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SA DX & TX II > Exam 1 - Infectious GI Disease > Flashcards

Exam 1 - Infectious GI Disease Flashcards

1
Q

what is definitive care?

A

treatment aimed to eliminate illness

example - fenbendazole for treating giardia

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2
Q

what are the 2 agents mainly involved in canine viral enteritis?

A

parvo & coronavirus

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3
Q

what 2 agents are mainly involved in bacterial enteritis of cats & dogs?

A

salmonella & campylobacter

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4
Q

what is the main agent involved in causing protozoal diarrhea in small animals?

A

giardia

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5
Q

T/F: no clinical presentation of enteritis is pathognomonic

A

true - there is a lot of overlap with clinical signs & diagnosis may matter for prognosis more than therapy

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6
Q

what is enteritis?

A

inflammation of the gut - can be infectious or not

diarrhea is the most typical sign but vomiting can also be seen

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7
Q

what viral agent causes the classic canine parvo?

A

CPV-2

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8
Q

what does CPV-1 cause in dogs?

A

fading puppy syndrome - limited pathogenicity

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9
Q

what is the morphology of canine parvovirus? when did we start seeing it in dogs?

A

small, non-enveloped, hardy DNA virus - CPV-2 is host range limited to canidae

jumped from cats & emerged in the 70’s - substrains 2a/2b/2c evolving since

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10
Q

what is the pathogenesis of canine parvovirus?

A

highly contagious virus through oronasal exposure - causes a systemic viremia with a tropism for rapidly dividing cells such as the gi epithelium, lymph nodes, thymus, & bone marrow

see mucosal collapse with increased permeability, decreased absorption, decreased secretion, & crypt cell damage in the gut

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11
Q

what is the typical incubation period for parvo prior to clinical signs appearing? when is the virus shed?

A

4-6 days but up to 14 before clinical signs

fecal shedding occurs during the incubation period & continues during the symptomatic period

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12
Q

T/F: an animal without clinical signs can be shedding parvovirus

A

true - shedding occurs during incubation

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13
Q

what are the main clinical signs of parvo?

A

acute severe vomiting & diarrhea that is often bloody leading to panhypoproteinemia & often worsened by concurrent infections

lethargy, anorexia, abdominal pain (due to enteritis, sloughing, cytokines), dehydration, & malnourishment

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14
Q

T/F: a dog with parvo is at risk for developing an intussusception

A

true

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15
Q

T/F: widespread vaccination has decreased the occurrence of parvovirus myocarditis because most vaccinated dams pass antibodies to their puppies

A

true - only seen on occasions

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16
Q

if you have a parvo patient that has signs of myocarditis and is <6 weeks of age, what does this imply?

A

late in utero infection - dam was not immune

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17
Q

when was myocarditis seen with parvo?

A

in early existence of the virus - heart failure occurred alone with gi signs or when gi signs were regressing

structural cardiac damage was irreversible & uniformly fatal

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18
Q

how is parvo diagnosed?

A

history/physical exam - highly sensitive but less specific

cbc - leukopenia, specifically neutropenia, & lymphopenia
chem - hypoproteinemia, possibly hypoglycemic/electrolyte disturbances

fecal parvo Ag SNAP test - patient side, highly specific but less sensitive

fecal PCR - send out, highly sensitive & specific

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19
Q

if a puppy presents to you with signs of parvo, what patient side diagnostic test do you want to run that is highly specific but less sensitive? why? what test could you send out in case it comes back negative?

A

fecal parvo antigen snap test

virus is only shed for about 72 hours during clinical illness

fecal PCR

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20
Q

why is the main treatment for parvo symptomatic & supportive? what does this mean?

A

symptomatic - preventing or treating, as early as possible, the symptoms of the disease and the side effects caused by treatment of the disease (example - anti-emetics)

supportive - pain management, nutritional support

it is a virus - want to help the body get through it, antibiotics for secondary infections/help immune system, support nutrition

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21
Q

T/F: early enteral nutrition through an NG tube reduced hospitalization time in parvo patients

A

true - also allows for suction of residual gastric contents prior to feeding

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22
Q

how should you feed a parvo patient with an NG tube?

