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Gastroenterology (1-13) Flashcards

1
Q

name the term

difficulty eating/swallowing

A

dysphagia

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2
Q

name 3 general causes of dysphagia

A
  1. physical/morphological causes in oral cavity
  2. physical/morphological causes in pharyngeal area
  3. functional (neuromuscular) causes
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3
Q

name 4 physical/morphological causes of dysphagia in the oral cavity

A
  1. gingivitis
  2. cleft palate
  3. symphysiolysis (jaw dislocation)
  4. growths (benign/malignant)
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4
Q

name 5 physical/morphological causes of dysphagia in the pharyngeal area

A
  1. feline stomatitis
  2. laryngeal neoplasia
  3. enlarged tonsils
  4. foreign body
  5. retropharyngeal abscess
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5
Q

name 4 functional (neuromuscular) causes of dysphagia

A
  1. masticatory myositis
  2. cricopharyngeal achalasia
  3. rabies, tetanus, botulism
  4. CNS disease (trigeminus neuritis, facial paralysis, laryngeal paralysis)
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6
Q

what 2 things must you differentiate dysphagia from

A
  1. vomiting
  2. regurgitation
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7
Q

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)

A

regurgitation

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8
Q

name 3 luminal causes of regurgitation

A
  1. foreign body
  2. neoplasia
  3. granuloma
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9
Q

name 6 intramural causes of regurgitation

A
  1. megaoesophagus
  2. oesophagitis
  3. stricture
  4. granuloma
  5. oesophageal diverticulum
  6. dysmotility (brachycephalics)
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10
Q

name 3 extramural causes of regurgitation

A
  1. vascular ring anomaly (PRAA)
  2. mediastinal mass
  3. hiatal hernia
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11
Q
A
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12
Q

name 4 clinical signs of an oesophageal foreign body

A
  1. regurgitation
  2. anorexia
  3. drooling
  4. pain when swallowing
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13
Q

name 2 treatment options for an oesophageal foreign body

A
  1. endoscopic removal of object asap (ideal)
  2. if digestible, push into stomach
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14
Q

name 4 frequent causes of mediastinal masses

A
  1. lymphomas
  2. thymomas
  3. mesotheliomas
  4. carcinomas (thyroid, lung)
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15
Q

name 5 local diseases (oesophagus only) that are differentials for generalized megaoesophagus

A
  1. focal myasthenia gravis
  2. idiopathic
  3. congenital
  4. oesophagitis (reflux)
  5. hiatal hernia/gastro-oesophageal intussusception/dysmotility (brachycephalics)
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16
Q

name 5 systemic diseases that are differentials for generalised megaoesophagus

A
  1. myasthenia gravis
  2. paraneoplastic (mediastinal mass)
  3. lead intoxication?
  4. assoc. w/ endocrine disease? (hypothyroidism, hypoadrenocorticism)
  5. dysautonomia (rare)
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17
Q

how to diagnostically differentiate myasthenia gravis from generalized megaoesophagus

A

AchR-antibodies

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18
Q

how to diagnostically differentiate paraneoplastic from generalized megaoesophagus

A

radiographs
(mediastinal mass)

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19
Q

how to diagnostically differentiate hypothyroidism from generalized megaoesophagus

A

serum T4/TSH

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20
Q

how to diagnostically differentiate hypoadrenocorticism from generalized megaoesophagus

A

basal cortisol or ACTH stimulation test

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21
Q

how to diagnostically differentiate lead intoxication from generalized megaoesophagus

A

blood lead levels

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22
Q

how to diagnostically differentiate dysmotility/sliding hernias from generalized megaoesophagus

A

fluoroscopy (referral)

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23
Q

how to diagnostically differentiate oesophagitis from generalized megaoesophagus

A

treatment trial / endoscopy

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24
Q

how to diagnostically differentiate idiopathic/congenital from generalized megaoesophagus

A

diagnosis of exclusion

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25
Q

this is an acquired disease of the neuromuscular junction;
(auto-)immune disorder;
antibodies against nicotinic AChR on the postsynaptic muscle terminal

A

Myasthenia gravis

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26
Q

what is the treatment for Myasthenia gravis

A

Acetylcholine esterase blockers

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27
Q

name 3 clinical signs of generalised myasthenia gravis

A
  1. exercise intolerance, weakness
  2. “bunny hopping” gait
  3. +/- regurgitation
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28
Q

what is the management for idiopathic/congenital megaoesophagus (3)

A
  1. gastroprotectants/antacids
  2. feeding management
  3. Bailey’s chair
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29
Q

name 4 gastro-intestinal signs

A
  1. vomiting
  2. diarrhea
  3. abdominal pain
  4. weight loss
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30
Q

name 4 signs of abdominal pain

A
  1. bruxism (teeth grinding)
  2. inappetence
  3. lethargy
  4. aggression
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31
Q

name 4 causes of acute vomiting that all respond well to “supportive” treatment

A
  1. acute gastritis
  2. garbagitis
  3. food intolerance
  4. food hypersensitivity

conundrum!

