Exam 1 - General Approach to GI Disease Flashcards
what are the 3 main problems associated with gi disease in small animals?
vomiting, diarrhea, & anorexia
what is the difference between acute & chronic gi problems?
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
what type of patient may you pursue supportive care for gi problems?
first offender, young/previously healthy, stable animal with a normal physical exam
what type of patient may you pursue diagnostic investigation for gi problems?
recurrent/persistent disease, comorbidities, painful/dehydrated/unstable animals, weight loss, & abnormal physical exam
what is the suggested localization if you have a patient with dysphagia?
mouth, pharynx, esophagus
what is the suggested localization if you have a patient with regurgitation?
esophagus
what is the suggested localization if you have a patient with vomiting?
gi tract (primary gi or visceral) vs. secondary gi/chemical
what is the suggested localization if you have a patient with gagging/retching/reverse sneezing?
respiratory, pharynx, larynx
when do you expect to see issues in your patient if they have dysphagia?
with food and/or water
when do you expect to see issues in your patient if they have regurgitation?
unexpected timing
when do you expect to see issues in your patient if they have vomiting?
prodromal signs prior
what do you expect to see as far as contents in your patient if they have dysphagia?
excessive salivation
what do you expect to see as far as contents in your patient if they have regurgitation?
undigested food!! no bile
what do you expect to see as far as contents in your patient if they have vomiting?
digested food & bile
what is the difference in acidity between regurgitation & vomiting?
regurgitation - neutral pH
vomiting - low pH/acidic because of bile
what is expected of timing if you have a patient with dysphagia?
coughing, gagging, dropping food when eating
what is expected of timing if you have a patient with regurgitation?
shortly after eating/drinking
what is expected of timing if you have a patient with vomiting?
variable
what control is vomiting under?
chemical - CRTZ
neuronal - vestibular centers, cerebral cortex, & CRTZ
visceral - stretch/pain receptors in the gi tract
what clinical signs are associated with a patient with weight loss that has a good appetite?
dysphagia, unobserved regurgitation/vomiting/diarrhea, malassimilation (maldigestion/malabsorption), & increased metabolism
what clinical signs are associated with a patient with weight loss & a poor appetite?
nausea, pain associated with eating, & neurologic disease
what characteristics are associated with small bowel diarrhea?
increased volume, weight loss, melena, & vomiting
what characteristics are associated with large bowel diarrhea?
increased frequency, pain or straining, & frank blood/mucus
what are some examples of differentials for small bowel diarrhea?
EPI, ketones/uremia/ammonia, strange/spoiled food, infiltrative tumors, IBD, toxins, & foreign bodies causing trauma
what are some examples of differentials for large bowel diarrhea?
motility disorders, strange/spoiled food, infiltrative/obstructive tumors, IBD, & head trauma
is small bowel diarrhea or large bowel diarrhea associated with weight loss?
small bowel - especially if chronic
if there is frank blood present in diarrhea, where do you localize it to?
large bowel diarrhea
where does melena localize to?
stomach or small intestine
where does hematochezia localize to?
large intestines
what is the definition of diarrhea?
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
what is the default state of the intestinal immune cells? why is this important?
default state is tolerance
danger/signal must subside for the intestine to repair itself, so if it doesn’t, chronic inflammation will persist
what are the 3 categories of schemes when approaching gi disease?
temporal, anatomic (to organize differentials), & etiologic (to devise therapy)
what are some examples of differentials of extra-gastrointestinal causes of gi disease?
fever/hyperthermia, liver disease, prostatic disease, & renal disease
what parasites are associated with causing large intestinal issues?
trichuris, tritrichomonas, & giardia
what bacteria is associated with causing issues in the large intestines?
clostridiums & e. coli
between dogs & cats, which are more likely to develop stress large intestinal diarrhea?
dogs
what bacteria are associated with causing gi issues in the stomach & small intestines?
salmonella, e. coli, campylobacter
what are your top tier diagnostics for working up a patient with gastroenteritis?
thorough history/physical, quick assessment tests (PCV, TS, BG, NOVA, ISTAT), fecal float, fecal smear for bacterial population, & symptomatic therapy
what are your top differentials for gastroenteritis?
dietary indiscretion, dietary indiscretion of objects, & acute hemorrhagic diarrhea syndrome
what is the most common cause of acute vomiting in dogs & cats?
dietary indiscretion - self-limiting problem
what is the most important definitive diagnosis to consider in the acute setting of a patient with vomiting?
foreign body obstruction - surgical removal
what may your diagnostic tests look like in a patient with dietary indiscretion?
normal physical exam, patients otherwise well with an acute onset
PCV/TS may be elevated if dehydration is severe, fecal cytology is normal
what are some examples of causes of dietary indiscretion?
rapid diet change & unusual treats/snacks/meds/supplements
what may your diagnostic tests look like in a patient with dietary indiscretion of objects?
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!!!
what is the classic presentation of a patient with acute hemorrhagic diarrhea syndrome?
may have vomiting (hematemesis), depression, abdominal pain, often small breed (urban indoor) dogs, & some present in distributive shock before diarrhea even begins
how do you diagnose AHDS?
high PCV (> 65%), absence of other diagnosis, & response to supportive care
what are some theories on causation of AHDS?
clostridial enterotoxin a/b (c. dificile & c. perfringens), ETEC, & type I hypersensitivity of the gi tract
what are the hallmarks of AHDS?
marked hemoconcentration, absent concurrent increased TP due to gi loss of protein, & possible splenic contraction (shock) helps increase PCV)
when is empiric therapy reasonable for a patient with gi disease?
systemically well patients with acute vomiting or diarrhea - response to therapy can be viewed as a diagnostic test
why should you withhold food in dogs if vomiting is present in a gi case?
symptomatic care - avoids provoking nausea or further vomiting
fast for 12-24 hours & gradually re-introduce water & a bland diet
NOT IN CATS
what kind of diet should be offered to a gi case?
highly digestible food with limited ingredients - may need fiber especially if large intestinal signs are present
T/F: the need for anti-emetics should make you question the idea of self-limiting gi disease
true - can use them if vomiting is severe
T/F: there is a role for acid blockers & mucosal coating agents in patients with acute disease
false - doubtful
what is the most common cause of acute vomiting in dogs & cats?
dietary indiscretion - self-limiting problem
focus on excluding more dangerous things & then help patient recover on its own
