Final: GI - vomiting, SI, LI Flashcards
What is the preferred test for T. foetus ?
Fecal PCR
The large intestine is characterized by deep, straight _____ in which there are large numbers of _______.
Crypts
Goblet cells
*Stressed in class*
Why is the antigen ELISA for giardia not recommended as a recheck test?
Can remain positive for a long time after clearance of the disease
What emperic therapy do you try for a stable patient with chronic disease in which you suspect a primary enteropathy?
Deworming
Diet change
Antibiotic trial
+/- Pre or pro-biotics
A young shelter cat presents with waxing and waning LI diarrhea and a very painful edematous rectum. What is the likely diagnosis and how would you treat it? What symptoms, that usually resolve, can you expect?
Tritrichomonas foetus
Tx: Ronidazole (SID q2 weeks)
Neuro signs
Whatever the histologic type of IBD, treatment usually involves a combination of ________ with ______and/or ______ therapy.
Dietary modification
Antibacterial
Immunosuppressive
What is the most important treatment modality in idiopathic IBD?
Immunosuppression
What drugs do you give a dog with Salmon Poisoning?
Oxytetracycline or Doxycycline (for neorickettsia)
Praziquantel (for fluke)
What are the 2 most important considerations when choosing a diet to feed an animal with GI disease?
Nutrient content
Digestibility
*Starred on slide*
A young dog has developed acute colitis due to dietary indiscretion. What is your first course of therapy?
Withhold food temporarily and modify diet (low fat, highly digestible)
What cause of large bowel colitis also causes ocular and CNS signs in dogs? What is the treatment?
Prototheca (toxic algae)
Amphotericin B + Intraconazole
T/F: Most cats affected with feline idiopathic megacolon eventually require a colectomy.
True
What is the major substrate for bacteria that is not digested by the SI?
Fermentable fiber
Why should TLI/PLI, serum cobalamin and/or folate be run on a dog presenting with colitis?
Extension of pancreatic inflammation can cause inflammation of the adjacent regions of the colon and cause signs of colitis
Histoplasmosis causes chronic LI diarrhea in young dogs and cats. What stains can you use to help demonstrate the organism in fixed tissues? What is the treatment?
PAS and Gomori’s Methenamine silver stain
Intraconazole for 4-6 months
What is the term for repeated unsuccesful attempts to defecate or pain on defecation? What usually precedes this (clinical sign)?
Dyschezia
Staining to urinate and/or blood in urine
Enterotoxigenic E.coli (ETEC) causes ____ (SI/LI) disease, while enterohemorrhagic E.coli (EHEC) causes _____(SI/LI) disease.
ETEC= SI
EHEC= LI
Renal disease causes a loss of _____, with GI disease ______ and _______ are lost.
Albumin
Globulins and Albumin
What must you give a dog with Heterobilharzia americana who has hypercalcemia?
Praziquantel
*Starred on sides*
What medications can you use to treat mild histoplasmosis? Severe?
For how long do you treat?
Mild: Intraconazole, Fluconazole, Ketoconazole (can cause Addision’s)
Severe: Amphotericin B
Treat 6mo - 1 yr
What are the 3 main functions of the colonic microbiome?
Immune system interface
Energy for colonocytes
Synthesizing AAs and vitamins
If you have neuro signs accompanying GI signs in a cat, what parasite do you suspect? What eye clinical sign can this also cause?
T. gondii
Chorioretinitis
What is the diet indicated for a dog with lymphangiectasia?
Fat-restricted
Calorie-dense
Highly digestible
+ Fat-soluble vitamin supplements
(Do not feed weight-reduction diet)
What disease associated with intracellular E.coli (AIEC) occurs frequently in young Boxer dogs and causes disease limited almost exclusively to the colon? How is it characterized histologically? What is the treatment?
Granulomatous Colitis
(formely known as Histiocytic Ulcerative Colitis (HUC))
Histo: Presence of macrophages full of PAS-positive stain
Tx: Enrofloxacin
(Do not give immunosuppressives!)
