Exam 1 Flashcards
How do the dog and cat esophaguses (esophagui?? Idk the plural for this) differ?
Dog- all skeletal muscle
Cat- 2/3 striated muscle in the upper part and smooth muscle in the lower 1/3, Also herringbone pattern with barium studies
what does the fundus, body, and antrum do?
Fundus- storage of food
Body- mixing of food
Antrum- propulsion
What do the peptic (chief) cells do?
create pepsinogen
What do the Parietal (oxyntic) cells do?
Create hydrochloric acid and intrinsic factor
How do peptic and parietal cells work together?
Peptic cells create the pepsinogen which becomes pepsin because of HCl from parietal cells
Explain the phases of digestion and what controls the stomach in each one
Cephalic- preparing to eat- the brain is controlling the stomach
Gastric- breaking down food- the stomach is controlling itself
Intestinal- emptying the stomach and further absorbing and digesting- the intestines control the stomach here
what is the difference between an omega-3 and an omega-6 fatty acid
omega-3 is anti-inflammatory and vasodilative and omega-6 is inflammatory and vasoconstrictive
Why can cats not utilize 18-carbon long chain fatty acids?
Do not have the enzyme (delta-6-desaturase) to convert it into a 20 or 22 carbon amino acid
What type of anemia (hematology wise) would you see with a porto-systemic shunt (hint: it would be the same as iron deficiency anemia)
Microcytic, hypochromic anemia
What type of anemia (hematology wise) are you most likely to see with a GI bleed
Macrocytic, hypochromic anemia
What are 5 indirect biochemistry markers that can indicate liver function
Albumin, glucose, cholesterol, BUN, Bilirubin
What does GGT, ALT, and ALP show and how are they different? (broad difference)
GGT and ALP are elevated if there is cholestatic disease and ALT is a liver damage enzyme
Should I be concerned if a cat has a few bilirubin crystals in its urine (aka bilirubinuria)
Yes! it is always abnormal for a cat to have this (dogs can have a few and its normal though)
I have a dog that I am concerned has esophageal dysmotility/ dysphagia. Would a barium contrast study be a good thing to use to conclusively diagnose this
NO! These dogs have an increased risk of aspiration so you should never give them barium
What are the four tests on a GI panel and what do they test for/show (very briefly)
TLI- exocrine pancreatic ability through quantification of trypsinogen and trypsin
PLI- testing for pancreatitis
B12- decreased with ileal disease or pancreatitis in cats
Folate- decreased with intestinal disease and increased with bacterial overgrowth
What are some clinical signs of an animal with dysphagia
May see problems with forming the food bolus and moving it to esophagus, exaggerated swallow, food/water falling out of mouth, gagging
A cay presents to you and the owner is complaining that the cat hasn’t been wanting to eat, it runs away or gets angry any time she goes to pet it near its face, and you see in its chart it is herpes positive.
You sedate the cat and do an oral exam and see redness and ulceration along its gums and near the back of its throat. What are you thinking this may be?
Stomatitis
A cat presents for an ulcer on its lip. You do a cytology and there are eosinophils in it. What disease could this be? How should you treat it
Eosinophilic Granuloma Complex
Treat with glucocorticoids and possibly surgery
A rottie presents with a history of dysphagia and the owner says he doesn’t want to open his mouth and growls when pet on his head. You give him a physical examination and the muscles around his jaw seem hard and enlarged. What could be going on? Describe the disease and its etiology
Masticatory myositis which is caused by an autoantibody reaction to the 2M muscle fiber
A dog refluxing under anesthesia and a cat with chronic URIs can both be at risk for this disease even though these things seem so unrelated. What disease is this?
Nasopharyngeal stenosis
Which is more of an active process regurgitation or vomiting
vomiting
A 4 month old puppy presents for a history of “throwing up” its food immediately after eating. The owner says it always spits up undigested food and some saliva. What may it have?
