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DiBartola - Gautier > Chapter 18 - Fluid and electrolyte disturbances in gastrointestinal and pancreatic disease > Flashcards

Chapter 18 - Fluid and electrolyte disturbances in gastrointestinal and pancreatic disease Flashcards

1
Q

T/F: CFP is a more sensitive marker of inflammation than white cell count

A

True

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2
Q

What are the two factors appear to be largely responsible for activation of the coagulation cascades secondary from pancreatitis?

A

Activated factor 12 (Hageman’s factor) and trypsin

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3
Q

T/F: hyperglycemia and glucosuria are especially frequent in cats with pancreatitis, but ketonuria is infrequent, suggesting that stress may be a more common cause of these abnormalities than diabetes mellitus

A

True

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4
Q

T/F: hypoproteinemia is more common in cats with acute pancreatitis than in dogs

A

False (Dog > cat)

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5
Q

What’s the cause of hypoproteinemia from pancreatitis?

A

intrapancreatic and peripancreatic exudation of albumin

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6
Q

Surgical intervention and aggressive postoperative care may be necessary for which group dogs with pancreatitis?

A

EHBO or pancreatic abscessation

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7
Q

Which product was shown to improve pancreatic microcirculation in dogs with experimental pancreatitis?

A

dextran-containing solutions (than crystalloids)

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8
Q

Which product was shown to maintain pancreatic microcirculation in cats with experimental pancreatitis?

A

low dose dopamine infusion

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9
Q

What are the thoughts behind giving FFP as a treatment of pancreatitis?

A

replenish antiproteases, primarily alpha-macroglobulins, that are lost during the inflammatory process

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10
Q

What are the reasons FFP is not advocated as a treatment of pancreatitis in dogs?

A

lack of benefit, higher mortality in dogs received FFP that received FFP. Pre-existing illness, evidence of SIRS, and presence of coagulopathy were not significantly different between the groups did and did not receive FFP

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11
Q

Why heparin might be warranted in the early stages of acute pancreatitis?

A

To delay development of DIC.

Decreases the risk of thromboembolic events by cleaning lipemia

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12
Q

What are the major benefits of enteral support in human and experimental dogs with acute pancreatitis?

A
  1. reductions in SIRS

2. reduction of translocation of enteric bacteria

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13
Q

The most common cause of extraluminal cause of obstruction?

A

intussusception

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14
Q

What are the major mediators (hormones) of gastrointestinal secretion?

A

Acetylcholine and vasoactive intestinal polypeptide (VIP)

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15
Q

What are the principal regulators of gastrointestinal absorption?

A

Norepinephrine, somatostatin, and opioids

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16
Q

T/F: Luminal osmolality is normally lower than plasma osmolality

A

F - Luminal osmolality is normally maintained close to plasma osmolality

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17
Q

What poorly absorbed cation can lead to osmotic diarrhea?

A

Magnesium

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18
Q

By which mechanisms does inflammation result in fluid loss?

A

Inflammation can lead to mucosal ulceration, exudation of protein, motility dysfunction, and loss of absorptive surface area, all of which can result in intestinal fluid loss

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19
Q

Give examples of secretagogues (stimulate secretion in the GI tract)

A
  • Adenosine, serotonin, and histamine
  • Oxidants
  • Cytokines
  • Arachidonic acid and eicosanoids
  • Platelet-activating factor
  • Substance P
  • Kallikreins
  • Bradykinin
  • Escherichia coli heat-labile enterotoxin and enterotoxin
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20
Q

What can stimulate the vomiting center in the reticular formation of the medulla oblongata?

A
  • The chemoreceptor trigger zone (CRTZ), itself stimulated by blood-borne substances, or neurologic input from the vestibular nucleus
  • Disease or irritation of the GIT, abdominal organs, or peritoneum and cerebral diseases
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21
Q

What are the sequence of events that happens when the vomiting center is stimulated?

A

This sequence of events includes inhibition of proximal gastrointestinal motility, a retrograde power contraction in the small intestine, and antral relaxation, which enables the transfer of intestinal contents to the stomach followed by moderate-amplitude contractions in the gastric antrum and intestine, and shortening of the intraabdominal esophagus

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22
Q

What are the ions lost when vomiting of gastric and intestinal content occurs?

A

Loss of fluid containing Cl-,K+,Na+, and HCO3-.

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23
Q

What is the most common in dogs with gastrointestinal disease?
Metabolic alkalosis or acidosis?

A

Metabolic acidosis is generally more common than metabolic alkalosis in dogs with gastrointestinal disease

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24
Q

How do the kidneys participate to the metabolic alkalosis seen with GI fluid loss?

A

Metabolic alkalosis is self-perpetuating because of increased renal reabsorption of NaHCO3 in the presence of volume, chloride, and potassium depletion

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25
Q

What are the pathomechanisms of diarrhea

A

The pathomechanisms in patients with diarrhea include increased intestinal secretion, decreased intestinal absorption, rapid transit of intestinal contents, and mesenteric, vascular, or lymphatic disease

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26
Q

What are the fluid and electrolyte abnormalities associated with diarrhea?

A

The fluid and electrolyte abnormalities associated with diarrhea include volume depletion, hyponatremia or hypernatremia, hypokalemia, and metabolic acidosis (characterized by hyperchloremia and a normal anion gap caused by loss of diarrheal fluid with relatively low chloride and high bicarbonate concentrations)

27
Q

What is the percentage of dogs with hypoadrenocorticism that have normal mineralocorticoid function and normal Na+/K+ ratio?