A

start at 25% RER & trickle feed using a CRI pump if 24 hour care

if not - intermittent syringe feeding & always position them in sternal

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23
Q

T/F: parenteral nutrition for parvo patients is expensive, complicated, & risks sepsis in neutropenic patients

A

true

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24
Q

‘if the gut works, use it’ - what does this mean for treating parvo patients? what should you do if the animal is vomiting?

A

the gi contents are nourished from the luminal contents

rest the gi tract - 12 hours after last vomiting episode

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25
Q

_______ is often a cause of mortality in parvo patients due to expensive treatment

A

euthanasia

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26
Q

what are some potential complications associated with parvo virus infections?

A

aspiration pneumonia, intussusception, sepsis, & esophageal strictures

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27
Q

T/F: timing is critical in parvo patients with puppies surviving the first 3 days having a better chance at recovery

A

true

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28
Q

how is parvo prevented in dogs?

A

core vaccine starting at 6 weeks & boostered every 3-4 weeks until 16 weeks old - boostered again at 1 year, & every 3 years after (dogs are likely boosted through natural environmental exposure

MLV for sterilizing immunity - don’t give to pregnant bitches

disinfect areas with bleach, accelerated H2O2, steam/autoclave, direct sunlight/drying

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29
Q

coronavirus has a tropism for what cells?

A

gi epithelium at villus tips

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30
Q

what is the incubation period & shedding period of coronavirus?

A

short incubation & long shedding period whether or not the animal shows clinical signs

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31
Q

T/F: despite widespread seropositivity, many animals are never symptomatic for coronavirus

A

true

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32
Q

how is coronavirus spread in small animals?

A

fecal-oral - most commonly in high density environments

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33
Q

what is the morphology of coronavirus?

A

collection of closely related viruses that can infect most domestic species - enveloped ssRNA virus that isn’t very durable in the environment

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34
Q

what are some clinical signs associated with enteric coronavirus in small animals?

A

none

acute, mild diarrhea occasionally with vomiting - fever is unlikely & no leukopenia

chronic watery diarrhea that isn’t hemorrhagic (severe clinical signs more commonly seen in animals with comorbidities)

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35
Q

T/F: a positive serology result for coronavirus in a dog indicates current infection

A

false - indicates exposure (widespread disease)

a positive PCR or EM of feces indicates shedding that is prolonged after infection

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36
Q

T/F: there are no helpful labwork changes to help guide you in diagnosing coronavirus infection in small animals

A

true

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37
Q

how is coronavirus treated?

A

diagnose & treat whatever else is wrong (parasites, parvo, enteric bacterial infection)

supportive care - most needed in juveniles or severe cases of dehydration

consider husbandry changes

38
Q

T/F: coronavirus is vaccinated against in both canine & feline core vaccine protocols

A

false - not at all

MLV & inactivated products are available but are likely ineffective

39
Q

what is the treatment for parvo patients?

A

symptomatic & supportive care

fluid therapy +/- colloids

antibiotics to block gi flora translocation, anti-emetics, pain management, nutrition, & impeccable nursing care in isolation

40
Q

what are clinical signs of bacterial enteritis?

A

presence of a particular pathogenic bacterial population (strong pathogen)

imbalance in proportions of types - dysbiosis

gut is full of bacteria - mixed population is normal, not just tolerated, but necessary

41
Q

what clinical signs can e. coli cause in small animals? is it a part of the resident flora of the gi tract?

A

resident flora

UTI, pneumonia, or direct invasion of gut wall causing diarrhea

42
Q

T/F: some species of helicobacter can cause gastric ulcers & others hepatitis in people

A

true

43
Q

T/F: clostridial species can produce toxins - including tetanus toxins, under the right conditions, even though it is a part of the resident flora of the gi tract

A

true

44
Q

what campylobacter species is most commonly associated with diarrheal disease in small animals?

A

campylobacter jejuni

45
Q

what is the morphology of campylobacter?

A

genus of g- motile, spiral rods - diverse species with some host preferences but lots of overlap

generally adherent/non-invasive, may produce toxins - more invasive in people causing systemic sugns

46
Q

how is campylobacter transmitted?

A

fecal oral exposure - includes fomite contamination of food

47
Q

animals affected by campylobacter are more likely: _______?