This puppy is actually regurging and likely has a congenital vascular ring anomaly which is encircling the esophagus and constricting it causing an obstruction
A dog and a cat have the same problem and present to your clinic! Woah weird! The dog had a bone FB removed from his esophagus a few weeks ago and the cat has recently finished a course of doxycycline. What could be the presenting problem if both of these histories are relevant to the problem
They both have esophageal strictures! It must be esophageal stricture Wednesday
What 3 agents stimulate the production of HCl
gastrin, acetylcholine, and histamine
A Chihuahua presents because its owner gave him the carprofen (NSAID) that was meant for the Great Dane. What medicine that we talked about might be a good idea to give
Misoprostol, it can help with ulcers from NSAID overdoses by increasing bicarbonate and mucous production and increasing mucosal blood flow
What drug is good for treating ulcers because it forms a gel on the mucosal surface of exposed submucosa
sucralfate
Which drug works better as an acid suppressant, famotidine or omeprazole
omeprazole works better because it is a proton pump inhibitor, famotidine is a histamine blocker
What drugs are used to treat gastric ulcers
Cytoprotective agents- sucralfate
Acid suppressants- proton pump inhibitor
Prostaglandin analogs- misoprostol
How do you manage GERD
BOAS surgery if brachycephalic dog
Small frequent meals
Pro-kinetics- cisapride, metoclopramide, etc.
Acid inhibitor- PPI (omeprazole, pantoprazole)
What are three possible causes of chronic gastritis (other than unknown cause even through that is the first one he has listed
Helicobacter, parasites, pythiosis
A dog is having large, very watery bowel movements (think muddy water coming out of a hose, yikes..) but there is no mucous or blood in the stool. is this likely small or large intestinal diarrhea
likely small intestine
Cisapride, erythromycin, metoclopramide, phenothiazine, domperidone, and bethanacol are all used as what
prokinetics
At what locations does maropitant (NK1 antagonist) work
At the pharynx/stomach/intestines (GI organs), at the chemoreceptor trigger zone, at the labyrinths
Famotidine, Ranitidine, and Cimetidine are all what type of drug and what is their MOA
antacids and they are histamine 2 receptor blockers
Omeprazole and Esomeprazole are what type of drug and what is their MOA
antacids and they are protein pump inhibitors
What is a good drug used for its anti-inflammatory effects to treat colitis
azulfidine
Diphenhydramine, dexamethasone, Maropitant, metoclopramide, and ondansatron are all used as what
anti-emetics
What are the four main categories of disruptions of the protective mechanisms of the stomach to result in ulceration
Disruption of epithelial barrier
excess acid production
decrease in mucosal blood flow
decreased prostaglandins
A dog presents for lethargy, anorexia, and hematemesis. You run blood work and there is an anemia, the BUN is higher than the creatinine, and there is a panhypoproteinemia. What might this dog have and what medications might you give to help
a gastric ulcer, give sucralfate to coat the ulcer and give omeprazole (proton pump inhibitor)
misoprostol isn’t necessarily wrong either, especially if there is a possible NSAID overdose
A bulldog presents for reverse sneezing, what a joke right?? However before you chastise the owner for wasting your time you do a physical exam like the good vet you are. You notice this dog could benefit from a BOAS surgery (no surprise), but also during the exam you notice the dog is smacking his lips. Do you think there is something underlying causing the reverse sneezing?
Yes! this dog likely has GERD (gastroesophageal reflux disease) time to get the BOAS surgery, give it small frequent meals, pro-kinetics, and an acid inhibitor
Sydney’s dog Thor likes to puke if he doesn’t get food soon enough, especially in the mornings! Often the vomit is very bile tinged. What is going on with him?
He has bilious vomiting syndrome
T/F I don’t understand why Dr. Barges gets so excited about the microbiome its just a bunch of useless bacteria
False, it is part of the largest immune organ (the gut) and it has many systemic effects
What is a good way to symptomatically treat acute gastroenteritis
fluids, NPO and then bland diet, Probiotics, motility modifying agents (ex. loperamide)
A 7 year-old lab mix presents with acute bloody diarrhea and its lab work shows an elevated PCV. What disease does this dog have and how should you treat it
Acute hemorrhagic diarrhea syndrome
probiotics are the main treatment but also fluids and anti-emetics if needed (anti-emetics probably not in this case)
Coccidiosis typically presents how? Signalment? Treatment?
A young puppy or kitten presenting with severe large bowel diarrhea
tx- sulfa drug (albon)
Which has small bowel diarrhea typically, salmonella or campylobacter
salmonella is typically small bowel diarrhea and campylobacter is typically large bowel
Should you run a culture to confirm a diagnosis of salmonellosis or campylobacter
no they can both be normal inhabitants of the GIT
Which cause of chronic enteropathy can be resolved typically with a change in diet
food responsive enterophathy
Which type of chronic enteropathy is typically in younger adult to middle aged animals and how about one that is in older animals?
