Gastroenterology (1-13) Flashcards
name the term
difficulty eating/swallowing
dysphagia
name 3 general causes of dysphagia
- physical/morphological causes in oral cavity
- physical/morphological causes in pharyngeal area
- functional (neuromuscular) causes
name 4 physical/morphological causes of dysphagia in the oral cavity
- gingivitis
- cleft palate
- symphysiolysis (jaw dislocation)
- growths (benign/malignant)
name 5 physical/morphological causes of dysphagia in the pharyngeal area
- feline stomatitis
- laryngeal neoplasia
- enlarged tonsils
- foreign body
- retropharyngeal abscess
name 4 functional (neuromuscular) causes of dysphagia
- masticatory myositis
- cricopharyngeal achalasia
- rabies, tetanus, botulism
- CNS disease (trigeminus neuritis, facial paralysis, laryngeal paralysis)
what 2 things must you differentiate dysphagia from
- vomiting
- regurgitation
name the term
the action of bringing swallowed food up again to the mouth;
passive process (no heaving/abdominal muscle contraction);
no prodromal signs (nausea, hypersalivation, pacing)
regurgitation
name 3 luminal causes of regurgitation
- foreign body
- neoplasia
- granuloma
name 6 intramural causes of regurgitation
- megaoesophagus
- oesophagitis
- stricture
- granuloma
- oesophageal diverticulum
- dysmotility (brachycephalics)
name 3 extramural causes of regurgitation
- vascular ring anomaly (PRAA)
- mediastinal mass
- hiatal hernia
name 4 clinical signs of an oesophageal foreign body
- regurgitation
- anorexia
- drooling
- pain when swallowing
name 2 treatment options for an oesophageal foreign body
- endoscopic removal of object asap (ideal)
- if digestible, push into stomach
name 4 frequent causes of mediastinal masses
- lymphomas
- thymomas
- mesotheliomas
- carcinomas (thyroid, lung)
name 5 local diseases (oesophagus only) that are differentials for generalized megaoesophagus
- focal myasthenia gravis
- idiopathic
- congenital
- oesophagitis (reflux)
- hiatal hernia/gastro-oesophageal intussusception/dysmotility (brachycephalics)
name 5 systemic diseases that are differentials for generalised megaoesophagus
- myasthenia gravis
- paraneoplastic (mediastinal mass)
- lead intoxication?
- assoc. w/ endocrine disease? (hypothyroidism, hypoadrenocorticism)
- dysautonomia (rare)
how to diagnostically differentiate myasthenia gravis from generalized megaoesophagus
AchR-antibodies
how to diagnostically differentiate paraneoplastic from generalized megaoesophagus
radiographs
(mediastinal mass)
how to diagnostically differentiate hypothyroidism from generalized megaoesophagus
serum T4/TSH
how to diagnostically differentiate hypoadrenocorticism from generalized megaoesophagus
basal cortisol or ACTH stimulation test
how to diagnostically differentiate lead intoxication from generalized megaoesophagus
blood lead levels
how to diagnostically differentiate dysmotility/sliding hernias from generalized megaoesophagus
fluoroscopy (referral)
how to diagnostically differentiate oesophagitis from generalized megaoesophagus
treatment trial / endoscopy
how to diagnostically differentiate idiopathic/congenital from generalized megaoesophagus
diagnosis of exclusion
this is an acquired disease of the neuromuscular junction;
(auto-)immune disorder;
antibodies against nicotinic AChR on the postsynaptic muscle terminal
Myasthenia gravis
what is the treatment for Myasthenia gravis
Acetylcholine esterase blockers
name 3 clinical signs of generalised myasthenia gravis
- exercise intolerance, weakness
- “bunny hopping” gait
- +/- regurgitation
what is the management for idiopathic/congenital megaoesophagus (3)
- gastroprotectants/antacids
- feeding management
- Bailey’s chair
name 4 gastro-intestinal signs
- vomiting
- diarrhea
- abdominal pain
- weight loss
name 4 signs of abdominal pain
- bruxism (teeth grinding)
- inappetence
- lethargy
- aggression
name 4 causes of acute vomiting that all respond well to “supportive” treatment
- acute gastritis
- garbagitis
- food intolerance
- food hypersensitivity
conundrum!
