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SA DX & TX II > Exam 1 - General Approach to GI Disease > Flashcards

Exam 1 - General Approach to GI Disease Flashcards

1
Q

what are the 3 main problems associated with gi disease in small animals?

A

vomiting, diarrhea, & anorexia

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2
Q

what is the difference between acute & chronic gi problems?

A

acute - less than 2-3 weeks & either life-threatening or self limiting

chronic - greater than 2-3 weeks (may be intermittent/recurrent) & becomes a nuisance/annoyance/owner quality of life problem

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3
Q

what type of patient may you pursue supportive care for gi problems?

A

first offender, young/previously healthy, stable animal with a normal physical exam

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4
Q

what type of patient may you pursue diagnostic investigation for gi problems?

A

recurrent/persistent disease, comorbidities, painful/dehydrated/unstable animals, weight loss, & abnormal physical exam

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5
Q

what is the suggested localization if you have a patient with dysphagia?

A

mouth, pharynx, esophagus

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6
Q

what is the suggested localization if you have a patient with regurgitation?

A

esophagus

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7
Q

what is the suggested localization if you have a patient with vomiting?

A

gi tract (primary gi or visceral) vs. secondary gi/chemical

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8
Q

what is the suggested localization if you have a patient with gagging/retching/reverse sneezing?

A

respiratory, pharynx, larynx

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9
Q

when do you expect to see issues in your patient if they have dysphagia?

A

with food and/or water

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10
Q

when do you expect to see issues in your patient if they have regurgitation?

A

unexpected timing

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11
Q

when do you expect to see issues in your patient if they have vomiting?

A

prodromal signs prior

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12
Q

what do you expect to see as far as contents in your patient if they have dysphagia?

A

excessive salivation

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13
Q

what do you expect to see as far as contents in your patient if they have regurgitation?

A

undigested food!! no bile

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14
Q

what do you expect to see as far as contents in your patient if they have vomiting?

A

digested food & bile

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15
Q

what is the difference in acidity between regurgitation & vomiting?

A

regurgitation - neutral pH

vomiting - low pH/acidic because of bile

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16
Q

what is expected of timing if you have a patient with dysphagia?

A

coughing, gagging, dropping food when eating

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17
Q

what is expected of timing if you have a patient with regurgitation?

A

shortly after eating/drinking

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18
Q

what is expected of timing if you have a patient with vomiting?

A

variable

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19
Q

what control is vomiting under?

A

chemical - CRTZ

neuronal - vestibular centers, cerebral cortex, & CRTZ

visceral - stretch/pain receptors in the gi tract

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20
Q

what clinical signs are associated with a patient with weight loss that has a good appetite?

A

dysphagia, unobserved regurgitation/vomiting/diarrhea, malassimilation (maldigestion/malabsorption), & increased metabolism

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21
Q

what clinical signs are associated with a patient with weight loss & a poor appetite?

A

nausea, pain associated with eating, & neurologic disease

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22
Q

what characteristics are associated with small bowel diarrhea?

A

increased volume, weight loss, melena, & vomiting

23
Q

what characteristics are associated with large bowel diarrhea?

A

increased frequency, pain or straining, & frank blood/mucus

24
Q

what are some examples of differentials for small bowel diarrhea?

A

EPI, ketones/uremia/ammonia, strange/spoiled food, infiltrative tumors, IBD, toxins, & foreign bodies causing trauma

25
Q

what are some examples of differentials for large bowel diarrhea?

A

motility disorders, strange/spoiled food, infiltrative/obstructive tumors, IBD, & head trauma

26
Q

is small bowel diarrhea or large bowel diarrhea associated with weight loss?

A

small bowel - especially if chronic

27
Q

if there is frank blood present in diarrhea, where do you localize it to?

A

large bowel diarrhea

28
Q

where does melena localize to?

A

stomach or small intestine

29
Q

where does hematochezia localize to?

A

large intestines

30
Q

what is the definition of diarrhea?