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32
Q

name 7 common GI diseases

A
  1. inflammation, infection
  2. outflow obstruction
  3. foreign body
  4. GDV
  5. Dysmotility
  6. bilious vomiting
  7. neoplasia
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33
Q

name 4 places haematemesis may originate from

A
  1. stomach
  2. lungs
  3. naso-oral cavity
  4. oesophagus
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34
Q

name 4 GI causes for haematemesis

A
  1. Drugs (NSAID, pred), caustic agent
  2. gastric neoplasia
  3. foreign body
  4. chronic enteropathy
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35
Q

name 4 extra-GI causes of haematemesis

A
  1. liver, kidney, pancreas, hypoadrenocorticism…
  2. neoplasia (mast cell, gastrinoma)
  3. sepsis/shock
  4. heat stroke
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36
Q

name the 3 main causes of haematemesis/melena in CATS

A
  1. GIT tumors
  2. ulcerations
  3. coagulopathies
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37
Q

name the 6 main causes of haematemesis in DOGS

A
  1. hookworm
  2. ulceration
  3. neoplastic
  4. ingested blood
  5. hypoadrenocorticism
  6. coagulopathies
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38
Q

name 4 treatment options for a vomiting dog with no haematemesis and clinically well

A
  1. Nutrition (bland v. elimination diet)
  2. anti-emetic (maropitant, ondansentron)
  3. probiotic
  4. gastro-protectant (Sucralfate)
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39
Q

what treatment should be given to a vomiting dog with haematemesis and clinically well

A

antacid
(omeprazole, famotidine/Ranitidine, barium)

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40
Q

name 6 treatment options for a vomiting dog that is clinically unwell

A
  1. intravenous fluids
  2. blood transfusions
  3. surgey (ulcers)
  4. endoscopy (foreign body)
  5. feeding tube
  6. parenteral feeding
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41
Q

name the 4 types of diarrhea

A
  1. osmotic
  2. incr. motility
  3. secretory
  4. incr. permeability
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42
Q

name the 4 main causes of diarrhea

A
  1. infectious agent
  2. parasitic
  3. diet
  4. additive (e.g. chemicals)
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43
Q

small or large intestine problem?

diarrhea with:
decreased appetite,
abdominal discomfort,
chronic weight loss
and vomiting

A

small intestine

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44
Q

small or large intestine problem?

diarrhea with:
no change in appetite,
abdominal discomfort,
no/small amount of weight loss,
and some vomiting

A

large

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45
Q

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)

A

small intestine

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46
Q

small or large intestine problem?

diarrhea with:
incr. volume per defecation,
mucus,
incr. frequency,
tenesmus,
dyschezia,
and haematochezia (fresh blood)

A

large intestine

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47
Q

name the term

present, painful desire to evacuate the bowel despite an empty colon

A

tenesmus

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48
Q

name the term

difficulty pooping
(disordered defecation)

A

dyschezia

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49
Q

name 6 signalments which may indicate that the diarrhea is infectious

A
  1. young animal
  2. unvaccinated
  3. ill thrift
  4. recently boarded at a kennel
  5. poor husbandry
  6. haematochezia or pyrexia
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50
Q

name 3 nematodes that may cause acute diarrhea in the dog

A
  1. roundworms
  2. hookworms
  3. whipworms
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51
Q

name 2 nematodes that may cause acute diarrhea in a cat

A
  1. roundworms
  2. hookworms
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52
Q

name 3 protozoa that may cause acute diarrhea in a dog or cat

A
  1. Isospora
  2. Cryptosporidium
  3. Giardia
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53
Q

name the 3 most common causes of acute diarrhea if the dog/cat is clinically well

A
  1. dietary
  2. nematodes
  3. protozoa
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54
Q

what specific clinical sign may be seen with an animal affected by hookworms causing acute diarrhea

A

anemia

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55
Q

what specific clinical sign may be seen with an animal affected by roundworms causing acute diarrhea

A

pulmonary signs

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56
Q

name 5 treatments for a clinically well dog/cat with acute diarrhea

A
  1. fluid (PO, SQ, IV)
  2. (acid-base)
  3. electrolytes
  4. anti-emetic (2-3d)
  5. (anti-diarrhea)
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57
Q

name 10 clinical signs that make an acute diarrhea case more worrying/more complicated

A
  1. significant weight loss
  2. fever
  3. abdominal pain/effusion
  4. organomegaly, abdominal mass
  5. moderate to severe dehydration
  6. severe lethargy
  7. melena or haematochezia
  8. pallor, jaundice, congestion
  9. frequent vomiting
  10. PU/PD
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58
Q

name 3 clinical signs with acute diarrhea that indicate prescribing antibiotics

A
  1. fever and neutropenia
  2. asp. pneumonia
  3. suspected sepsis
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59
Q

what should you prescribe if an animal is vomiting blood or has melena in stool?

A

anti-acids
(omeprazole)

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60
Q

what are the clinical signs for Canine Parvovirus-2 (CPV-2)

A

anorexia and vomiting (first 12-48h)
then diarrhea/haematochezia

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61
Q

name 4 main differentials for Canine Parvovirus-2 (CPV-2)

A
  1. foreign body
  2. intestinal intussusception
  3. garbage disease
  4. severe infestation
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62
Q

when will a dog start shedding canine parvovirus-2 (CPV-2) antigens

A

10-12 days post-infection

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63
Q

name 2 reasons for a false-negative Parvoviral antigen test (snap test)?

