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SAM 2 > Colonic Disease > Flashcards

Colonic Disease Flashcards

1
Q

What are the segments of the large intestine?

A

Cecum, colon, and rectum

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2
Q

What is a cecum?

A

A blind diverticulum of the colon that is more functional in herbivores and is the site of bacterial fermentation

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3
Q

What are the components of the colon?

A

Ascending, transverse, and descending

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4
Q

How much of the GI length is comprised by the colon?

A

20-25% total length

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5
Q

What are the layers of the large intestine?

A

Mucosa- submcosa- muscularis- serosa

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6
Q

T/F: The large intestinal mucosa possesses villi but no goblet cells.

A

False

Mucosal layer of the LI does not have villi but has many mucus secreting cells

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7
Q

What are crypts of Leiberkuhn?

A
  • Tubular crypts that extend through the entire thickness of hte mucosa
  • High mitotic index
  • Absorbtion of vitamins and minerals
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8
Q

How long is the cell turnover rate in the large intestine compared to the small intestine?

A

4-7 days

Slower than the SI

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9
Q

What are the functions of the large intestine?

A
  • Conversion of digested materials into feces
  • Expulsion of fecal matter
  • Mucous and bicarbonate secretion
  • Absorption of LOTS of water and sodium chloride
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10
Q

What is the function of the mucus and bicarbonate secretion function of the large intestine?

A
  • Protection of mucosa/epithelium
  • Lubricates and binds fecal component
  • Neutralizes acidic content of feces
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11
Q

What are clinical signs of colonic disease?

A 
Diarrhea OR constipation
Blood in or on the stool
Mucus on stool
Tenesmus
Dyschezia
Urgency

No weight loss or vomiting usually unless severe disease (more common in cats)

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12
Q

What are some potential physical exam findings in a patient with colonic disease?

A

Typically normal

Anal or peri-anal irritation
Weight loss in advanced disease
Dehydration or fever
Constipation

Must assess for hind end neurologic disease

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13
Q

What may you find on a rectal palpation in an animal with colonic disease?

A
  • Compression or obstrutive lesions
  • Hernias
  • Able to assess nature of stool
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14
Q

What are some general disease processes found in the colon?

A
  • Inflammatory
  • Neoplasia
  • Obstructive
  • Motility disorders
  • Metabolic or endocrine disorders (secondary)
  • Infectious diseases
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15
Q

What can you find on CBC that can help you characterize colonic disease?

A
  • Non-regenerative anemia: chronic systemic disease
  • Regenerative anemia: blood loss
  • Leukocytosis: Inflammation, infection, neoplasia
  • Eosinophilia: Addison’s disease, parasites, mast cell tumors, hypereosinophilic syndromes
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16
Q

What serum chemistry findings can help you characterize colonic disease?

A
  • Hypoproteinemia: disease extends to small intestine
  • Hyperglobulinemia: FIP, infectious, neoplasia
  • Hypercalcemia: neoplasia, fungal
  • Hypoglycemia: septic abdomen, paraneoplastic, Addison’s
  • Hyponatremia: Addison’s, pseudo-addisons (whipworms), effusions
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17
Q

What are radiographs useful for when assessing colonic disease?

A

Obstructions, constipation, megacolon, masses, lymphadenopathy

Negative contrast colonogram for intraluminal masses

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18
Q

What is the importance of assessing the sublumbar LN in colonic patients?

A

Enlarged sublumbar LN can compress the rectum leading to obstruction and constipation in an otherwise healthy gut

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19
Q

What can be assessed on ultrasound of the large intestine?

A
  • Ileocolic junction, cecum, and colon up to the pelvis
  • Thin walled struction that are typically gas or feces distended
  • Masses, thickening of the wall, evidence of perforation, effusion
  • Regional LN enlargement
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20
Q

When would MRI or CT be approriate?

A

Evaluation of intrapelvic structures- distal colon, rectum, and anal canal

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21
Q

When is a colonoscopy useful?

A
  • Non-GI disease is ruled out
  • Evidence of gross disease is present on imaging and need a biopsy
  • No abnormal findings on imaging and CS support LI disease
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22
Q

What is the prep required for a colonoscopy?

