Gastroenterology Flashcards
GI functions
motility, secretion, digestion, and absorption
patient history questions to ask when dealing with a GI issue
describe vomitus, how long has patient been vomiting, recent trauma, how frequently is patient vomiting, other concurrent signs, habits of patient, diet, environmental changes, medications
signs of GI dysfunction
vomiting, regurgitation, diarrhea, constipation, anorexia
vomiting
forceful neurologically mediated reflex expulsion of gastric content from oral cavity
signs of vomiting
active abdominal heaving, occurs after eating, food at least partially digested, linked with a prodromal phase
causes of vomiting
diet, systemic disease, abdominal disorders, neurologic disease, parasites, randoms (fear, pain, motion sickness, anaphylaxis)
stages of vomiting
- saliva, bicarbonate
- retching and pressure changes: (negative pressure intrathoracic, positive pressure intra-abdominal)
- expulsion: pressure changes to positive pressure intrathoracic to prevent aspiration
acute vs chronic vomiting
acute: short duration (< 5-7 days) and variable frequency
chronic: longer duration (> 5-7 days) or vomiting that occurs intermittently several days or weeks
hematoemesis
blood in vomitus
hematochezia
blood in stool
melena
digested blood, darker in color
tenemus
straining to defecate
frank
bright red blood color
regurgitation
passive, retrograde movement of undigested gastric or esophageal contents into oral cavity
signs of regurgitation
little to no abdominal effort, no prodromal phase, increased amount of mucus, occurs shortly after or while eating, presence of undigested food
causes of regurgitation
congenital pharyngeal/esophageal issue or acquired pharyngeal/esophageal issue
megaesophagus
generalized or focal enlargement of the esophagus with loss/absence of peristalsis
causes of megaesophagus
congenital defect, idiopathic, excessive vomiting, toxicity (lead), esophageal obstruction (vascular ring anomaly, neoplasia), underlying disease- neuromuscular (myasthenia gravis, lupus)
CS of megaesophagus
bad breath, dysphagia, agitation with eating, weight loss/nasal discharge with aspiration
treatment for megaesophagus
treat underlying cause, H2 blockers for esophagitis (ranitidine or famotidine), proton pump inhibitors in severe cases (omeprazole), feed in an elevated position (45-90 degrees from floor) and remain upright for 10-15 minutes after, intermittent esophageal suctioning can reduce or eliminate aspiration pneumonia
diarrhea
rapid movement of fecal matter through the intestine resulting in poor absorption of water, nutrients and electrolytes, and producing abnormal frequent evacuations of watery droppings
acute vs chronic diarrhea
acute: sudden onset
chronic: > 3 weeks
causes of diarrhea
primary or secondary from disorders associated with maldigestion, dietary, metabolic, and congenital factors
diagnostics for diarrhea
fecal analyses: float, cytologic examination, virus detection, cultures
plain and contrast radiographs, ultrasonography, surgical examination, endoscopy, biopsies
small bowel diarrhea
large volume, normal - increased frequency of defecation, flatulence or steatorrhea (increased fat excretion), melena, weight loss, vomiting may occur
large bowel diarrhea
small volume, increased frequency of defecation, mucus in feces, hematochezia, tenesmus, pain/urgency to defecate, vomiting less common
what fecal score it considered diarrhea?
7/7, 3-6 are just considered loose stool
constipation
infrequent, incomplete, or difficult defecation with passage of hard/dry feces
obstipation
intractable constipation caused by prolonged retention of hard, dry feces
defecation impossible
CS of constipation/obstipation
straining with small or no fecal volume, infrequent defecation, small amount of liquid/mucoid stool (+/- blood after prolonged tenesmus), occasional vomiting, inappetence +/- lethargy
treatment for constipation/obstipation
enema, manual de-obstipation (sedated), chronic dietary management (fiber: pumpkin, metamucil, balanced with stool softener- lactulose, enulose)
megacolon
persistently increased large bowel diameter associated with chronic constipation/obstipation with low/absent chronic motility
CS of megacolon
reduced, absent, or painful defecation, tenesmus (with small or no fecal volume produced), vomiting, anorexia, prolonged constipation/obstipation, lethargy
treatment for megacolon
correct dehydration, de-obstipation, enema, control reoccurrence (high fiber diet: more bulk or low residue diet: less bulk, stool softeners- lactulose, DSS and prokinetic drugs- cisapride), colectomy surgery
colitis
inflammation of the colon
show CS of large bowel diarrhea (fecal consistency variable from semi-formed to liquid, usually marked increased in frequency ~6-15 times a day)
diagnosis of colitis
fecal analyses, endoscopy for severe or prolonged cases
treatment of colitis
symptomatic, prescription diets
inflammatory bowel disease (IBD)
idiopathic intestinal inflammation
antigenic hypersensitivity believed to be main cause
what are the forms of IBD?
