Gastroenterology Flashcards

Question

What is helicobacter gastritis?

Answer 1

Helicobacter is is often a normal inhabitant. however in some it triggers chronic gastritis that seems to respond to treatment for helicobacter. symptoms are chronic vomiting, anorexia, nausea, weight loss. Combination therapy with metronidazole amoxicilin bsmuth salicylate or famotidine has been used to ameliorate symptoms.

Answer 2

Physaloptera rara (dogs) and ollulanus tricuspis (cats) cause chronic vomiting. may see worms in vomitus. otherwise may see parasite during endoscopic examination. In suspected cases with exposure, response to empiric traetment may provide presumptive diagnosis. For physaloptera, pyrantel pamoate or ivermectin, for ollulanus, fenbendazole may be effective.

Answer 3

The muscles of the pyloric sphincter become hypertrophied due to an unknown cause but potentially related to gastrin. Most frequently brachycephalic dogs and siamese cats, usually younger animals. vomiting soon after eating, may be projectile. hypochloremic metabolic alkalosis may occur secondary to loss in vomitus of hydrochlorid acid. Gastric outflow obstruction is confirmed using barium contrast abdominal radiographs, abdominal ultrasound or endoscopy. Biopsies should be taken to confirm lack of infiltrative disease. Treat with surgical pyloroplasty.

Answer 4

Excessive mucosal thickening at the pylorus (versus submucosal/muscular thickening of pyloric hypertrophy). The underlying cause of hypertrophy is unknown. Signalment: small breed dogs. As with pyloric hypertrophy signs consistent with gastric outflow obstruction. Surgical examination of the pylorus, thickened mucosa will be visible. biopsies should be taken to rule out infiltrative disease. surgical pyloroplasty and mucosal resection needed. excellent prognosis with surgical treatment.

Answer 5

Acute inflammation of the intestinal mucosa, usually due to dietary indiscretion or drug reaction. May also include sudden changes in diet. Acute vommiting/diarrhoea, anorexia, abdominal pain, may be small or large bowel diarrhoea depending on section of intestine affected, may also see hemetochezia, tenesmus or mucous in feces with acute colitis, usually presumptive diagnosis based on acute presentation, absence of other causes of vomiting and response to symptomatic care. rule out foreign body and underlying metabolic disturbances. discontinue any offending medication, feed bland diet, give h2 antagonist or PPI, antiemetic such as maropitant, no response to symptomatic care in a day or two - more investigation, fluid therapy may be needed.

Answer 6

This is generally considered the mildesst in the inflammatory bowel disease spectrum. most likely related to a food related hyper sensitivity causing inflammation in the intestinal mucosa. usually middle aged to older dogs and cats. chronic vomiting and diarrhoea. could include weight loss and hypoalbuminaemia though patients more mildly affected than with IBD. may be small or large bowel diarrhoea. patients may exhibit signs of atopic dermatitis. Diagnosis of dietary responsive diarrhoea is made presumptively based on a history of chronic GI signs and response to dietary therapy with an elimination diet, typically a hydrolyzed protein diet. Treatment is strict feeding of hydrolyzed protein diet. if these diets are not palatable other novel protein diets may be tried. response typically seen within weeks.

Answer 7

Diarrhoea may be responsive to antibiotics without a confirmed overgrowth of bacteria. Due to various environmental and genetic facotrs, there is a derangement in the normal GI flora , favouring a more pro inflammatory population of bacteria. This results in secondary inflammation in the intestinal mucoa. Presumptive diagnosis made based on response to antibiotic therapy. treatment is with broad spectrum antibiotics with aerobic and anaerobic coverage. treatment with Tylosin or metronidazole is most effective. these antibiotics amy have some immuno modulatory properties as well. there may be better response to one over the other so courses of each should be attempted. Good prognosis for responders.

Answer 8

Idiopathic inflammation of the gastrointestinal mucosa that may affect any segment of the intestine. likely a result of a complex series of factors including patient susceptiility, gut microbiome and diet. Lymphocytic plasmacytic infiltration of the intestinal mucosa is most frequently described. eosinophilic infiltration may also be present. chronic vomiting and diarrhoea seen. may also see weight loss, loss of protein into the gut (protein losing enteropathy), if protein loss is severe> may develop ascites or be at risk for thromboembolic disease due to loss of anti coagulant proteins into the gut. Rule out all other causes of inflammation. Confirm infiltrative inflammatory cells by biopsy. Small cell lymphoma appears very similarly. Immunosuppressive doses of prednisolone. Refractory cases may be treated additionally with azathioprine or cyclosporine.

