Clinical Approach to GI Disease

Question 1

What are the common signs of GI disease?

Are these signs specific

Answer 1

none are specific to GI disease e/c dyschezia

Question 2

A dog presents with vomiting. What are the key questions to ask?

Answer 2

1) the presence of food in the vomitus and its state of digestion
2) the temporal relationship of vomiting to eating
3) the presence of mucus, bile or blood, and
4) the color and consistency of the vomitus.

Question 3

Vomiting results from the stimulation of what that ultimately affects the emetic center?

Answer 3

higher brain centers

cerebellum

CRTZ (drugs/toxins)

viscera

extra-viscera sources (aka metablic/endocrine/systemic disease)

Question 4

If a dog presents for vomiting 10-14 hrs after a meal, what two general reasons could be causing this?

Answer 4

gastric outflow obstruction

decreased secretion & motility

Question 5

What does in the vomit indicate:

bile

blood

Answer 5

bile→ reflux duodenal content & possible reflux gastritis

blood→ disruption of the mucosal barrier

Question 6

What are the key differences between regugitaiton and vomiting?

Answer 6

Question 7

What is the difference in regugitated material and vomit?

Answer 7

regurgitated material: often does not smell like vomit & appears undigested

Question 8

What are the general causes of regurgitation?

Answer 8

1. esophageal inflammatory disease
2. Extraluminal esophageal compression
3. intraluminla esophageal obstruction
4. neuromuscular dysfxn

Question 9

How is the clinical approach different for acute vs. chronic diarrhea?

Answer 9

Acute: likely result of a single insult to stomach, proximal GI, or panreas; tx via supportive care

Chronic: rarely self-limiting (>2wks); need to dx

Question 10

If a patient has diarrhea for >2 wks and it remains even with fasting- what type of diarrhea is it?

What is the diarrhea stopped with fasting?

Answer 10

chronic secretory diarrhea

chronic osmotic diarrhea (when food is not in bowel→diarrhea stops)

Question 11

A patient presents with diarrhea where they have accidents in the house because of the level of urgency associated with the diarrhea→ is it likely SI or LI?

Answer 11

large intestinal diarrhea

Question 12

Localized the diarrhea problem if a dog presents with tenesmus and dyshcezia (pain on defecation).

Answer 12

distal colonic, rectal, or anal disease

Question 13

Excessive mucus in the feces suggests what type of intestinal disease?

Answer 13

LI disease

Question 14

What does small-volume feces suggest?

Answer 14

colonic disease

Question 15

A patient presents with 1-3 bowel movements/day→localize the issue to SI/LI?

>5 bowel movements/day?

Answer 15

SI (1-3)

LI (>5)

Question 16

Possible reasons for abdominal pain.

How can these possible cause be localized?

Answer 16

1. GI
2. referred from thoracic cavity or spine
3. related to other viscera

abdominal palpation (often pain is acute and inflammatory)

Question 17

Tenesmus before defecation indicates…

Tenesmus after defecation indicates ….

Other body systems associated with tenesmus?

Answer 17

before: constipations or obstructive colonic lesion
after: colitis

urinary or reproductive tracts

Question 18

A dog presents with pain and crying upon defecation (painful & difficult defecation). What is this called?

What diseases are associated?

Answer 18

dyschezia

perianal fistula, proctitis (inflammation of rectum & anus), rectal tumors & strictures

Question 19

A patient presents with frank blood mixed in with the feces→which indicates what?

What is the blood was on the outside of the feces?

Melena?

Answer 19

mixed: proximal colon lesion
outside: distal colon or rectal lesion

melena= SI or gastric (also epistaxis or hemoptysis)

Question 20

a colon incapable of normal contraction due to dilation from a neuromuscular disorder.

Answer 20

megacolon

Question 21

What is the difference between constipation and tenesmus?