A
  1. shedding can wax and wane
  2. too early in clinical course (not started shedding yet)
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64
Q

what may cause a false positive on a Parvoviral antigen test (snap test)

A

recent vaccination with modified-live vaccine (5-15 days post)

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65
Q

name 4 pathogenic bacteria that have an incr. risk of causing bacterial enteritis with raw meat diets

A
  1. Campylobacter
  2. Clostridium perfringens
  3. Salmonella
  4. Escherichia coli
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66
Q

name 5 differential diagnoses for bacterial enteritis

A
  1. parvovirus
  2. parasite infestation
  3. dietary indescretion
  4. acute haemorrhagic diarrhea syndrome
  5. Titrichomonas (cats)
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67
Q

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

A

score 1

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68
Q

name the fecal score

firm, but not hard;
should be pliable;
segmented appearance;
little or no residue left on ground when picked up

A

score 2

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69
Q

name the fecal score

log-like;
little or no segmentation visible;
moist surface;
leaves residue, but hold form when picked up

A

score 3

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70
Q

name the fecal score

very moist (soggy);
distinct log shape visible;
leaves residue and loses form when picked up

A

score 4

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71
Q

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

A

score 5

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72
Q

name the fecal score

has texture, but no defined shape;
occurs as piles or as spots;
leaves residue when picked up

A

score 6

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73
Q

name the fecal score

watery, no texture, flat;
occurs as puddles

A

score 7

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74
Q

name the 4 types of enteropathy

A
  1. food-responsive enteropathy (FRE)
  2. antibiotic-responsive enteropathy (ARE) bad idea - replaced w/
  3. Microbiota-modifying enteropathy (MRE)
  4. Immuno-modulator enteropathy (IRE)
  5. non-responsive enteropathy (NRE)
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75
Q

name 3 types of diets that can be used to treat enteropathy

(food-responsive enteropathy (FRE))

A
  1. limited ingredient novel protein diets
  2. hydrolyzed diet
  3. commercial therapeutic GI diets
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76
Q

how quickly should you expect an improvement in food-responsive enteropathy (FRE) with a diet trial

A

2 weeks

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77
Q

what is the benefit of home-cooked vs. commercial diet?

A

no preservatives
(cross-contamination less likely)

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78
Q

name 4 reasons to measure vitamin B12 in a dog with chronic diarrhea/enteropathy

A
  1. screening tool
  2. prognostic factor (neg. in CE + EPI)
  3. should be supplemented
  4. monitoring purposes
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79
Q

name 3 additional considerations in cats with chronic diarrhea

A
  1. more infectious causes than dogs
  2. parasites more common than dogs (esp. if hunters)
  3. Titrichomonas foetus: unique to cats
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80
Q

name the 3 main types of protein losing enteropathy in dogs/cats

A
  1. primary lymphangiectasia
  2. secondary lymphangiectasia due to inflammation
  3. secondary lymphangiectasia due to neoplasia
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81
Q

name 7 clinical signs associated with “caudal” intestinal disease

A
  1. faecal incontinence
  2. dyschezia
  3. haematochezia
  4. constipation/obstipation
  5. tenesmus
  6. systemic signs
  7. licking/itching/scooting
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82
Q

what 6 structures should you feel when performing a rectal exam on a dog

A
  1. rectum
  2. descending colon
  3. urethra
  4. prostate gland
  5. pelvic symphysis
  6. sublumbar lymph nodes
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83
Q

name 3 local/external diseases of the “caudal” intestinal tract

A
  1. anal gland/sack disease
  2. anal furunculosis/perianal fistulas
  3. perineal hernia
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84
Q

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

A

perianal fistulas/anal furunculosis

(GSDs)

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85
Q

how to treat perianal fistulas/anal furunculosis

A

cyclosporin,
topical tacrolimus

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86
Q

name 3 examples of abnormal content causing large intestinal or recto-anal disease

A
  1. constipation/obstipation
  2. “bone” material
  3. foreign material
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87
Q

name 4 examples of rectal/colonic mucosal disease causing signs of large intestinal or recto-anal disease

A
  1. rough/inflamed
  2. strictures
  3. masses/polyps
  4. haematochezia/mucus
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88
Q

name 2 examples of surrounding bony structures causing signs of large intestinal or recto-anal disease

A
  1. pelvic fractures/asymmetry/narrow pelvic canal
  2. lumbar vertebrae
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89
Q

name 3 types of structures possible in the large intestine

A
  1. inflammatory
  2. traumatic
  3. neoplastic
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90
Q

what is the treatment for large intestinal strictures

A

balloon dilation if benign;
chemo/RT if malignant

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91
Q

name 3 types of rectal masses possible in the lg intestine

A
  1. inflammatory polyps
  2. carcinoma in situ
  3. other neoplasms
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92
Q

how to treat rectal masses in the lg intestine

A

minimal invasive removal (electric snare) or surgical pull

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93
Q

how to diagnose stricutres/rectal masses in the large intestine

A

endoscopy and biopsies

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94
Q

name 5 infectious causes of colitis

A
  1. bacteria (Clostridia)
  2. Parasites
  3. Algae
  4. Amoeba
  5. Fungi
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95
Q

name 3 main parasites that cause colitis in dog/cat

A
  1. Trichuris vulpis
  2. Giardia
  3. Tritrichomonas foetus (cat)
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96
Q

name 5 inflammatory causes of colitis

A
  1. chronic enteropathy/IBD
  2. Fibre-responsive
  3. “idiopathic” colitis
  4. irrital bowel syndrome (IBS)
  5. Granulomatous colitis
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97
Q

what 2 dog breeds most commonly get granulomatous colitis

A
  1. young boxers
  2. french bulldogs
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98
Q

what bacteria causes granulomatous colitis

A

E. coli

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99
Q

what antibiotic should be used to treat granulomatous colitis

A

Fluoroquinolone
(careful of resistance!)