name 7 common GI diseases
- inflammation, infection
- outflow obstruction
- foreign body
- GDV
- Dysmotility
- bilious vomiting
- neoplasia
name 4 places haematemesis may originate from
- stomach
- lungs
- naso-oral cavity
- oesophagus
name 4 GI causes for haematemesis
- Drugs (NSAID, pred), caustic agent
- gastric neoplasia
- foreign body
- chronic enteropathy
name 4 extra-GI causes of haematemesis
- liver, kidney, pancreas, hypoadrenocorticism…
- neoplasia (mast cell, gastrinoma)
- sepsis/shock
- heat stroke
name the 3 main causes of haematemesis/melena in CATS
- GIT tumors
- ulcerations
- coagulopathies
name the 6 main causes of haematemesis in DOGS
- hookworm
- ulceration
- neoplastic
- ingested blood
- hypoadrenocorticism
- coagulopathies
name 4 treatment options for a vomiting dog with no haematemesis and clinically well
- Nutrition (bland v. elimination diet)
- anti-emetic (maropitant, ondansentron)
- probiotic
- gastro-protectant (Sucralfate)
what treatment should be given to a vomiting dog with haematemesis and clinically well
antacid
(omeprazole, famotidine/Ranitidine, barium)
name 6 treatment options for a vomiting dog that is clinically unwell
- intravenous fluids
- blood transfusions
- surgey (ulcers)
- endoscopy (foreign body)
- feeding tube
- parenteral feeding
name the 4 types of diarrhea
- osmotic
- incr. motility
- secretory
- incr. permeability
name the 4 main causes of diarrhea
- infectious agent
- parasitic
- diet
- additive (e.g. chemicals)
small or large intestine problem?
diarrhea with:
decreased appetite,
abdominal discomfort,
chronic weight loss
and vomiting
small intestine
small or large intestine problem?
diarrhea with:
no change in appetite,
abdominal discomfort,
no/small amount of weight loss,
and some vomiting
large
small or large intestine problem?
diarrhea with:
no/limited incr in volume per defacation,
no mucus,
no/small incr. in frequency,
no tenesmus,
no dyschezia,
and presence of melena (digested blood)
small intestine
small or large intestine problem?
diarrhea with:
incr. volume per defecation,
mucus,
incr. frequency,
tenesmus,
dyschezia,
and haematochezia (fresh blood)
large intestine
name the term
present, painful desire to evacuate the bowel despite an empty colon
tenesmus
name the term
difficulty pooping
(disordered defecation)
dyschezia
name 6 signalments which may indicate that the diarrhea is infectious
- young animal
- unvaccinated
- ill thrift
- recently boarded at a kennel
- poor husbandry
- haematochezia or pyrexia
name 3 nematodes that may cause acute diarrhea in the dog
- roundworms
- hookworms
- whipworms
name 2 nematodes that may cause acute diarrhea in a cat
- roundworms
- hookworms
name 3 protozoa that may cause acute diarrhea in a dog or cat
- Isospora
- Cryptosporidium
- Giardia
name the 3 most common causes of acute diarrhea if the dog/cat is clinically well
- dietary
- nematodes
- protozoa
what specific clinical sign may be seen with an animal affected by hookworms causing acute diarrhea
anemia
what specific clinical sign may be seen with an animal affected by roundworms causing acute diarrhea
pulmonary signs
name 5 treatments for a clinically well dog/cat with acute diarrhea
- fluid (PO, SQ, IV)
- (acid-base)
- electrolytes
- anti-emetic (2-3d)
- (anti-diarrhea)
name 10 clinical signs that make an acute diarrhea case more worrying/more complicated
- significant weight loss
- fever
- abdominal pain/effusion
- organomegaly, abdominal mass
- moderate to severe dehydration
- severe lethargy
- melena or haematochezia
- pallor, jaundice, congestion
- frequent vomiting
- PU/PD
name 3 clinical signs with acute diarrhea that indicate prescribing antibiotics
- fever and neutropenia
- asp. pneumonia
- suspected sepsis
what should you prescribe if an animal is vomiting blood or has melena in stool?