Answer 21

tenesmus: feeling of inability or difficulty in defecating
constipation: absent, infrequent, or difficult defecation

Question 22

What is the term for:

fresh blood in the feces

digested dark red/black blood in the feces

Answer 22

hematochezia

melena

Question 23

Causes of constipation

Answer 23

Question 24

Two causes of flatus?

When is flatus normal?

When is flatus associated with disease?

Answer 24

1. swallowed air
2. maldigestion
   normal: brachycephalics (swallow air), colonic fermentation (soy CHO)
   abnormal: nutrient malabsorption (colonic bacterial degradation)

Question 25

A cat presents with ptyalism (excessive salivation). What are the possible causes?

Answer 25

a. **Chemical poisoning** (e.g., organophosphates). b. **Pharyngeal or esophageal disease** (foreign bodies, inflammation, reflux esophagitis, tumors). c. **Oral disease**: stomatitis and/or periodontal disease. (Insect stings in the oral cavity elicit salivation. Cats that chew certain insects may also salivate). d. **Nausea**, especially in the cat. e. **Hepatic encephalopathy**, especially in the cat.

Question 26

Is a young dog presents with weight loss, what should be tested for?

Answer 26

parasites

Question 27

Causes of weight loss?

Answer 27

a) **Decreased nutrient intake** (through reduced appetite or poor diet/feeding) b) **Maldigestion/malabsorption** (exocrine pancreatic insufficiency, IBD) c) **Malassimilation** (organ failures such as liver) d) **Excessive utilization** (hyperthyroidism, some neoplasia) e) **Increased loss of nutrients** (protein-losing enteropathy or nephropathy)

Question 28

Two main causes of Anemia?

Answer 28

1. GI hemorrhage (tumors, ulcers, parasites, bleeding disorder) 2. defective RBC production (malabsorption B12, bone marrow depression)

Question 29

Pica is a sign commonly associated with what condition?

Answer 29

pancreatic insufficiency (malabsorption)

Question 30

Anorexia is commonly associated with acut or chronic conditions?

Answer 30

acute (inflammatory dz or tumors)

Question 31

Based on serum protein levels, how can PLE and PLN generally be differentiated? What is important to keep in mind regarding this?

Answer 31

PLE: hypoalbuminemia & low globulins PLN: hypoalbuminemia but normal globulines in 50% PLE cases→ globulines were normal :(

Question 32

A fecal culture is rarely useful unless there is an infection with what organisms?

Answer 32

salmonella camypylobacter yersinia tritrichomonas fetus

Question 33

Severe distal small intestinal disease, bacterial overgrowth and exocrine pancreatic insufficiency may all be associated with decreased serum concentrations.

Answer 33

cobalamin (B12)

Question 34

Proximal small intestinal disease can be associated with decreased serum concentrations, while pancreatic insufficiency and bacterial overgrowth can be associated with **(increased/decreased)** levels.

Answer 34

folate increased

Question 35

What do these tests test for? fecal a1 proteinase inhibitor Serum trypsin like immunoreactivity (TLI) Pancreatic lipase (cPLI/fPLI)

Answer 35

intestinal protein loss exocrine pancreatic insufficiency (EPI) (trypsin decreases with EPI) pancreatitis

Question 36

With chronic GI disease, which diagnostic tools are usually not helpful?

Answer 36

radiographs U/S

Question 37

What are the two most common causes of peritoneal effusion seen on a radiograph?

Answer 37

1) transudates, seen in hypoproteinemia and some types of liver disease 2) the inflammatory exudate of peritonitis.

Question 38

Lateral displacement of the duodenum seen on a radiograph may indicate ?

Answer 38

chronic pancreatitis pancreatic tumors

Question 39

What parts of the GI tract can be assessed via endoscopy?

Answer 39

* esophagus * stomach * duodenum & proximal jejunum (in some patients) * ileum and colon

Question 40

What radiographic signs indicated GI diease?

Answer 40

Question 41

What are the three general types of diagnostic tests?

Answer 41

Lab radiograph/imaging special studies (biopsy via endoscopy, laparatomy, laparoscopy)