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100
Q

name the term

intractable constipation caused by prolonged retention of hard, dry feces; defecation is impossible

A

obstipation

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101
Q

name 3 treatment options for severe constipation

A
  1. rehydrate before suppositories, enemas, or oral laxatives
  2. attempt oral administration of larger volumes of laxatives
  3. manual extraction/large volume enemas (GA)
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102
Q

name 2 important cares that must be taken to give an enema to a cat

A
  1. ALWAYS under GA and protect airways by intubation
  2. NEVER use phosphate containing products (lethal hyperphosphataemia, hypocalcaemia)
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103
Q

what should be used for large-volume laxatives in cats

A

polyethylene glycol (PEG)
(with NO flavoring)

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104
Q

how to administer large-volume laxatives in cats

A

nasogastric tube

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105
Q

what 2 things should a complete physical exam for large intestinal disease include?

A

rectal and neuro exam

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106
Q

what 2 ways can emetics cause vomiting by?

A
  1. gastric irritation
  2. stimulation of CNS chemoreceptor trigger zone
  3. both
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107
Q

when is an emetic most effective?

A

1-2h after ingestion

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108
Q

what is the risk of giving emetics to a subdued animal
(reduced gag reflex/cannot swallow)

A

aspirate pneumonia risk

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109
Q

name 2 emetic drugs for dogs

A
  1. hydrogen peroxide
  2. apomorphine
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110
Q

name 1 emetic drug for cats

A
  1. Xylazine
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111
Q

name the mechanism for hydrogen peroxide as an emetic

A

irritates oropharynx and gastric mucosa

(oral)

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112
Q

name the mechanism for apomorphine as an emetic

A

CRTZ stimulation

(injection or subconjunctival)

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113
Q

what is the mechanism for Xylazine as an emetic

A

centrally acting;
alpha-2-adrenergic agonist

(injection)

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114
Q

name 4 options for toxin binders/decontamination of GIT

A
  1. activated charcoal
  2. cathartics
  3. gastric lavage
  4. whole bowel irrigation
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115
Q

name 2 most commonly used antiemetics

A
  1. Maropitant
  2. Metoclopramide
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116
Q

what 5 things should be considered when prescribing medications for a pet

A
  1. Route
  2. Potency
  3. Frequency
  4. Adverse effect
  5. Cost
117
Q

what is the SQ dosage for maropitant

A

1 mg/kg SQ q24h

118
Q

what is the oral doseage for maropitant for a dog?

A

2 mg/kg PO q24h

119
Q

what is the oral doseage for maropitant for a cat?

A

1 mg/kg PO q24h

120
Q

what is the IV doseage for ondansetron?

(antiemetic)

A

0.1-0.2 mg/kg IV q8-24h

121
Q

what is the oral doseage for ondansetron?

(antiemetic)

A

0.5-1 mg/kg PO q8-12h

122
Q

what is the constant rate infusion doseage for metoclopramide

A

1-2 mg/kg/day

123
Q

what is the PO/IV/SQ doseage for metoclopramide

A

0.2-0.5 mg/kg q6-8h

124
Q

what is the mechanism of action for Maropitant?

(antiemetic)

A

neurokinin-1 receptor antagonist

125
Q

what is the mechanism of action for Ondansetron?

(antiemetic)

A

Serotonin type 3 receptor antagonist

126
Q

what is the mechanism of action for Metoclopramide?

(antiemetic)

A

Dopamine antagonist

127
Q

what drug can be used for mucosal protection in the stomach and oesophagus?
works best in an “acid” environment;
on an empty stomach, 1h before other Tx

A

Sucralfate

(SUChrose ALuminum sulFATE)

128
Q

name 4 types of prokinetics

A
  1. Cisapride
  2. Metoclopramide
  3. Prucalopride
  4. Domperidon
129
Q

name the anti-diarrhoeal

this is an opioid-derivative that blocks μ-receptors of smooth muscles (less peristalsis) AND δ-receptors of epithelium (less secretions)

(rarely indicated, care in collies!)

A

Loperamide

130
Q

these are carbohydrate polymers: >10 monomeric units;
naturally occurring in food as consumed;
raw materials which have a benefit to health;
synthetic carbohydrte polymers which have been shown to have a physiological benefit;
can be prebiotics = encourage “friendly” gut bacteria

A

dietary fibre

131
Q

name 6 uses of dietary fibre

A
  1. “bulking up” agents/laxatives
  2. prokinetics for the colon (megacolon)
  3. “feeding” colonic enterocytes
  4. fibre-responsive colitis
  5. chronic enteropathy
  6. anal gland impaction
132
Q

this is the most frequently used dietary fibre;
improves GI motility, well-fermented, moderate amount of gas and SCFA production

133
Q

this is a synthetic disaccharide that cannot be metabolized by eneterocytes, so it causes osmotic diarrhea;
it is fermented by bacteria into SCFA causing increased peristalsis

134
Q

this is an amphipathic polymer;
it is soluble in water and minimally absorbed in GIT;
it forms hydrogen bonds with water molecules → prevent reabsorption of water → water retention → stool softener

A

Polyethylene glycol (PEG)

135
Q

name the anti-inflammatory used for GI disease

not for acute signs;
typically used late in the work up (except for PLE!);
stop if vomiting, diarrhea, or GI bleeding

A

Glucocorticoids

136
Q

name the anti-inflammatory used for GI disease

calcineurin inhibitor;
specific T cell inhibition;
V/D most frequent adverse effects

A

cyclosporine

137
Q

name the anti-inflammatory used for GI disease

for “uncomplicated” cases of ‘colitis’;
can be a treatment trial if local disease is ruled out;
immunosuppressive, antibacterial and anti-inflammatory actions

A

Sulfasalazine

138
Q

this is a microorganism which when consumed in adequate amounts confers a health benefit to the host

139
Q

this is a substance that ncourages the growth and metabolism of probiotics

140
Q

this is a combination of pre- and probiotics

141
Q

name 3 commonly used probiotics

A
  1. Vivomixx (Europe)
  2. Visbiome (USA, Canada)
  3. Sivomaxx
142
Q

the aim of this is to transplant healthy microbiota to dogs and cats with acute or chronic enteropathy

A

faecal microbiota transplant

143
Q

what doseage of prednisolone should be given for chronic enteropathy?