A

26%

28
Q

What is the Na+/K+ ratio that may be indicative of Addison’s disease?

A

Less than 27:1

29
Q

What other diseases other than Addison’s disease may cause Na+/K+ ratio less than 27:1 and metabolic acidosis?

A

Trichuriasis, ancylostomiasis, salmonellosis, and perforated duodenal ulcer

30
Q

How does the potassium, sodium and chloride fecal content evolve as diarrhea progresses?

A

As stool volumes increase in human patients with diarrhea, there is a progressive increase in the sodium and chloride concentrations and a decrease in potassium concentration

31
Q

What are the different factors that contribute to hypokalemia in dogs with GI diseases?

A

Potassium depletion may be a consequence of prolonged diarrhea, vomiting, or anorexia

32
Q

What are the possible electrolyte derangements induced by IV sodium bicarbonate therapy?

A

Cerebrospinal fluid acidosis, aggravation of hypokalemia, or hypocalcemia.

33
Q

T/F: Oral rehydration is not recommended for dogs with GI diseases and epithelial damage

A

F - the epithelium maintains its absorptive capacity and cotransport processes that are important for the success of oral rehydration therapy. With certain viral causes of diarrhea (e.g., rotaviral infection in children), patchy epithelial damage may allow oral rehydration to be of benefit

34
Q

What components of oral rehydration solutions used instead of glucose may result in decreased volume and duration of diarrhea?

A

ORSs containing complex carbohydrates or glucose polymers in place of glucose (more glucose residues without delivering a high osmotic load to the intestinal lumen)

35
Q

What are the inconvenients of Pedialyte used as an oral rehydration solutions?

A

Commercial solutions such as Pedialyte are readily available but usually contain too much glucose and too little sodium and carry some risk of hypertonic diarrhea

36
Q

What are the clinical advantages seen when dogs with parvovirus disease are fed through NG tubes as soon as possible?

A

In one study, dogs with parvovirus infection experienced increased weight gain, shorter hospital stay, decreased morbidity, and a trend toward decreased intestinal permeability (a risk factor for bacterial translocation and endotoxic shock)

37
Q

T/F: dogs that received eicoimmunonutrition (probiotics) followed by enteral nutrition did better than dogs that did not receive eicoimmunonutrition and only enteral nutrition

A

T

38
Q

How much fluid does the GIT absorb?

A

99%

39
Q

Where does most of the fluid absorbed in the GIT come from?

A

Derived from endogenous secretions

40
Q

How much fluid is secreted endogenously (in terms of blood volume)?

A

1.5-2 blood volumes

41
Q

What is the term used for the surge in gastric acid secretion increasing bicarbonate concentration?

A

Alkaline tide

42
Q

How does the concentration of K and Cl in the gastric juice compare to the plasma levels?

A

They are both higher

43
Q

What is the concentration of K and Cl in the gastric juice?

A

K: 10-20mEq/L
Cl: 120-160mEq/L

44
Q

What is the difference in the bile ducts of cats and dogs?

A

The CBD of the dog opens near the minor pancreatic duct at the major duodenal papilla and the accessory pancreatic duct opens a few inches distally, in cats, the pancreatic duct fuses with the CBD before entering the duodenal papilla (This is why pancreatitis in cats often influences bile flow causing obstruction and icterus)

45
Q

What cells of the pancreas are responsible for the synthesis of the digestive enzymes?

A

Pancreatic acinar cells

46
Q

What cells of the pancreas are responsible as being the major source of fluid and electrolyte secretion?

A

Cells lining the ductular system

47
Q

Entry of gastric acid secretion causes the pancreas to do what?

A

Secrete an alkaline solution into the gut

48
Q

What hormone is the principal mediator of pancreatic fluid and electrolyte secretion?

A

Secretin (from the secretin secreting cells)

49
Q

What causes the release of secretin?

A

Acidification of the proximal small intestine

50
Q

What protein is necessary for absorption of cobalamine?

A

Intrinsic factor

51
Q

T/F: Dogs produce intrinsic factor in the stomach.

A

True

52
Q

T/F: Cats produce intrinsic factor in the stomach.

A

False

53
Q

What two hormones produced by the pancreas also decrease pancreatic secretion?

A

Glucagon and somatostatin

54
Q

In a dog, where is most of the fluid that is presented to the intestines absorbed?

A

Jejunum (with ileum a close second!)

55
Q

What percentage of water presented to the GIT is lost in the feces?

A

1%

56
Q

T/F: The absorption of water is passive in the small intestine.

A

True

57
Q

T/F: The absorption of water is passive in the large intestine.

A

True

58
Q

What term is used to describe solute movement secondary to water flow?

A

Solvent drag

59
Q

What transporter drives the net absorption of both Na, glucose and amino acids?

A

Na/K ATPase

60
Q

In the small intestine, is most K secretion active or passive?

A

Passive

61
Q

T/F: The contents of the ileum and colon are normally alkaline.

A

True

62
Q

What are the primary anions in the colon?

A

Short chain fatty acids generated by bacterial metabolism of carbs and protein

63
Q

Name the short chain fatty acds that are the primary anions in the colon.

A

Acetate, butyrate and proprionate

DiBartola - Gautier (11 decks)

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