In what part of the GIT are most nutrients broken down?
Jejunum (microvilli of the)
Is cell turnover faster or slower in the large intestines (compared to SI)? How long is turnover?
Slower
LI= 4-7 days
(SI=3 days)
Impairement of Pattern Recognition Receptors, found on _____, are thought to be involved in IBD.
Phagocytes
What is the main energy requirement of enterocytes? What occurs when this is absent (4 things) ? What does this look like clinically?
Glutamine
Decline in villi structure, loss of epithelial integrity, decreased immune function, decreased absorptive function
CS: Weight-loss, secondary bacterial infections (-> sepsis), unthrifty
What are the most common biopsy diagnoses?
Inflammatory bowel disease (several types)
Lymphangectasia
Lymphoma
What are the 2 reasons a dog with colonic disease may be losing weight?
Concurrent small intestinal disease
Advanced disease
(Things that cause inappetence)
What are the fat soluble vitamins?
Vit A, D, E, and K
What kinds of antidiarrheals may bind bacterial toxins and produce firmer stool? What can you give to reduce tenesmus?
For diarrhea: Kaolin-based
For tenesmus: Diphenoxylate or Loperamide
T/F: The long-term prognosis for lymphangiectasia is poor and patients almost invariably succumb ultimately to severe malnutrition, incapacitating effusions, and intractable diarrhea.
True
Tenesmus, increased urgency, and watery diarrhea is indicative of _________ disease.
Large bowel/intestine
You have a feline patient with severe pancreatitis. On the blood work you have elevated bilirubin and mildly elevated AST. What is causing the elevated bilirubin?
Cholestasis due to duct obstruction
Sher Pai, Giant Schnauzers, Beagles, and Border Collies get a congenital deficiency of which vitamin?
B-12
What 2 lipases digest short and medium chain fatty acids?
Lingual
Gastric
Which dog breed(s) get(s) gluten-sensitive enteropathy?
Irish Setter
Which 4 breeds commonly get PLE?
Wheaton Terrier
Lundehund
Yorkie
Rotties (in Europe)
How long does a dog with parvovirus shed?
While sick and up to 8-10 days after acute illness
What can you use in combination with pred to treat IBD when the initial response to therapy is poor or the steroid side effects are marked?
Azathioprine
Make sure you warn owner that drug is toxic also must monitor CBC (myelosuppressive)
T/F: Most cats affected with feline idiopathic megacolon eventually require a colectomy.
True
Which of the following is not associated with large bowel diarrhea?
Fecal volume normal to mildly increased
Urgency and marked increase in frequency
Steatorrhea
Tenesmus
Hematochezia
Melena
Melena
Steatorrhea
The large intestine secretes mucus and _______.
Bicarbonate
What is the preferred diagnostic test for T. gondii in a sich pet?
Antibody titers for IgG and IgM
However note, positive titers do not indicate oocyst shedding or clinical diseae esp if only IgG is +
T/F: Performing a canine parvo SNAP test on a kitten showing parvo signs can help diagnose feline panleukopenia.
True
What makes the prognosis for AHDS poor?
Hypoproteinemia and sepsis
What drug can be used off-label to treat IBD by immunosuppression in a diabetic patient?
Apoquel (need ihgh dose, does not affect glucose metabolism)
What are the 2 drugs you can use to treat Giardia duodenalis? For how long do you treat?
Fenbendazole
Metronidazole
5 days
What is associated with peri-natal infection with feline panleukopenia?
Cerebellar hypoplasia
Can improve clinically over time
This radiograph is from a dog that presented for coughing. What are your 3 DDx/rule-outs?
Neoplasia
Heart failure
Fungal disease
What must you give a dog with Heterobilharzia americana who has hypercalcemia?