A

young - under 6 months

stressed - household changes, surgery, pregnancy

experiencing co-infections

48
Q

what clinical signs are associated with campylobacter bacterial enteritis?

A

mucoid to watery to bloody diarrhea - large intestinal or mixed type

fever, lethargy, anorexia, vomiting, leukocytosis, or leukopenia if they become septic

49
Q

why does it matter that many dogs & cats are asymptomatic with campylobacter enteritis?

A

there is a zoonotic risk!!

people are more susceptible to infection & get more systemically ill than pets

50
Q

T/F: a fecal smear cytology with ‘seagulls’ should be plentiful for diagnosing campylobacter, but it is not a definitive diagnosis

A

true

51
Q

how is campylobacter bacterial enteritis diagnosed in small animals?

A

history/physical exam - husbandry, age, & clinical signs

fecal smear cytology - leukocytes may be seen

PCR or species-specific culture to confirm

need to consider alternate or concurrent diseases

52
Q

how is campylobacter enteritis prevented?

A

better husbandry - cook pets’ food, minimize crowding, maintain sanitary environment at appropriate temperature, & deworm appropriately

concern for zoonotic risk - client education about hygiene!!! people are more susceptible to infection & get more systemically ill than pets

53
Q

what is the goal of treatment for campylobacter enteritis?

A

resolution of clinical signs - symptomatic & supportive care tailored to severity of signs

54
Q

why should you be careful with definitive therapy for treating campylobacter enteritis?

A

BE CAREFUL - may use erythromycin, chloramphenicol, & quinolones - pay attention to puppy’s source, may need to do culture & susceptibility

antibiotics will further disrupt the gi flora & complete eradication of campy is not likely or necessary in most cases

55
Q

what is the morphology of salmonella enterica?

A

genus of g- motile facultatively anaerobic rods - considered a single pathogenic species with many serotypes with most serotypes NOT BEING HOST SPECIFIC (affects mammals, birds, reptiles)

56
Q

what is the damage caused by salmonella enterica?

A

invasive species that may produce toxins - will cause enterocyte sloughing leading to severe diarrhea

allows for systemic spread leading to endotoxemia & bacteremia

57
Q

what is the pathogenesis of salmonella enterica?

A

fecal oral exposure (food or fomites) that is very durable in water sources - can also be isolated from cooked food in dirty environments

58
Q

T/F: clinical signs of salmonella enterica depends on host factors, strain factors, of dose

A

true

59
Q

what animals commonly show clinical signs with salmonella enterica?

A

old, young, immune-compromised, & those stressed by the environment or co-morbidity

60
Q

T/F: an animal can be an asymptomatic carrier of salmonella & may never show signs of illness

A

true - may shed 6 weeks or more after clinical recovery if showing signs

61
Q

what clinical signs are seen with salmonella bacterial enteritis?

A

gastroenteritis - both small & large bowel, fever, lethargy, anorexia, vomiting, diarrhea (may be bloody), abdominal pain, & clinical signs may last weeks with shedding persisting after resolution of clinical signs

+/- septicemia - may lead to shock or death

+/- organ infections - abscesses anywhere following bacteremia

62
Q

how is salmonella bacterial enteritis diagnosed?

A

history/physical exam

labwork varies based on clinical syndrome - leukocytosis including left shift in many cases, neutropenia in severe cases (juveniles), & chemistry reflects dehydration or particular organ involvement

fecal salmonella specific culture or PCR - isolation of salmonella from sterile site is definitive, fecal smear may show chaining rods but can’t identify it on microscope alone

63
Q

what is the treatment for salmonella bacterial enteritis?

A

symptomatic & supportive care tailored to the severity of signs - may be self-limiting

hospitalize (isolation) if needed - attentive monitoring to guide therapeutic adjustments

be very careful with definitive therapy

64
Q

why should you be very careful with definitive therapy for an animal with salmonella bacterial enteritis?

A

antibiotics will disrupt gi flora - may use empiric beta lactams & quinolones pending culture & susceptibility

rapidly growing bacteria may rapidly acquire & share resistance

65
Q

how is salmonella bacterial enteritis prevented?