A
  1. 24-36 hour fast
  2. Enemas before and under GA
  3. Oral polyethylene glycol (osmotic laxative) or other laxatives
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23
Q

What does a normal colon look like?

A

Pink, smooth, glistening with frequent peristalsis

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24
Q

What parasites can you find in the colon?

A 
Trichuris vulpis
Heterobilharzia americana
Tritrichomonas foetus
Giardia
Histoplasmosis
Pythium
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25
Q

What is Trichuris vulpis and what does it do?

A

Whipworm in dogs that causes acute to chronic large bowel diarrhea

  • Fecal oral transmission of eggs
  • Live in cecum and colon

CS: may be asymptomatic, hematochezia, mucoid diarrhea, tenesmus

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26
Q

How do you diagnose and treat T. vulpis?

A

Non-specific clin path findings: can see hyperkalemia and hyponatremia (pseudo-addisons disease)

Fecal floatation, ELISA, colonoscopy

Treatment: 3 months of fenbendazole

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27
Q

What is heterbilharzia?

A
  • Trematode found in the gulf coat states that causes chronic large intestinal diarrhea
  • Reservoirs in mice, rabbits, racoons, and nutria
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28
Q

What are the clinical signs and clin path findings of heterobilharzia?

A

CS: vomiting, large bowel diarrhea, weight loss, inappetence

Clin path: hypoalbuminemia, hyperflobulinemia, increased liver enzymes, hypercalcemia

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29
Q

How do you diagnose and treat heterobilharzia and what is the progosis?

A

Dx: fecal sediment, PCR, ELISA, biopsy

Tx: Fenbendazole with praziquantel

Prognosis: fair to good in acute disease, guarded in chronic disease with liver cirrhosis

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30
Q

What is entamoeba histolytica?

A
  • Uncommon disease of dogs and cats caused by an ameoba
  • Lives in cecum and colon primarily but can go to other organs
  • Zoonotic; fecal-oral
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31
Q

What are the clinical signs of entamoeba?

A
  • Diarrhea
  • Hematochezia
  • Tenesmus
  • Systemic illness if disseminated (weight loss and inappetence most common)
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32
Q

How do you diagnose and treat entamoeba?

A

Dx: Trophozoites in cysts in feces, colonic wall scrape (best method), colonoscopy biopsy

Tx: Metronidazole and furazolidone

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33
Q

What is tritrichomonas foetus and what does it cause?

A

Protozoa of young cats

Causes waxing and waning LI diarrhea that is typically self limiting but can be serious in immune compromised animals

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34
Q

How do you diagnose and treat tritrichomonas?

A

Dx: Direct fecal smear, PCR (best) or fecal puch culture

Tx: Ronidazole but typically resolves without intervention

Relapses are common

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35
Q

What is prototheca and what does it cause?

A
  • Toxic blue-green algae species in soil and sewage

CS: vomiting, diarrhea, ataxia, rapid death; chronic forms can see disseminated disease

Cats: cutaneous more common

Dogs: CNS, ocular, and Large bowel signs

36
Q

How do you diagnose and treat prototheca and what is the prognosis?

A

Dx: culture, scraping, biopsy

Tx: Amphotericin B + Itraconazole

Prognosis: gave for disseminated and guarded for cutaneous

37
Q

What are the pathogenic bacteria of the large intestine?

A

Campylobacter and clostridium

38
Q

What clinical signs does campylobacter cause in the large intestine and how is it diagnosed?

A

CS: acute or chronic colitis with large bowel signs, pyrexia, anorexia

Dx: Culture and direct fecal smear

39
Q

How is campylobacter diagnosed and what is the prognosis?

A

Tx: if healthy carrier tx isn’t necessary, erythromycin and tylosin for ill pets

Prognosis: good

40
Q

What are the clinical signs of clostridium difficile?

A

Large bowel diarrhea

May only be a contributing factor, not a primary cause

41
Q

How do you diagnose and treat C. diff and what is the prognosis?