anti-acids
(omeprazole)
what are the clinical signs for Canine Parvovirus-2 (CPV-2)
anorexia and vomiting (first 12-48h)
then diarrhea/haematochezia
name 4 main differentials for Canine Parvovirus-2 (CPV-2)
- foreign body
- intestinal intussusception
- garbage disease
- severe infestation
when will a dog start shedding canine parvovirus-2 (CPV-2) antigens
10-12 days post-infection
name 2 reasons for a false-negative Parvoviral antigen test (snap test)?
- shedding can wax and wane
- too early in clinical course (not started shedding yet)
what may cause a false positive on a Parvoviral antigen test (snap test)
recent vaccination with modified-live vaccine (5-15 days post)
name 4 pathogenic bacteria that have an incr. risk of causing bacterial enteritis with raw meat diets
- Campylobacter
- Clostridium perfringens
- Salmonella
- Escherichia coli
name 5 differential diagnoses for bacterial enteritis
- parvovirus
- parasite infestation
- dietary indescretion
- acute haemorrhagic diarrhea syndrome
- Titrichomonas (cats)
name the fecal score
very hard and dry;
requires much effort to expel from body;
no residue left on ground when picked up;
ofte nexpelled as individual pellets
score 1
name the fecal score
firm, but not hard;
should be pliable;
segmented appearance;
little or no residue left on ground when picked up
score 2
name the fecal score
log-like;
little or no segmentation visible;
moist surface;
leaves residue, but hold form when picked up
score 3
name the fecal score
very moist (soggy);
distinct log shape visible;
leaves residue and loses form when picked up
score 4
name the fecal score
very moist but has distinct shape;
present in piles rather than as distinct logs;
leaves residue and loses form when picked up
score 5
name the fecal score
has texture, but no defined shape;
occurs as piles or as spots;
leaves residue when picked up
score 6
name the fecal score
watery, no texture, flat;
occurs as puddles
score 7
name the 4 types of enteropathy
- food-responsive enteropathy (FRE)
- antibiotic-responsive enteropathy (ARE) bad idea - replaced w/
- Microbiota-modifying enteropathy (MRE)
- Immuno-modulator enteropathy (IRE)
- non-responsive enteropathy (NRE)
name 3 types of diets that can be used to treat enteropathy
(food-responsive enteropathy (FRE))
- limited ingredient novel protein diets
- hydrolyzed diet
- commercial therapeutic GI diets
how quickly should you expect an improvement in food-responsive enteropathy (FRE) with a diet trial
2 weeks
what is the benefit of home-cooked vs. commercial diet?