A

better husbandry - cook pets’ food, wash hands, maintain cleanliness in kennels/shelters/clinics, & isolate affected animals

66
Q

why is there a major zoonotic concern for animals with salmonella bacterial enteritis?

A

need client education - particular risk from reptiles (large proportion carry as normal flora) & need to be concerned about young children, elderly people, & immunocompromised

increasing documentation of multi-drug resistant strains

67
Q

what are the 2 morphologic forms of giardia?

A

trophozoite in the gut - motile, adherent, short lived

cyst - excreted into the environment, highly resistant in moist & cold conditions but can be desiccated by dry & hot conditions

68
Q

T/F: giardia can complete its lifestyle within a single host

A

true

69
Q

what is this?

A

giardia trophozoite - smiley face sting ray looking thing

70
Q

what agent is this?

A

giardia cysts

71
Q

T/F: giardia usually causes no clinical signs

A

true

72
Q

what animals typically do have clinical signs of giardia?

A

very old, very young, immunocompromised, those with comorbidities, & those house in dense or unsanitary conditions

73
Q

what clinical signs are associated with giardia?

A

chronic small bowel diarrhea & weight loss - may be mucoid or fatty

not hemorrhagic - no vomiting

afebrile & normal labwork

74
Q

T/F: diagnosing giardia is very hard

A

true

75
Q

what is the gold standard of diagnosing giardia?

A

fecal IFA

76
Q

what are some different ways to diagnosis giardia?

A

fecal direct smear to look for trophozoites - fragile/dies quickly, must confirm identity

fecal concentration/floatation to look for cysts - cysts are shed intermittently, so 3 negative samples over a week must be proved to call it negative

snap elisa - unclear on how presence of detectable antigen correlates to symptomatic infection

pcr - unclear on how presence of detectable DNA correlates to symptomatic infection

77
Q

T/F: there is a wide disagreement about treatment of asymptomatic giardia cases in small animals

A

true - the treatment goal is the resolution of clinical signs

78
Q

what is the treatment of choice for giardia in symptomatic cases? why?

what husbandry changes should be made?

A

fenbendazole - extremely cheap, limited to no side effects (less disruption of gi flora), & might be indicated for other parasites anyway

probiotics & fiber, bathe & thoroughly dry patients, & environmental hygiene

79
Q

how is giardia diarrhea prevented?

A

husbandry!!!! maintain dryness & cleanliness in kennels, shelters, & clinics

avoid exposure to contaminated yards & water sources

80
Q

is there a zoonotic risk associated with giardia?

A

uncertain - humans do get giardia but unsure if it is transmitted directly from pets

theoretical risk for very old, very young, & immunocompromised people

81
Q

how is an asymptomatic giardia fecal-positive case managed?

A

still treat - potential risk of zoonosis

82
Q

what is the pathogenesis of giardia?

A

fecal oral route (fomites, water)

encyst in gut lumen & trophozoites adhere to microvilli

83
Q

how does giardia cause clinical signs?

A

mechanisms by which trophozoites cause disease is poorly understood but potentially due to -

secretion due to inflammation, malabsorption due to microvilli loss

84
Q

what is sensitivity?

A

ability of the test to accurately identify a positive result in an animal that has the disease

85
Q

what is specificity?

A

probability that an animal that does not have the disease will test negative

likelihood that a healthy, disease free animal will get a negative test result

86
Q

what is positive predictive value?

A

probability that a sick animal has a positive test result

the probability that an animal has the disease given that the test is positive

87
Q

what is negative predictive value?

A

likelihood that a healthy, disease free animal will get an accurate negative test result

probability that an animal that tests negative does not have the disease

88
Q

T/F: sensitivity & specificity are independent of prevalence

A

true

89
Q

_______/_______ are features of the tests

A

sensitivity/specificity

90
Q

_______/_______ _______ _______ are features of how you use a test

A

positive & negative predictive value

91
Q

T/F: sensitivity & specificity evaluate your diagnostic test’s ability to determine if an animal has a disease or does not have a disease

A

true

92
Q

if you are thinking your patient has a bacterial cause of enteritis, what 2 agents must you include on your differential list & why?

A

campylobacter & salmonella

both affect similar populations, have the same clinical signs, & require the same work up/therapy/client education/zoonotic risk

SA DX & TX II (62 decks)

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