A

Dx: Overabundence on fecal smear, PCR/ELISA for toxins, culture

Tx: metronidazole

Prognosis: Good

42
Q

Clostridium perfringens, all the things.

A
  • High prevalence in normal pets
  • Consider toxigenic culture to support d
  • Metronidazole or tylosin for tx
  • Theoretic zoonosis
43
Q

Does inflammatory colonic disease present as an acute or chronic condition?

A

Chronic large intestinal signs for which no other cause can be found and fails to respond to empiric therapy

44
Q

What will you find on histopath of an animal with inflammatory colonic disease?

A

Mucosal changes including inflammatory infiltrate

45
Q

What diet trials can be attempted in colitis patients?

A
  • Hydrolyzed or novel antigen
  • Low residue (prolonged time)
  • High fiber or addition of fiber
  • Prebiotic supplementation
46
Q

What is typically given as a prebiotic in colitis patients?

A

Fermentable fibers able to be used an an energy source for intestinal bacteria

  • Beet pulp
  • Psyllium husks
  • Fructooligosaccharides
47
Q

What are some fiber responsive diseases of the colon?

A

Chronic diarrhea without any apparent pathogens, infection, inflammation, neoplasia

Responsive to highly digestible diet with soluble fiber or fiber supplementation

48
Q

What are fiber responsive diseases similar to in the small intestine?

A

Minimal change enteropathy

49
Q

What antibiotics are typically used for large bowel diseases?

A

Metronidazole and tylosin

50
Q

What is the typical cinical summary of colitis patients?

A
  • Middle aged to older patients
  • CS: large bowel diarrhea with occasional weight loss
  • PE: good body condition, some thickening of intestine, may have mass lesions or pain on rectal
51
Q

Patients with colitis typically have a good body condition unless they have what processes?

A
  • Concurrent small intestinal disease
  • Histiocytic ulcerative colitis
  • Inappetence
52
Q

What are the minimum database diagnostics for an animal with colitis?

A

CBC, CHEM, UA
Fecal
Imaging

53
Q

What may colonoscopy show?

A
  • Inflammatory bowel disease
  • Histiocytic ulcerative colitis
  • Neoplasia (polyps as well)
  • Fibrosing structures
  • Fungal plaques or granulomas
54
Q

What are the clinical signs of histiocytic ulcerative colitis?

A

Tenesmus, mucoid diarrhea, hematochezia, weight loss, decreased appetite

55
Q

What are the US, histo, and biopsy/culture results of a patient with granulomatous/HU colitis?

A

US: diffusely or segmetally thickened colonic wall or normal

Histopath: Macrophage infiltration of the mucosa, PAS positive

Biopsy/culture: FISH positive

56
Q

T/F: HUC is treated with immunosuppressive drugs.

A

FALSE- do not use immune suppression

Baytril long term pending resolution of clinical signs

57
Q

What is the issue with resistance and HUC?

A

Stopping baytril early will create resistance and a poor prognosis

Animals that do not respond to therapy may already have resistance

58
Q

T/F: Most neoplasms of the large intestine are benign polyps.

A

False- most are malignant but benign polyps do occur

59
Q

What neoplasms occur in the large intestine and rectum?

A

Adenocarcinoma, lymphosarcoma, stromal tumors, leiomyosarcoma (cecum), firbosarcoma, neurofibrosarcoma, ganglioneuroma, plasmacytoma, mast cell

60
Q

What is the percentage of cases that have palpable neoplasms in dogs and cats?

A

Dogs- 60-80%

Cats- 50%

61
Q

What tests can be done to find/ classify large intestinal neoplasia?

A
  • Colonoscopy
  • Colon/rectal scrape and cytology
  • Blind biopsy
  • US guided aspirate
  • Surgical biopsy (avoid cutting into colon)
62
Q

What are come causes of colonic obstruction?

A
  • Neoplasia or polyps
  • Fibrosing strictures
  • Fungal plaques or granulomas
  • Foreign bodies
  • Inflammatory disease
  • Intussussceptions
  • Constipation and obstipation
63
Q

What is the most common type of colonic intussusception?

