach and intestinal surgeries?
Cephalosporins
Which direction of foreign body do you make the incision?
Aborally
What do you do after an enterotomy to ensure adequate closure?
A leak test
How do you perform resection and anastomosis?
Isolate bowel with crushing forceps (on inside part)
Occlude bowel with non crushing (on outside part)
What clamps are used for non-crushing?
Doyens (one click)
What are 5 tips to resolve luminal disparity?
Angling clamps
Suture placement
Spatulate intestine
Luminal reduction
Stapler
Where os most common anchor place for a linear foreign body in dog and cat
Dog: Pylorus
Cat: Underneath tongue
What are 2 causes of intussusception?
Neoplasia
Parasites
What percent results in short bowel syndrome?
50-80%
What needs to be done 12-24hrs after surgery?
Feeding (NG or enteral)