A

anti-inflammatory dose

144
Q

name the 2 most common diseases of the exocrine pancreas in dogs

A
  1. Exocrine pancreatic insufficiency (EPI)
  2. acute (necrotising) Pancreatitis
145
Q

name the most common disease of the exocrine pancreas in cats

A

chronic pancreatitis

146
Q

this is inflammation of the pancreas due to autodigestion/premature activation and release of pancreatic enzymes (mostly idiopathic)

A

acute pancreatitis

147
Q

this is inflammation of the pancreas due to progressive fibroinflammatory disease (lymphoplasmacytic);
can lead to EPI (exocrine failure) and/or Diabetes mellitus (endocrine failure)

A

chronic pancreatitis

148
Q

pacreatitis is usually (acute or chronic?) in dogs

149
Q

pacreatitis is usually (acute or chronic?) in cats

150
Q

name 8 risk factors for acute pancreatitis

A
  1. adipositas
  2. familiar (min. Schnauzer)
  3. hypertriglyceridaemia (min. Schnauzer)
  4. dietary (fatty meal?)
  5. endocrine (Diabetes mellitus, hypothyroidism)
  6. prev. GI or liver disease
  7. drugs (Azathiprin, L-Asparaginase, etc)
  8. trauma or ischaemia
151
Q

name 3 clinical signs of acute/chronic pancreatitis

A
  1. vomiting
  2. diarrhea
  3. abdominal pain, inappetence
152
Q

name 4 biochemistry abnormalities possible seen with acute or “flaring” pancreatitis

A
  1. elevated liver enzymes
  2. elevated bilirubin and bile acids
  3. hypocalcaemia (saponification)
  4. azotaemia (pre-renal or renal)
153
Q

name the 2 most commonly used specific lab tests for pancreatitis

A
  1. abdominal ultrasound
  2. quantitative canine/feline pancreatic specific lipase (SNAP test)
154
Q

what is the treatment for acute pancreatitis

A

supportive!
(antiemetics, gastroprotectants, IVFT, pain management)

155
Q

what is the main cause of EPI (exocrine pancreatic insufficiency) in dogs

A

pancreatic acinar atrophy

156
Q

what is the main cause of EPI (exocrine pancreatic insufficiency) in cats

A

chronic pancreatitis

157
Q

name the typical “triad” of clinical signs of EPI (exocrine pancreatic insufficiency)

A
  1. weight loss
  2. polyphagia (excessive eating)
  3. chronic diarrhea (steatorrhea)
158
Q

name the diagnostic tool of choice for EPI (exocrine pancreatic insufficiency)

A

Trypsin-like immunoreactivity (TLI)

159
Q

what is the treatment for EPI (exocrine pancreatic insufficiency)

A
  1. substitute pancreatic enzymes
  2. supplement cobalamin if low (esp. cats)
160
Q

what is the median survival time for dogs/cats with EPI (exocrine pancreatic insufficiency)

161
Q

what is the main prognostic factor for EPI (exocrine pancreatic insufficiency)

A

low cobalamin

162
Q

what dog breed is EPI (exocrine pancreatic insufficiency) especially prevalent in

A

German Shepherd

163
Q

what is the most common clinical sign of liver disease

164
Q

what are the 4 most common clinical signs of liver disease

A
  1. vomiting
  2. diarrhea
  3. weight loss
  4. anorexia
165
Q

name 3 causes of pale mucus membranes/bleedings with liver disease

A
  1. reduced production of clotting factors
  2. reduced production of vit K (to activate clotting factors)
  3. blood loss anaemia
166
Q

name 7 hepatic encephalopathy/CNS signs

A
  1. obtundation
  2. head pressing
  3. focal or generalized seizures
  4. fly catching
  5. blindness
  6. aggression
  7. circling
167
Q

what is the measurable ‘toxin’ causing Hepatic Encephalopathy (HE)?

168
Q

name 4 liver enzymes that are parameters of hepatocellular damage

A
  1. ALT (cytoplasm)
  2. AST (cytoplasm & mitochondria)
  3. AP (biliary epithelium)
  4. GGT (biliary epithelium)
169
Q

what is the most specific liver enzyme (for indicating cell damage) in dogs and cats?