A

increase in fecal mass caused by an increase in fecal water and/or solid content typically accompanied by an increase in frequency, fluidity, and/or volume of feces

31
Q

what is the default state of the intestinal immune cells? why is this important?

A

default state is tolerance

danger/signal must subside for the intestine to repair itself, so if it doesn’t, chronic inflammation will persist

32
Q

what are the 3 categories of schemes when approaching gi disease?

A

temporal, anatomic (to organize differentials), & etiologic (to devise therapy)

33
Q

what are some examples of differentials of extra-gastrointestinal causes of gi disease?

A

fever/hyperthermia, liver disease, prostatic disease, & renal disease

34
Q

what parasites are associated with causing large intestinal issues?

A

trichuris, tritrichomonas, & giardia

35
Q

what bacteria is associated with causing issues in the large intestines?

A

clostridiums & e. coli

36
Q

between dogs & cats, which are more likely to develop stress large intestinal diarrhea?

A

dogs

37
Q

what bacteria are associated with causing gi issues in the stomach & small intestines?

A

salmonella, e. coli, campylobacter

38
Q

what are your top tier diagnostics for working up a patient with gastroenteritis?

A

thorough history/physical, quick assessment tests (PCV, TS, BG, NOVA, ISTAT), fecal float, fecal smear for bacterial population, & symptomatic therapy

39
Q

what are your top differentials for gastroenteritis?

A

dietary indiscretion, dietary indiscretion of objects, & acute hemorrhagic diarrhea syndrome

40
Q

what is the most common cause of acute vomiting in dogs & cats?

A

dietary indiscretion - self-limiting problem

41
Q

what is the most important definitive diagnosis to consider in the acute setting of a patient with vomiting?

A

foreign body obstruction - surgical removal

42
Q

what may your diagnostic tests look like in a patient with dietary indiscretion?

A

normal physical exam, patients otherwise well with an acute onset

PCV/TS may be elevated if dehydration is severe, fecal cytology is normal

43
Q

what are some examples of causes of dietary indiscretion?

A

rapid diet change & unusual treats/snacks/meds/supplements

44
Q

what may your diagnostic tests look like in a patient with dietary indiscretion of objects?

A

acute onset but patient may become depressed from repeated vomiting/dehydration - physical exam is unremarkable but abdominal palpation may be painful

important to distinguish this group for further investigation!!!

45
Q

what is the classic presentation of a patient with acute hemorrhagic diarrhea syndrome?

A

may have vomiting (hematemesis), depression, abdominal pain, often small breed (urban indoor) dogs, & some present in distributive shock before diarrhea even begins

46
Q

how do you diagnose AHDS?

A

high PCV (> 65%), absence of other diagnosis, & response to supportive care

47
Q

what are some theories on causation of AHDS?

A

clostridial enterotoxin a/b (c. dificile & c. perfringens), ETEC, & type I hypersensitivity of the gi tract

48
Q

what are the hallmarks of AHDS?

A

marked hemoconcentration, absent concurrent increased TP due to gi loss of protein, & possible splenic contraction (shock) helps increase PCV)

49
Q

when is empiric therapy reasonable for a patient with gi disease?

A

systemically well patients with acute vomiting or diarrhea - response to therapy can be viewed as a diagnostic test

50
Q

why should you withhold food in dogs if vomiting is present in a gi case?

A

symptomatic care - avoids provoking nausea or further vomiting

fast for 12-24 hours & gradually re-introduce water & a bland diet

NOT IN CATS

51
Q

what kind of diet should be offered to a gi case?

A

highly digestible food with limited ingredients - may need fiber especially if large intestinal signs are present

52
Q

T/F: the need for anti-emetics should make you question the idea of self-limiting gi disease

A

true - can use them if vomiting is severe

53
Q

T/F: there is a role for acid blockers & mucosal coating agents in patients with acute disease

A

false - doubtful

54
Q

what is the most common cause of acute vomiting in dogs & cats?

A

dietary indiscretion - self-limiting problem

focus on excluding more dangerous things & then help patient recover on its own

SA DX & TX II (62 decks)

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