Praziquantel
*Starred on sides*
A dog presents to you with high fever, hematochezia, hematemsis, enlarged lymph nodes as well as ocular discharge. The CBC shows thrombocytopenia. He has lost so much blood that a transfusion is indicated. You have ruled out fungal disease. What is your top DDx?
Salmon Poisoning Disease
What clinical staple item can decrease the sensitivity of the parvo SNAP test?
Lubricant
Which virus can mutate to manifest as FIP?
Feline Enteric Coronavirus
T/F: Coccidiosis can be self-limiting in healthy adults, but in young or immunocompromised animals can cause ilness including anorexia, vomiting and diarrhea.
True
Why are antibiotics indicated with parvovirus infeciton?
To decrease the risk of sepsis - GIT protection is striped by the virus so secondary bacterial infection is facilitated
Where does Ondansetron work to inhibit vomiting?
Directly in the stomach
Which of the following is found in the small intestines but NOT in the colon?
Intestinal crypts
Intestinal villi
Muscularis
Myenteric nerve plexus
Goblet cells
Intestinal villi
*Stressed in class*
What zoonotic anaerobic bacterium destroys the intestinal villi in young, parasitized, immunocompromised, or stressed kennel dogs?
Salmonella
Colitisis considered chronic if it lasts longer than _____ days/weeks/months
3 weeks
What are the 2 most common clinical signs of colonic disease? Name some signs that are unique to colonic disease.
1 Diarrhea
CS: Frank blood, mucus, tenesmus, dyschezia, urgency
The large intestine secretes mucus and _______.
Bicarbonate
T/F: The gut mucosa hosts the largest population of immune cells in the body.
True
What are the 2 pathologic mechanims through which megacolon develops? What is the underlying cause of each?
Dilation- caused by obstruction
Hypertrophy - caused by e-lyte abnormalities, neuromuscular disorders (or idiopathic)
The neurotransmitter subtance ___ binds to _____ receptors in the CRTZ, creating a lock and key effect that initiates vomiting.
Which drug directly targets the NK1 receptor to stop vomiting?
P
NK1
Cerenia (which also helps to control pain)
Which of these is not a clinical sign associated with small intestinal disease?
Vomiting
Tenesmus
Melena
Increased fecal volume per defecation
Weight-loss
Skin and coat changes
Tenesmus
What is one action that ranitidine has that other H2 blockers (Femotidine) and Omeprazole do not?
Mildly increases GI motility
T/F: Salmon Poisoning is a self-limiting disease and can be treated wih supportive theray.
False, death in up to 90% of untreated animals
T/F: You should advise an owner who had a puppy with parvo at home not to get another puppy for at least 1 year.
True
Remains infectious in the environment for long time
What are the 2 medications you can use to trat pythiosis? Are there any side effects to either medication? How long must you treat?
Intraconazole
Terbinafine - hepatotoxic
2-3 months
Note: Low chance of survival with meds alone
What is the term for repeated unsuccesful attempts to defecate or pain on defecation? What usually precedes this (clinical sign)?
Dyschezia
Staining to urinate and/or blood in urine
What are the 2 most common types of IBD?
Lymphocytic-Plasmacytic Enteritis (LPE) - more common
Eosinophilic Enteritis (EE)
What 2 drugs can be used to treat C. parvum?
Tylosin
Paromomycin
A 3 year old King Charles presents to you with profuse hemorrhagic diarrhea resembling raspberry jam, vomiting, and lethargy. You notice a marked increase in PCV with a normal TP. What is your suspected diagnosis?
Acute Hemorrhagic Diarrhea Sydrome
(old name= Hemorrhagic gastroenteritis (HGE))
Which of the following is not associated with large bowel diarrhea?
Fecal volume normal to mildly increased
Urgency and marked increase in frequency
Steatorrhea
Tenesmus
Hematochezia
Melena
Melena
Steatorrhea
A young shelter cat presents with waxing and waning LI diarrhea and a very painful edematous rectum. What is the likely diagnosis and how would you treat it? What symptoms, that usually resolve, can you expect?