170
Q

name 7 things that can be measured for assessment of liver function

A
  1. glucose
  2. cholesterol
  3. urea
  4. albumin
  5. ammonia
  6. bilirubin
  7. bile acids
171
Q

describe the bile acids stimulation test (BAST)

A
  1. fasting sample
  2. feed small meal
  3. 1-2h postprandial sample
    if repeatedly normal = liver dysfunction ruled out
172
Q

what is ammonia converted to in the liver

173
Q

name 2 conditions that cause increased ammonia levels

A
  1. portosystemic shunts
  2. severe liver dysfunction
174
Q

name a cause of pre-hepatic jaundice

A

haemolysis

175
Q

name 3 causes of post-hepatic jaundice

A
  1. EHBDO (extra hepatic bile duct obstruction)
  2. gall bladder
  3. pancreatitis
176
Q

name the 3 techniques for biopsies of the liver

A
  1. surgical “wedge” biopsy
  2. tru-cut
  3. laparoscopic (cup or snare )
177
Q

name 3 things biopsies of the liver should be submitted for

A
  1. histopathology
  2. quantitative copper determination
  3. culture & sensitivity
178
Q

name 4 environmental liver toxins

A
  1. aflatoxins
  2. blue-green algae
  3. sagopalm
  4. amanita mushroom
179
Q

name 1 food liver toxin

A

xylitol

(chewing gum)

180
Q

what dog breed most commonly has the congenital/gene defect causing copper associated hepatitis

A

Bedlington Terrier

181
Q

which type of hepatitis is purulent/neutrophilic

182
Q

which type of hepatitis is lymphoplasmacytic

183
Q

which type of hepatitis is a mixed inflammatory picture of purulent/neutrophilic & lymphoplasmacytic

A

chronic-active

184
Q

name 3 systemic infections that involve the liver and may cause hepatitis

A
  1. Leptospirosis
  2. Toxoplasmosis
  3. FIP (cats)
185
Q

how to diagnose infectious/neutrophilic cholangiohepatitis and cholecystitis

A
  1. abdominal ultrasound
  2. bile cytology and culture
  3. hepatic biopsy and culture
186
Q

what two conditions must be ruled out via abdominal ultrasound in order to diagnose infectious/neutrophilic cholangiohepatitis and cholecystitis

A
  1. mucocele (dog)
  2. EHBDO (cat»dog)
187
Q

name 3 viral causes of infectious hepatitis in dogs & cats (rare in UK)

A
  1. CAV-1(HCC)
  2. Feline Coronavirus (FIP)
  3. Calicivirus (cat)
188
Q

name 3 bacterial causes of infectious hepatitis in dogs & cats (rare in UK)

A
  1. Leptospirosis
  2. Mycobacterium
  3. Clostridium piliforme
189
Q

name 3 parasitic causes of infectious hepatitis in dogs & cats (rare in UK)

A
  1. Protozoal (toxoplasma)
  2. Rickettsia
  3. Nematodes
190
Q

name 3 common clinical signs of Leptospirosis

A
  1. jaundice/hepatocellular damage
  2. cholestasis
  3. acute kidney injury (azotaemia, PUPD, oliguria)
191
Q

name 2 tests used to diagnose Leptospirosis

A
  1. PCR for Leptospira in urine
  2. Microagglutination test (MAT) for specific serovars
192
Q

what is the treatment for Leptospirosis

A
  1. amoxicillin to stop shedding (w/in 24h) - first line
  2. Doxycycline as definitive Tx (once stable)
193
Q

how to diagnose non-infectious chronic hepatitis in dogs?

A

Biopsy
(for definitive diagnosis)

194
Q

what is the treatment for non-infectious chronic hepatitis

A
  1. supportive liver management
  2. glucocorticoids
  3. immunosuppressants (R/O infection!)
195
Q

describe the aetiology of vacuolar hepatopathy
(dogs > cats)

A

glycogen accumulation in hepatocytes → cell swelling and cholestasis

196
Q

what breed of dogs have the primary form of vacuolar hepatopathy

A

Scottish terriers

197
Q

what species is hepatic lipidosis more common in?
(cats or dgs?)

198
Q

how will a liver with hepatic lipidosis appear on abdominal U/S

A

bright and enlarged

199
Q

how to treat hepatic lipidosis?

A
  1. nutritional support! (tube if necessary)
  2. IVFT
  3. vit K if coagulopathic
200
Q

name the two types of cholangitis common in cats

A

Lymphocytic & Neutrophilic

201
Q

which type of cholangitis is cats is usually unspecified, mild, jaundice

A

lymphocytic cholangitis

202
Q

which type of cholangitis in cats usually meakes them severely ill

A

neutrophilic cholangitis

203
Q

what are the 2 most common causes of Extrahepatic bile duct obstruction (EHBO)

A
  1. triaditis
  2. biliary neoplasia
204
Q

name 6 causes of post-hepatic jaundice

A
  1. cholangitis
  2. cholecystitis (bacterial)
  3. mucocele
  4. pancreatitis
  5. neoplasm
  6. mechanical obstruction
205
Q

this is concretions in the gallbladder that result in biliary obstruction;
mostly idiopathic but can be secondary to Diabetes mellitus, hyperadrenocorticism, hypothyroidism, pancreatitis

A

gallbladder mucocele

206
Q

what is the treatment for gallbladder mucocele

A

surgical removal

207
Q

name 3 possible congenital liver diseases in the dog

A
  1. portosystemic shunt
  2. portal vein hypoplasia
  3. non-cirrhotic portal hypertension
208
Q

name 3 clinical signs common to cats with congenital portosystemic shunts

A
  1. hyperthermia
  2. poor growth
  3. copper coloured irises
209
Q

name a sign of portosystemic shunt on baseline bloodwork

A

Microcytic hypochromic (anaemia) =
decr. MCV

210
Q

which antiemetic would you prefer to use for an animal with impaired liver function?