A

Ileocolic

Can have cecocolic, cecal inversion, ileocecal, and colonic as well

64
Q

How do you tell the difference between a prolapse and an intussuseption?

A

Prolapse- should not be able to pass a probe at the mucosal junction

Protruding intussusception- will be able to pass a probe into the rectum

65
Q

Which small animal species is more likely to present with chronic constipation?

A

Cats

66
Q

What are some conditions that can lead to constipation?

A
  • Dehydration and associated diseases
  • Obesity
  • Hypokalemia, hypercalcemia
  • Environmental/behavioral issues
  • Inflammation
  • Mechanical obstruction
  • Neuromuscular dysfunction
67
Q

What is the difference between constipation, obstipation, and megacolon?

A

Constipation: infrequent and/or difficult impaction of feces, is not a permanent loss of function, mild to moderate dilation

Obstipation: intractable constipation refractory to cure or control, implies loss of function

Mega colon: severe dilation of hypertrophy of the colon, end stage of colonic dysfunction, can be secondary to obstructive lesion and may be reversible if caught early

68
Q

What type of animals are more likely affected with megacolon?

A

Middle aged male cats most commonly

69
Q

What are the clinical signs/presenting concerns of a constipated animal?

A
  • Reduced, painful, or absent fecal production
  • Multiple unproductive attempts at defecation
  • Prolonged litterbox use
  • Vocalization
  • Vomiting (cats)
70
Q

What are some physical exam findings on a constipated animal?

A
  • Normal appearance
  • Dehydration
  • Weak
  • Abdominal pain and positive palpation

Rectal: may have lyphadenopathy, mass lesions, strictures, pelvic narrowing

71
Q

What should you look for on the clin path of a constipated animal?

A

Causes of dehydration and electrolyte imbalances

72
Q

Why are radiographs useful in assessing a constipated patient?

A
  • Assess severity

- Point towards structural causes

73
Q

Do we typically use colonoscoy and biopsy in the constipated patient?

A

Rarely, may need to for recurrent cases or to look for strictures and intraluminal masses

Biopsy to confirm congenital aganglionic megacolon in cats

74
Q

How do you treat a constipated cat?

A
  • Laxatives
  • Prokinetic drugs
  • Diet modification
  • Enemas
  • Surgery if recurrent

May require hospitalization depending on severity and chronicity

75
Q

What are the different types of laxatives?

A
  1. Emmoillent- increased lipid and decreased water absorption
  2. Bulk forming
  3. Lubricant- prevention of water reabsorbtion
  4. Hyperosmotic- stimulates colonic cectreiton and propulsive motility
  5. Stimulant- Increases propulsive motility
76
Q

What is an emoillent laxatine?

A

Dicotyl sodium sulfosuccinate

77
Q

What are bulk forming laxatives?

A

Psyllium, wheat bran, pumpkin

78
Q

What are lubricant laxatives?

A

Mineral oil or white petroleum

79
Q

What are hyper osmotic laxatives?

A

Magnesium salts or polyethylene glycol

80
Q

What are stimulant laxatives

A

Prokinetic drugs

Cisapride

81
Q

What can be used as a rectal suppository laxative?

A
  • Glycerine
  • DSS
  • Bisacdyl
82
Q

What do you use for enemas to disimpact an animal?

A

Warm water and lube via a red rubber catheter per rectum

83
Q

What kind of enema do you never want to give and why?

A

Fleet enema (human drug) or anything with sodium phosphate as they can lead to severe electrolyte disturbances

84
Q

What are two drugs that are helpful in constipated cats?

A

Miralaxx and lactulose

85
Q

What is a concern when administering enemas?

A

Fluid overload

Especially a concern in small animals

86
Q

What is the procedure for manual deobstipation?

A
  • General anesthesia
  • Warm water with lube or saline enema
  • Manual external manipulation “milking”

Must be prepped with hydration, antibiotics, and enemas and may have to stage over several days

87
Q

What surgery can you perform on an obstipated patient and when is it indicated?

A

Subtotal colectomy

Only if refractory to meds

Has a good prognosis but may have diarrhea for a significant time post op

SAM 2 (21 decks)

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