Younger adult to middle aged animals- immunosuppressive responsive enteropathy
Older- Neoplasia
Which chronic enteropathies typically effect younger animals
Food responsive and infectious antibiotic responsive enteropathy (dysbiosis)
Which chronic enteropathy can cause a protein-losing enteropathy
Idiopathic inflammatory bowel disease
What is PARR testing
a PCR for antigen receptor arrangements to determine if a population of lymphocytes are clonally expanded (which can indicate neoplasia)
What diagnostic is useful in cases of enteroinvasive E. coli
FISH- fluorescence to show the bacteria
Is a diet using kangaroo as the protein classified as a hydrolyzed protein diet?
No this could be a novel protein diet but hydrolyzed diets have broken down proteins into their animo acids and they are so small they can’t bind to the antigen receptors that are causing the food allergy/sensitivity
Fiber and visbiome are examples of what in regards to dysbiosis treatment
fiber is a prebiotic and can help select for good microbiome bacteria and visbiome is a good probiotic which can physically give the patient the good bugs for their microbiome
What are four complications that can be seen on bloodwork of chronic enteropathies
hypoalbuminemia, hypocobalaminemia, Iron deficiency, Vitamin D deficiency
What is the difference between large and small intestinal diarrhea
Small- increased volume, usually watery, may have melena
Large- increased frequency, soft pudding or constipation, usually not watery
What is dyschezia and how does it differ from tenesmus
dyschezia is difficult or painful defecation and tenesmus is straining to defecate
A French bulldog presents with chronic diarrhea with mucus and fresh blood. What would be a good diagnostic to run and what might be the cause and a good treatment (sorry I know this is a lot idk how else to ask about this)
Do FISH testing for enteroinvasive E.coli, this could be granulomatous colitis and that is treated with an antimicrobial like enrofloxacin that can get into host cells
You recently got a kitten from a cattery and she seems healthy but is having mucousy diarrhea and hematochezia. What could this be and how would you treat it?
likely tritrichomonas and you treat with ronidazole
Should you ever use a fleet enema in a cat
Absolutely positively NOT, it can kill them
What is proctitis and how can you treat it
inflammation of the anus and rectum, use anti-inflammatories, bland diet, and analgesia, maybe even immunosuppressives
anthelmintics if indicated (if they got the wormies)
What group of animals is at risk of developing perineal hernias
middle-aged intact male dogs
A German shepherd presents because its owner noticed it scooting and now says it looks like its “butthole is rotting off and it STINKS!” what might this be and how can you treat it
likely a perianal fistula, clip and clean and then treat with antimicrobials, laxatives, hypoallergenic diet, probiotics, and immunosuppressives
What cats are at risk for constipation/megacolon
middle-aged male cats, Manx is also a correct answer (if there is sacral disease)
A dog presents with large intestinal diarrhea and seems hypovolemic and having other signs of hypoadrenocortisism. What might this dog have and how can you treat it
trchuris (whipworms) treated with fenbendazole 3x in the span of 3 months
how does the stomach move in a GDV
It rotates on its axis because the pylorus moves from the right side to the left
What are the three main risk factors for a dog developing GDV
Large breed, increased thoracic depth to width ratio (aka deep chested), history of GDV in a first degree relative
What view is most important when taking X-rays of a possible GDV
right lateral recumbency
Why might a dog with GDV have weak pulses
the dilation of the stomach causes increased intra-abdominal pressure with leads to decreased venous return to the heart (portal vein and caudal vena cava compressed)
What should you do first if a dog presents with a potential GDV
stabilize with IV fluids
What are the parameters when assessing gastric viability in a GDV surgery, what are bad parameters
gastric wall thickness and color, you don’t want thin walls or grey/green colored wall
when preforming a gastropexy what are you cutting and how far down do you go
you cut the transversus abdominus muscle on the body wall and you cut down to the seromuscular layer of the stomach (incising the muscular and serosa) and suture the stomach to the wall
T/F you should give an anti-inflammatory like an NSAID to a GDV to help with post-op care
Definitely not an NSAID, you don’t want to make the already angry GI even angrier
On a radiograph you see what looks like granular material in the intestines, is this a normal finding?