A

metoclopramide
(eliminated in kidneys)

(over maropitant which is eliminated in liver)

211
Q

name 5 treatment options for chronic management of hepatic encephalopathy

A
  1. fix underlying problem (PSS)
  2. hepatic diet
  3. lactulose
  4. antibiotics to reduce ammonia-producing bacteria
  5. anti-epileptic if indicated
211
Q

these can be supplemented to increase caloric/protein intake in growing animals on a hepatic diet

A

dairy products (cottage cheese) & oils

212
Q

name 3 features of a hepatic/liver diet

A
  1. moderate protein content easy to digest
  2. increased zinc
  3. reduced copper
213
Q

name 3 functions of Lactulose in liver treatment

A
  1. reduces ammonia-producing bacteria (prebiotic)
  2. incr. faecal pH (less avail. H+ to form ammonium ions)
  3. Laxative (shorter GI transit time = less ammonia production)
214
Q

name the most commonly used Choloretic

A

Ursodeoxycholic acid (UDCA)

215
Q

which bile acids are more hydrophobic?
aggressive, cause oxidative damage to tissues they come in contact with

(primary or secondary?)

A

secondary bile acids
(Lithocholic & deoxycholic acids)

216
Q

which bile acids are more hydrophilic?
easier to excrete, preferred

(primary or secondary?)

A

primary bile acids
(cholic acid)

217
Q

what drug is most widely used in cholestatic hepatopathies?
stabilises plasma membranes, reduces biliary epithelium apoptosis, & changes bile metabolising enzymes to more hydrophilic bile acids

A

Ursodeoxycholic acid (UDCA)

218
Q

name 2 antifibrotics that can be used for Tx of chronic liver disease

(if evidence of fibrosis or no other options!)

A
  1. Colchicine
  2. Spironolactone
219
Q

name the antifibrotic

binds to tubulin during mtosis;
inhibits microtubule polymerisation;
mitotic spindle cannot form

A

Colchicine

220
Q

name the antioxidant

most poerful antioxidant;
dependent on cysteine in the body;
supplementation can be problematic and controversial

A

Glutathion (GSH)

221
Q

name the antioxidant

generated from ATP and methionine;
methyl donor for synthesis of important proteins;
involved in inactivation and detoxification;
can be metabolised to cysteine to make GSH

A

S-Adenosyl methionine (SAMe)

222
Q

name the antioxidant

“radical scavenger”
membrane stabilising;
immuno-modulatory;
antidote to amanita mshroom intoxication

A

Milk Thistle
(Silybum marianum)

223
Q

name the vitamin

co-factor for many enzymes;
water-soluble antioxidant;
low redox-potential

A

vitamin C
(ascorbic acid)

224
Q

name the vitamin

fat-soluble antioxidant;
prevents lipid peroxidation of cell membranes, lipoproteins, fat cells;
low redox-potential

A

vitamin E
(alpha-tocopherol)

225
Q

name 3 clinical features associated with GI malignancies in the oral cavity

A
  1. ptyalism
  2. dysphagia
  3. halitosis
226
Q

name 3 clinical features associated with GI malignancies in the oesophagus

A
  1. regurgitation
  2. dullness
  3. anorexia
227
Q

name 3 clinical features associated with gastric malignancies

A
  1. dullness
  2. vomiting
  3. weight loss
228
Q

name 3 clinical features associated with GI malignancies in the small intestine

A
  1. melena
  2. diarrhea
  3. weight loss
229
Q

name 4 clinical features associated with GI malignancies in the colon

A
  1. diarrhea
  2. weight loss
  3. temesmus
  4. haematochaezia
230
Q

name 2 clinical features associated with perianal malignancies

A
  1. mass lesion
  2. tenesmus
231
Q

what are the 4 main oral tumor types in dogs

A
  1. malignant melanoma
  2. SCC
  3. fibrosarcoma
  4. epulid
232
Q

what are the 2 most common oral tumour types in cats

A
  1. SCC
  2. fibrosarcoma
233
Q

what percent of oral tumours in cats are malignant

234
Q

how to diagnose an oral tumour?

A
  1. clinical signs
  2. biopsy
  3. radiography/CT
  4. LN aspirate/biopsy
235
Q

what type of biopsy should be performed for an oral tumor to avoid seeding in skin & incr. surgical margins

A

intraoral biopsy
(large, incisional)

236
Q

name 3 treatment options for an oral tumour

A
  1. radical surgery
  2. surgical debulking
  3. radiotherapy
237
Q

this is the most common canine oral tumour;
locally invasive and highly metastatic

A

malignant melanoma

238
Q

name 2 common sites of metastasis for an oral malignant melanoma

A
  1. regional lymph nodes
  2. lungs
239
Q

this is the second most common canine oral tumour;
locally invasive;
variable metastatic rate depending on location

A

squamous cell carcinoma (SCC)

240
Q

which SCC location has a much higher metastatic rate?
Rostral or Tonsillar?

A

Tonsillar SCC

241
Q

this canine oral tumour is histologically low grade but behaves aggressively;
local invasion, slow to metastasize;
surgery cure is difficult;
response to radiation is fair to poor

A

fibrosarcoma

242
Q

this canine oral tumour arises from the periodontal ligament;
tends to be slow growing and firm;
may appear similar to gingival hyperplasia;
locally aggressive, never metastasize

243
Q

name the 3 types of epulids

A
  1. fibromatous
  2. ossifying
  3. giant cell
244
Q

this i the most common oral tumour in a cat;
infrequently metastasizes to ipsilateral regional LNs;
most common site is sublingual region

245
Q

name 3 risk factors for oral SCC in cats

A
  1. passive smoking
  2. flea collars
  3. diet
246
Q

what is the supportive care for a cat with oral SCC

A
  1. pain control
  2. nutrition
247
Q

what infestation has been linked to oesophageal sarcoma development?

A

Spirocerca lupi
(nematode)

248
Q

what is the most common gastric tumour in dogs?