Tritrichomonas foetus
Tx: Ronidazole (SID q2 weeks)
Neuro signs
What do you call intractable constipation that has become refractory to cure or control? What does it imply? What is the end stage?
Obstipation
Implies permanent loss of function
End stage: Dilated megacolon
T/F: ARD is the name given to the condition in which SIBO is a clinical sign or secondary pathogenic mechanism. This is because a positive response to a range of antibiotics is usually seen.
True
*Starred on slide*
What does low cobalamine cause in the SI?
Blunting of microvilli
What toxin produced by Clostridium perfringens causes acute and often hemorrhagic enterocolitis in dogs? How is it treated? What is it often resistant to?
Type A toxin + Enterotoxin, aka Clostridium Perfringens Enterotoxin (CPE)
Metronidazole, Amoxicillin, Erythromycin, Tylosin
Commonly resistant to Tetracyclines
What are the 5 criteria for diagnosing IBD?
- Chronic (>3wks) GI signs
- Histopathologic evidence of mucosal inflammation
- All other diagnostic tests negative (inability to document other causes of gastroenterocolitis by thorough diagnostic evaluation)
- aInadequate response to therapeutic trials (ppropriately designed and implemented ) (meds and diet)
- Clinical response to anto-inflammatory or immunosuppressive drugs
T/F: Campylobacter and Clostridium species can be cultured from both healthy and diarrheic dogs.
True
What do you expect on your CBC/Chem from a dog with pythiosis? How is pythiosis diagnosed pre-treatment?
CBC: eosinophilia, anemia
Chem: hypoALB, hyperGLOB
Dx: ELISA (for antibody)
Which form of E.coli produces a Shiga-like tocin which kills colonocytes resulting in hemorrhagic diarrhea? How can you differentiate this from the other types of E.coli?
EHEC (Enterohemorrhagic)
PCR
*Stressed in lecture*
What is commonly seen on laboratory analysis of blood in a dog with lymphangiectasia?
Panhypoproteinemia
Hypocholesterolemia
Lymphopenia
(Due to leakage of lymph)
Hyperechoic mucosal striations on US in a dog with weight-loss, diarrhea, steatorrhea and polyphagia indicate which disease?
Lymphangiectasia
What do you call intractable constipation that has become refractory to cure or control? What does it imply? What is the end stage?
Obstipation
Implies permanent loss of function
End stage: Dilated megacolon
What kinds of antidiarrheals may bind bacterial toxins and produce firmer stool? What can you give to reduce tenesmus?
For diarrhea: Kaolin-based
For tenesmus: Diphenoxylate or Loperamide
When providing fluid therapy, what do you monitor to make sure the kidneys are not being adversly affected?
Azotemia
What will you find on your blood test results in a dog with whipworm?
Hyperkalemia
Hyponatremia
Pseudo-Addison’s Disease (Do ACTH stim - results will be normal)
T/F: Bacterial organisms represent approximately 90% of fecal dry matter.
False, 50%
What are the top 3 bacteria associated with intestinal disease?
Salmonella
Escherichia coli
Campylobacter
What is at the top of you DDx list if you see a dog with vomiting, weight-loss, apparent back pain, SI diarrhea, and non-healing skin lesions?
Pythium insidiosum
Which hypersensitivity reaction is not food related?
Type III
(Immune-complex mediated)
Enlargement of which lymph nodes is indicative of fungal disease rather than lung neoplasia?
Hilar
Sternal
Tend to not be enlarged w/cancer
When palpating a dog you note pain in the right dorsal area. What 2 organs could be the origin of the pain?
Duodenum
Pancreas
T/F: Giardia, Tritrichomonas foetus, Coccidia, Cryptosporidium and Toxoplasma gondii are all bacteria which can cause small intestinal disease.
False, they’re protozoa
T/F: Bacterial organisms represent approximately 90% of fecal dry matter.