no a granular pattern or gravel sign can indicate a foreign body
What are indications on X-ray of a linear foreign body
plicated bowel or comma shaped gas patterns
What is the holding layer of the intestines
the submucosa
What are all bad colors for intestine to be and might require resection
white, gray, green, and black are all bad and dark purple is questionable
T/F you shouldn’t do inverting suture patterns on intestine
true
A labrador retriever has had to have his 3rd foreign body surgery and each one has had to be an R&A. He now is having persistent watery diarrhea. What syndrome does he have
short bowel syndrome
How do you determine intestinal viability
color, feel for arterial pulses in the mesentery, pinch test to assess peristalsis
You do an abdominocentesis and compare the glucose and the lactate to the peripheral blood. Is this potentially a septic abdomen
Glucose-peritoneal fluid- 48 mg/dL, blood- 80mg/dL
Lactate- peritoneal fluid-8 mmol/L, blood- 5mmol/L
yes it potentially is the glucose difference is >20mg/dL and the lactate is >2mmol/L difference
What is one of the most important things you should do if you suspect septic peritonitis in an animal
start the animal on antibiotics! every hour you wait decreases survival rate
what types of cells may you see on cytology of septic peritoneal fluid
degenerative neutrophils and intracellular bacteria
After placing any feeding tube what should you do
take radiographs to ensure correct placement
What is the most common oral cancer in a dog and in a cat
dog- oral malignant melanoma
cat- squamous cell carcinoma
what is the most common cause of gastric neoplasia in cats and how is it best treated and how is the response
GI lymphoma, multi-agent chemotherapy (CHOP/COP), good response but short lasting (< 4months)
What is the best imaging tool for an animal presenting with a gastric mass
endoscopy
what is the most common salivary gland tumor (although in general they are rare)
adenocarcinoma
What is the most common cause of gastric neoplasia in dogs and how is it best treated
adenocarcinoma, surgery is the only option
How do animals with gastric neoplasia usually present
very sick- acute and progressive, vomiting, anorexia, weight loss, melena
Is a dog or cat more likely to get intestinal neoplasia
cat-common to get small cell lymphoma, rare in dogs
What should you look for on ultrasound in a case of intestinal neoplasia
loss of layering in the intestines and wall thickening
Which type of intestinal lymphoma is better to get an FNA on
large cell- it exfoliates well
Where is feline GI lymphoma likely to show up
in the small intestine, and then may spread to lymph nodes and liver
Which is more aggressive small or large cell lymphoma
large cell- may invade through the wall of the intestine
What would small cell vs large cell lymphoma look like on imaging
small cell is more likely to have diffusely thickened intestine and large cell is more likely to have a discrete mass
What may you see on bloodwork of a cat with GI lymphoma
increased BUN, liver enzymes, anemia, and hypoproteinemia
What is the best type of sample to get if you suspect small cell lymphoma in a cat
a biopsy (FNA may have a false negative)
How do you treat small cell vs. large cell feline lymphoma and which has a better prognosis
Large cell-chemo- CHOP/COP- but only 30-40% respond and you may only get 6-9 months- worse prognisis
small cell- Chlorambucil (oral chemotherapy) and prednisone, >90% response rate and get >18 months- much better prognosis
How should you treat K9 intestinal adenocarcinoma (non-metastatic vs. metastatic)
non-metastatic- surgically resect and may get 12-15 months
metastatic- palliative intraperitoneal chemo, sx not recommended, < 3 months
What is the treatment of choice for a leiomyosarcoma or GIST
surgery
A dog presents for excessive salivation, regurgitation, and inappetence. What area are you concerned may be the issue
oral cavity/pharynx or esophagus
An 11 year old dog presents with exaggerated swallowing (dysphagia) and regurgitation. What area are you thinking may be affected
pharynx or esophagus
An older dog on carprofen for his arthritis is at increased risk of developing what, especially when something happens like he is put under anesthesia
gastric ulcers
If an animal is straining to defecate a lot is it likely a small intestinal or large intestinal issue
large intestine
If an animal is having weight loss and diarrhea, is the diarrhea probably small or large intestine
small because that is where most nutrients are absorbed
What virus wipes out the microvillus in the intestine and causes very watery, stinky diarrhea
parvovirus
For small intestinal diseases like salmonella, campylobacter, etc. when animals are showing clinical signs are antibiotics part of the treatment
no unless septic, usually just probiotics and other supportive care
T/F it is difficult to tell idiopathic inflammatory bowel disease from small cell lymphoma in the intestine
true
An outdoor cat presents for an anal gland abscess. What may you also need to treat for
fleas! tapeworms can cause them
A 6 year old cat presents with a history of of chronic, progressive large bowel diarrhea. What may be the cause
Idiopathic Inflammatory bowel disease (idk how we would really know this above the other causes of chronic LI disease but this was an example he gave in class)