A

adenocarcinoma

249
Q

name the 4 common types of gastric tumours

A
  1. adenocarcinoma
  2. leiomyoma/leiomyosarcoma
  3. GI stromal tumour (GIST)
  4. lymphoma
250
Q

name 4 clinical signs of a gastric carcinoma

A
  1. weight loss, anorexia
  2. PUPD
  3. chronic vomiting
  4. anaemia
251
Q

what is the treatment of choice for gastric cancer

A

surgical excision
(but very challenging, so often palliative)

252
Q

name 3 palliative therapies for animals with gastric carcinomas

A
  1. nutritional support
  2. pain control
  3. anti-nausea medication
253
Q

what is the most common location for an adenocarcinoma in the small intestine in the dog

254
Q

what is the most common site of metastasis for an adenocarcinoma in the small intestine of a dog

A

regional lymph nodes

255
Q

what are the most common intestinal locations for leiomyoma/leiomyosarcoma in a dog

A

jejunum and cecum

256
Q

what is the most common location for a Gastrointestinal Stromal Tumour (GIST) in a dog

A

large intestine

257
Q

what is the most common intestinal tumour in a cat

258
Q

name 3 clinical signs of feline GI Lymphoma

A
  1. vomiting
  2. SEVERE weight loss
  3. varying degrees of anorexia
259
Q

name 4 possible physical findings for feline GI lymphoma

A
  1. thickened intestinal loops
  2. possible abdominal mass
  3. poss. hepatomegaly
  4. poss. splenomegaly
260
Q

name 3 instances where surgery is indicated for treatment of feline GI lymphoma

A
  1. solitary lesions
  2. if obstruction
  3. if necessary for definitive diagnosis
261
Q

which form of feline GI lymphoma has a better prognosis:
Lymphoblastic lymphoma OR Small Cell Lympoma?

A

Small Cell Lymphoma
(fair to good)

262
Q

what is the chemotherapy protocol for lymphoblastic feline GI lymphoma

A

multi-drug chemotherapy protocol
(doxorubicin, L-Asparginase, prednison, cyclophosphamide, vincristine)

263
Q

what is the prognosis for intestinal MCT of cats

A

grave
(unless early solitary lesion - rare)

264
Q

name 3 common tumours of the colon/rectum

A
  1. benign polyps and leiomyomas
  2. adenocarcinoma
  3. lymphoma
265
Q

how to treat lymphocytic lymphoma

A

prednisone & chlorambucil

266
Q

what is the treatment choice for polyps in the colon/rectum

A

surgical resection (full thickness)

267
Q

name 2 common perianal tumours

A
  1. sebaceous (hepatoid) adenomas and adenocarcinomas
  2. apocrine gland (anal sac) carcinoma
268
Q

what hormone are perianal sebaceous adenomas depedent on

A

testosterone-dependent

269
Q

what is the treatment for sebaceous adenomas in male dogs?

A

surgery and castration

270
Q

what is the treatment for an apocrine gland carcinoma?

A

surgery + RT + chemotherapy

271
Q

what is the treatment for a perianal sebaceous adenocarcinoma?

A

surgery +/- resection of SL LN

272
Q

name the 4 possible primary malignant hepatobiliary tumours

A
  1. hepatocellular carcinoma
  2. biliary carcinoma
  3. neuroendocrine tumour
  4. sarcoma
273
Q

what is the most common primary hepatobiliary tumour in dogs

A

hepatocellular carcinoma

274
Q

what is the most common primary hepatobiliary tumour in cats

A

biliary cystadenoma

275
Q

name the hepatobiliary tumour classification

large, solitary masses in a single lobe

A

massive tumours

276
Q

name the hepatobiliary tumour classification

multifocal and found in several lobes

A

nodular tumours

277
Q

name the hepatobiliary tumour classification

typically involve all lobes and may result in complete effacement of the hepatic parenchyma

A

diffuse tumours

278
Q

this is the most common primary hepatobiliary tumour in dogs and 2nd most common in cats;
paraneoplastic hypoglycaemia;
may be massive, diffuse or nodular;
metastatic rate low for massive but high for nodular and diffuse

A

hepatocellular carcinoma (HCC)

279
Q

this is the most common primary hepatobiliary tumour in cats and the 2nd most common in dogs;
intrahepatic more common in dogs, extrahepatic more common in cats;
very aggressive biologic behaviour with high metastatic rate

A

biliary carcinoma

280
Q

what is the most common histologic type of pacreatic tumour

A

adenocarcinoma

281
Q

what is the metastatic rate of pancreatic adenocarcinomas?

282
Q

what is the clinical sign for islet β-cell tumours of the pancreas?

A

hypoglycaemia

283
Q

name 8 differential diagnoses for hypoglycaemia

A
  1. neonatal
  2. toy breed
  3. type 2 glycogen storage disease
  4. hunting dog
  5. sepsis
  6. drugs
  7. extrapancreatic malignancy
  8. insulinoma
284
Q

this drug inhibits insulin secretion and has been used to control clinical signs of an insulinoma;
but is difficult to obtain and expensive

285
Q

what treatment for insulinoma generally has a better outcome

A

surgical excision

286
Q

what percent of cardiac output does the liver recieve

A

25% cardiac output

287
Q

what 5 questions should you ask yourself before selecting an anaesthetic drug

A
  1. where is it metabolized?
  2. what is the duration?
  3. are they highly protein bound?
  4. can you antagonize/reverse?
  5. can you use local anaesthetic?

Cat & Dog (19 decks)

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