False, 50%
Enterotoxigenic E.coli (ETEC) causes ____ (SI/LI) disease, while enterohemorrhagic E.coli (EHEC) causes _____(SI/LI) disease.
ETEC= SI
EHEC= LI
In which species are the bile and pancreatic duct usually fused?
Feline
Which opportunistic infection is accociated with disruption of mucosal integrity, and can cause peritonitis in dogs and pyothorax in cats?
Candidiasis
How long is the turnover time of enterocytes?
3 days
What 3 reasons are there for a dog with colonic diseasse to be vomiting?
Constipation
Systemic illness
Concurrent small intestinal disease
What are your 3 DDx etiologies for a dog with hematemesis or hematochezia with a PCV >60% and a normal TP?
Viral
Hypersensitivity reaction
Infection (Clostridium perfringens)
What are the 3 main functions of the colonic microbiome?
Immune system interface
Energy for colonocytes
Synthesizing AAs and vitamins
What do you need to add to your IBD treatment if you have PLE?
Cytotoxic drugs
T/F: Stress colitis can cause acute small or large bowel diarrhea.
False, large bowel only
Which of the following is found in the small intestines but NOT in the colon?
Intestinal crypts
Intestinal villi
Muscularis
Myenteric nerve plexus
Goblet cells
Intestinal villi
*Stressed in class*
What is the diseasethat occurs segmentally in the gut and causes marked dilation and dysfunction of intestinal lymphatics?
Lymphangiectasia
Which species is small cell lymphoma more common? What is the indicated treatment?
Felines
Chlorambucil + Prednisolone
T/F: Feeding a fiber-free diet has been shown to induce colitis.
True
A young dog has developed acute colitis due to dietary indiscretion. What is your first course of therapy?
Withhold food temporarily and modify diet (low fat, highly digestible)
What are the 3 most common causes of PLE?
Lymphoma
IBD
Lymphangiectasia
The cells on the tips of the intestinal villi are formed in the ____ and migrate up.
Intestinal crypts/ Crypts of Lieberkuehn
T/F: Feeding a fiber-free diet has been shown to induce colitis.
True
What effect, rather than its antibacterial activity, makes Metronidazole a good choice for a cat with IBD?
Immunomodulatory effects on cell-mediated immunity
What are the 2 pathologic mechanims through which megacolon develops? What is the underlying cause of each?
Dilation- caused by obstruction
Hypertrophy - caused by e-lyte abnormalities, neuromuscular disorders (or idiopathic)
The mucosa of the colon is made up of simple columnar epithelium in addition to immune system cells. The epithelium is made up of 2 cell types. What are these?
Mucus secreting cells
Absorpive epithelial cells
*Stressed in class*
What disease associated with intracellular E.coli (AIEC) occurs frequently in young Boxer dogs and causes disease limited almost exclusively to the colon? How is it characterized histologically? What is the treatment?
Granulomatous Colitis
(formely known as Histiocytic Ulcerative Colitis (HUC))
Histo: Presence of macrophages full of PAS-positive stain
Tx: Enrofloxacin
(Do not give immunosuppressives!)
How many days afer infection do you expect a puppy who has contracted parvo to show clinical signs?
4-7 days
Aside from bacteria, what can Metronidazole kill?
Parasites (certain)
What are 2 drugs that can be used to treat toxoplasmosis? For how long do you treat?
Trimethoprim-suphonamide (preferred)
Clindamycin
4 weeks
What is defined as an increase in the absolute number of bacteria in the upper SI during the fasted state?
SIBO (Small Intestinal Bacterial Overgrowth)
A young German Shepherd presents to you with stunted growth, large volume but normal frequency diarrhea, flatulence, and vomiting. The owner says she can hear the stomach growling and gurgling a lot. What condition is on top of your DDx? How can you diagnose it?
Antibiotic Responsive Diarrhea
Response to treatment trial: Metronidazole or Tylosin
What is the difference between a prebiotic and a probiotic?
Prebiotic = promote bacterial growth
Probiotic= the actual bacteria
