Ettinger GI And Hepatic Disease Flashcards
In what disease states is high or low serum folate seen?
- High folate - SIBO/dysbiosis
2. low folate - proximal small intestinal disease
How is folate absorbed and metabolized from diet?
Folate aka vit B9
Folate polyglutamate is found in food and is broken down to folate monoglutamate (by folate deconjugase) and absorbed by folate carriers
It is tough that serum folate can be increased during SIBO due to production by overproliferating bacteria
How is cobalamin (vitamin B12) absorbed from the diet?
Readily found in the diet bound to animal proteins
- Pepsin and HCL release cobalamin which is then bound to R proteins produced by the gastric mucosa.
- R proteins are broken down by pancreatic protease and then subsequently complexed by intrinsic factor by the exocrine pancreas.
- These complexed units are then transported across the mucosa at the ileum (Receptor mediated Endocytosis)
**In cats, intrinsic factor is only produced by the pancreas (none made by stomach). Cats also lack the binding protein transcobalamin 1 and thus can easily deplete their cobalamin stores within a month of malabsorptive disease
What is fecal alpha 1 proteinase inhibitor and why is it a potentially important biomarker of GI disease?
It is a marker of GI albumin loss
In cases where hypoalbuminemia exists, GI Loss can be confirmed by measuring alpha 1 proteinase inhibitor.
This marker is produced by the liver and has a rate of loss through the GI tract that is proportional to albumin. It is NOT hydrolyzed in the GI tract and therefore it is measurable in feces. To improve diagnostic accuracy, three samples should be evaluated and samples should be collected after voluntary evacuation
electrical burns may result in what change systemically that may cause respiratory distress?
Non-Cardiogenic pulmonary edema
What is the underlying pathophysiology of masticatory muscle myositis? How is it diagnosed?
Autoimmune response to 2M muscle fibers found in the temporal, massager and medial and lateral pterygoid muscle
Diagnostic workup - 2M Ab titer (demonstrate Ag-Ab complexes within muscle) and rule out other causes (e.g. CT head)
What are the most common canine oral tumors?
Malignant melanoma, SCC, fibrosarcoma, osteosarcoma and PNST
What are the most common feline oral tumors?
SCC and fibrosarcoma
What are the primary differentials for dysphagia in a cat?
Structural oropharyngeal lesions (e.g. mass or foreign body), ulcers, gingivostomatitis
What is Odynophagia and what might it indicate?
Painful swallowing, clinical sign of esophageal dysphagia
What comprises cricopharyngeal dysphagia?
Cricopharyngeal Achalasia (failure of upper esophageal sphincter relaxation) and cricopharyngeal dyssynchrony (lack of coordination between upper esophageal sphincter relaxation and pharyngeal relaxation)
What are potential causes of acquired secondary megaesophagus?
Myasthenia gravis (focal, generalized), hypoadrenocorticism, vascular ring anomalies, hypothyroidism, lupus myositis, polymyopathies, polyneuropathies, dysautonomia and severe esophagitis
Prognosis - ~50%
Prognosis of acquired idiopathic megaesophagus - poor, aspiration pneumonia common
What are the different types of hiatal hernia? Which is most common? How are hiatal hernias managed?
Type I - sliding, most common, especially in brachycephalic breeds (congenital) or with increases in intrathoracic pressure causing secondary/acquired hiatal hernia
Type II - paraesophageal (part of stomach displaced cranially with abdominal esophagus remaining fixed)
Type IV - liver, stomach and SI displaced cranially
Treatment - medical management, surgery (diaphragmatic crural apposition, esophagostopexy, gastropexy) when medical management fails
What are the most common primary esophageal tumors of dogs and cats?
Dogs - fibrosarcoma and osteosarcoma
Cats - SCC
What is granulomatous colitis?
Form of GI disease (predominates in Boxer and FRench Bulldogs) that is caused typically by a fluoroquinolone responsive E. Coli (adherent, invasive E. Coli)
What are common enteropathogenic bacteria?
Clostridium perfringens Clostridium difficile Clostridium jejuni Pathogenic E. Coli Salmonella
Risk factors for C. Difficile include antibiotics prior to hospitalization and immunosuppressive therapy during hospitalization
What are prebiotics?
Non digestible dietary carbohydrates that stimulate growth and metabolism of enteric protective bacteria
What are synbiotics?
Combination of probiotics and prebiotics
What are differentials for gastrin hypersecretion and vomiting, resulting in hypochloremia, hypokalemia, and metabolic alklaosis and paradoxical aciduria?
Gastrinoma (malignant transformation of somatostatin producing delta cells of the pancreas to gastrin producing cells) Mast cell tumor Renal failure (cat CKD) Proximal duodenal obstruction/ pyloric outflow tract obstruction
When unstimulated gastric pH is <3 and serum gastrin is elevated, gastrinoma can be diagnosed by secretin stimulation test, ultrasound (focused on liver and pancreas) and pentertreotide scintigraphy
What are potential differentials for chronic gastritis?
Systemic disease Ulcerogenic or irritant drugs Gastric foreign body Parasites (Physalloptera) Rare - fungal infection (Pythian or histoplasmosis)\ Dietary allergy/ intolerance Reaction to bacterial antigen/unknown pathogen Steroid responsive gastritis
Helicobacter? - role unknown, may play a role in some patients but generally considered a commensal organism
What is the most common gastric malignancy in dogs and cats?
Gastric lymphoma
Dog classifications: nodular and diffuse (more common)
Cat classifications: small (T cell) and large (B cell or T cell)
LP inflammation can coexist and precede lymphoma
What is required to diagnose clostridium perfringens overgrowth?
Fecal enterotoxin assay
What organism is Salmon poisoning caused by?
Aka rickettsial diarrhea
Caused by Neorickettsia helminthoeca or Neorickettsia elokominica found in a parasitic fluke (Nanophytes salmincola) found in salmon in norther California to Central Washington
What are clinical signs of Salmon poisoning?
Manifests one week following ingestion of salmon and results in high fever, HGE, vomiting, lethargy, anorexia, polydipsia, oculi nasal discharge and peripheral lymphadenopathy
How is salmon poisoning diagnosed?
History of raw fish ingestion in endemic areas, operculated fluke eggs in feces and intracytoplasmic inclusion bodies in the macrophages from lymph node aspirates
How is salmon poisoning treated?
Oxytetracycline 7 mg/kg IV q 8 for 5 days + praziquantel
In what breed might gluten sensitivity occur? What are clinical signs/ manifestations of gluten sensitivity in this breed?
Irish Setters
Disease manifests at weaning or introduction of gluten and causes poor weight gain and chronic intermittent diarrhea. Some dogs may become asymptomatic later in life
Gluten sensitivity causes direct toxicity to intestinal mucosa/ induces an adverse immune reaction
What are 4 suggested criteria for the diagnosis of antibiotic responsive diarrhea?
- Positive response to antibiotics
- Relapse on withdrawal of antibiotics
- Remission on reintroduction of antibiotics
- Elimination of other causes based on diagnostic testing and histopathologic assessment