lymphocytic plasmocytic enteritis (most common), eosinophilic enteritis, granulomatous enteritis
cause of IBD
believed to be a mix of genetics, mucosal immunity, and environment factors
CS of IBD
dogs: chronic intermittent vomiting, and/or small bowel diarrhea, weight loss
cats: anorexia, weight loss, vomiting, diarrhea, flatulence, hematochezia, abdominal pain
diagnosis of IBD
eliminate other causes, dietary elimination trials, intestinal biopsy
treatment for IBD
symptomatic, IVF if needed, depends on the form (varies from steroids to immunosuppressants to antibiotics)
what is a drug that is commonly used in diarrhea cases?
Metramidazole
performing an elimination dietary trial for IBD
used for diagnosis to eliminate adverse food reactions
can take up to 8-12 weeks to perform trial
if GI signs resolve within 2 weeks then a diagnosis of adverse food reaction is made
use a novel protein or hydrolyzed protein diet
must eliminate the ingredient you are trialing as a possible adverse reaction to from all food sources (even preventative meds- can have a meat flavoring to the chew)
what are hydrolyzed diets labeled as?
z/d
bloat and gastric dilation and volvulus (GDV)
stomach rotates on its short axis
most associated with ingesting large amounts of air, water, or food
causes delayed gastric emptying
bloat
stomach dilates beyond normal capacity
CS of GDV
vomiting, anxious behavior, drooling (ptyalism), collapse, lethargy, possible distended abdomen, tachycardia, tachypnea/dyspnea, weak pulse/pale mm with prolonged CRT
what happens systemically with GDV?
rapidly progresses
whole body suffers poor ventilation
ischemia, potential rupture of stomach wall, pressure on diaphragm= lungs can’t expand
diagnosis for GDV
radiograph
treatment for GDV
stabilize with IVF right away: only use jugular or cephalic catheter because condition of stomach will block fluids from going where it needs to go
need to decompress the stomach: pass an orogastric tube
trocar (aka percutaneous gastrocentesis): do if can’t pass an orogastric tube, large needle/catheter inserted behind the last rib
surgery: gastropexy, organs evaluated too and anastomosis performed if necessary
monitor ECG for PVC arrhythmias
GI obstruction/foreign body CS
signs may wax and wane if its a shifting foreign body obstruction
vomiting (acute or severe), abdominal pain, diarrhea, sepsis, shock
diagnosis of GI obstruction
radiographs +/- ultrasound
treatment for GI obstruction
surgery if obstructed, may try to rehydrate with IVF then recheck rads
caution with antiemetics: metoclopramide contraindicated, Cerenia safe but may mask symptoms
treat symptoms as needed
intussusception
telescoping of intestine requiring surgical intervention
CS of intussusception
presents like foreign body: vomiting, diarrhea, anorexia, weight loss
symptoms may wax and wane if intestine is sliding and partially correcting itself
diagnosis for intussusception
ultrasound preferred, radiographs with barium, palpation, exploratory surgery
physical exam findings for intussusception
lethargy, ADR, palpable sausage-shaped abdominal mass
causes of intussusception
foreign body, mass, obstruction, intestinal parasites, viral or bacterial infection, previous bowel surgery, organophosphate toxicity
pancreatitis
inflammation of pancreas most often of unknown causes
early trypsin activation causes it but we don’t know what causes the early trypsin activation
acute pancreatitis
occurs abruptly with little or no permanent pathological changes
chronic pancreatitis
continuing inflammatory disease that is accompanied by irreversible changes
what are a few breeds that are more prone to pancreatitis?
mini schnauzers, pugs, siamese cats
CS of pancreatitis
vague GI signs, “prayer position”
possible causes of pancreatitis
dietary indiscretions (usually from eating something high in fat), pancreatic trauma, pancreatic duct obstruction (cats), hypercalcemia, infectious agent like babesiosis
diagnosis of pancreatitis
difficult, most are non-specific
biochemistries: often a serum-amylase and lipase are run but can be unreliable
snap fPL (feline pancreatic lipase) or snap cPL (canine pancreatic lipase) test from Idexx
imaging: ultrasonography and needle biopsies can confirm diagnosis (pancreas will appear white on imaging if hyperechoic)
treatment for pancreatitis
aggressive fluid therapy, anti-emetics (Cerenia), analgesics, diet (avoid high fat and high protein foods)