no preservatives
(cross-contamination less likely)
name 4 reasons to measure vitamin B12 in a dog with chronic diarrhea/enteropathy
- screening tool
- prognostic factor (neg. in CE + EPI)
- should be supplemented
- monitoring purposes
name 3 additional considerations in cats with chronic diarrhea
- more infectious causes than dogs
- parasites more common than dogs (esp. if hunters)
- Titrichomonas foetus: unique to cats
name the 3 main types of protein losing enteropathy in dogs/cats
- primary lymphangiectasia
- secondary lymphangiectasia due to inflammation
- secondary lymphangiectasia due to neoplasia
name 7 clinical signs associated with “caudal” intestinal disease
- faecal incontinence
- dyschezia
- haematochezia
- constipation/obstipation
- tenesmus
- systemic signs
- licking/itching/scooting
what 6 structures should you feel when performing a rectal exam on a dog
- rectum
- descending colon
- urethra
- prostate gland
- pelvic symphysis
- sublumbar lymph nodes
name 3 local/external diseases of the “caudal” intestinal tract
- anal gland/sack disease
- anal furunculosis/perianal fistulas
- perineal hernia
name the local/external disease of the caudal intestinal tract
tunnel-like formations in the skin and deeper tissues, usually starts as small oozing holes
perianal fistulas/anal furunculosis
(GSDs)
how to treat perianal fistulas/anal furunculosis
cyclosporin,
topical tacrolimus
name 3 examples of abnormal content causing large intestinal or recto-anal disease
- constipation/obstipation
- “bone” material
- foreign material
name 4 examples of rectal/colonic mucosal disease causing signs of large intestinal or recto-anal disease
- rough/inflamed
- strictures
- masses/polyps
- haematochezia/mucus
name 2 examples of surrounding bony structures causing signs of large intestinal or recto-anal disease
- pelvic fractures/asymmetry/narrow pelvic canal
- lumbar vertebrae
name 3 types of structures possible in the large intestine
- inflammatory
- traumatic
- neoplastic
what is the treatment for large intestinal strictures
balloon dilation if benign;
chemo/RT if malignant
name 3 types of rectal masses possible in the lg intestine
- inflammatory polyps
- carcinoma in situ
- other neoplasms
how to treat rectal masses in the lg intestine
minimal invasive removal (electric snare) or surgical pull
how to diagnose stricutres/rectal masses in the large intestine
endoscopy and biopsies
name 5 infectious causes of colitis
- bacteria (Clostridia)
- Parasites
- Algae
- Amoeba
- Fungi
name 3 main parasites that cause colitis in dog/cat
- Trichuris vulpis
- Giardia
- Tritrichomonas foetus (cat)
name 5 inflammatory causes of colitis
- chronic enteropathy/IBD
- Fibre-responsive
- “idiopathic” colitis
- irrital bowel syndrome (IBS)
- Granulomatous colitis
what 2 dog breeds most commonly get granulomatous colitis
- young boxers
- french bulldogs
what bacteria causes granulomatous colitis
E. coli
what antibiotic should be used to treat granulomatous colitis
Fluoroquinolone
(careful of resistance!)
name the term
intractable constipation caused by prolonged retention of hard, dry feces; defecation is impossible
obstipation
name 3 treatment options for severe constipation
- rehydrate before suppositories, enemas, or oral laxatives
- attempt oral administration of larger volumes of laxatives
- manual extraction/large volume enemas (GA)
name 2 important cares that must be taken to give an enema to a cat
- ALWAYS under GA and protect airways by intubation
- NEVER use phosphate containing products (lethal hyperphosphataemia, hypocalcaemia)
what should be used for large-volume laxatives in cats
polyethylene glycol (PEG)
(with NO flavoring)
how to administer large-volume laxatives in cats
nasogastric tube
what 2 things should a complete physical exam for large intestinal disease include?
rectal and neuro exam
what 2 ways can emetics cause vomiting by?
- gastric irritation
- stimulation of CNS chemoreceptor trigger zone
- both
when is an emetic most effective?
1-2h after ingestion
what is the risk of giving emetics to a subdued animal
(reduced gag reflex/cannot swallow)
aspirate pneumonia risk
name 2 emetic drugs for dogs
- hydrogen peroxide
- apomorphine
name 1 emetic drug for cats
- Xylazine
name the mechanism for hydrogen peroxide as an emetic
irritates oropharynx and gastric mucosa
(oral)
name the mechanism for apomorphine as an emetic
CRTZ stimulation
(injection or subconjunctival)
what is the mechanism for Xylazine as an emetic
centrally acting;
alpha-2-adrenergic agonist
(injection)
name 4 options for toxin binders/decontamination of GIT
- activated charcoal
- cathartics
- gastric lavage
- whole bowel irrigation
name 2 most commonly used antiemetics
- Maropitant
- Metoclopramide