Answer 9

Obstruction of the lymphatic system of the intestinal mucosa causes lacteal dilation and rupture with secondary inflammation. Subsequent proteins and fats leak into the intestinal submucosa and lumen and may lead to granuloma formation. because lymphocytic plasmacytic inflammation occurs secondary ot IL, and primary inflammatory diseases such as IBD can lead to secondary lacteal obstruction, can be difficult to differentiate from IBD. Presence of diarrhoea is varable but will be small bowel and chronic if present.w eight loss typically occurs. ascites may be present. typically panhypoproteinaemic and hypocholesterolaemic. hypocalcaemia and lymphopenia also fairly common. Faecel a-1 protease inhibitor quantification in the feces may be consistent with intestinal protein loss but is not specific for intestinal llymphangiectasia. abdominal ultrasound may show a thickened mucosal later with hyperechoic mucosal striations. ultimately biopsies are required for diagnosis either via full thickness biopsy by laparotomy or endoscopic biopsies. dilated lacteals may be seen as white dots on the mucosal surface. it is difficult to differentiate between primary intestinal llymphangiectasia and primary IBV. lower fat, hydrolyzed protein diets suc as hills or purina are indicated. if primary lymphangiectasia truly suspected, a non hydrolyzed fat restricted diet may be tried. diets must not be calorie restricted. glucocorticoid therapy also recommended.

Answer 10

Any ingested object that is too large to pass may cause intestinal obstruction. most common area is ileo caecal junction but any small intestinal segment may be affected. linear foreign bodies may also cause obstruction. May include vomiting, diarrhoea, abdominal pain, or may be minimal - anorexia, decreased appetite. signs are usually acute but intermittently obstructive foreign bodies may cause more chronicity to signs. if perforation occurs more severe signs of systemic disease may develop such as shock, collapse, hyptension, distended or plicated loops of owel. Check under tongue in cats. Abdominal radiographs may show two populations of bowel or markedly distended bowel. linear foreign bodies may appearas bunched, plicated bowel. abdominal ultrasound may also show segmental intestinal distension. foreign bodies may also be visualised. exploratory laparotomy may be required for diagnosis, if hypochloremic, metabolic alkalosis is noted on pre anaesthetic bloodwork, this is supportive of gastric outflow obstruction. complete intestinal obstructions typicaly considered surgical emergencies, so relief of obstruction before perforation or devitalization of bowel. IV fluids and stabilisation of patient usually warranted.

Answer 11

One segment of bowel telescopes into adjacent section resulting in intestinal obstruction. can be intermittent or persistent. ileocolic intussusceptions are most common. most frequently seen as a complication of acute enteritis. more frequent in young dogs/puppies with acute enteritis of various etiologies. diarrhoea with/without melena or melatochezia, vomiting , abdominal pain, may see Hypoalbuminaemia due to mucosal congestion. elongated tubular structure may be palpable. Abdominal ultrasound more sensitive than radiograph. surgical reduction requited or intestinal resection and anastomosis. sometimes surgical plication performed.

Answer 12

Canine parvovirus 1 is relatively non pathogenic, may affect puppies 1-3 weeeks, canine parvovirus 2 causes classic parvovirus, feline parvovirus caused by feline panleukopenia virus (cats can be infected with canine parvovirus) virus attacks crypt cells of intestinal villus causing villus atrophy and collapse. usually puppies and kittens or poorly vaccinated/unvaccinated animals. dobermans, rottweilers, stafs, labs, GSDS. Signs develop 5-12 days after infection, include moderate to severe diarrhoea, inestinal bleeding, vomiting , secondary bacterial translocation, may become severely hypoprotinaemic, neutropenia, fever and septic shosck. In utero infections can cause cerebellar hypoplasia in cats. ELIA for CP2 in feces most sensitive. shedding may be undetectable within 10-14 days of infection. shedding time for feline parvo only a couple of days. Treatment: IV fluids, electrolytes, supportive care, anti emetic therapy, acid suppressant therapy, H2 antagonists or proton pump inhibitors, broad spectrum antibiotic, potentiated amoxicillin or cephalosporin, Plasma indicated in cases of moderate to severe hypoalbuminaemia. Intussusception reported as a sequealae. Recovered patients should be isolated. virus may persist in environment.

Answer 13

Coronavirus infects mature epithelial cells at the villus tip, so signs are less severe than with parvovirus. there is also no effect on bone marrow. as with parvovirus signalment. rarely causes haemorrhagic diarrhoea. similar signs but milder than parvo. signs last 1-2 weeks. usually not definitively diagnosed but treated symptomatically. symptomatic care including IV fluids, anti emetics and nutritional support.

Answer 14

Campylobacter jejuni and upsaliensis are most common. noramally found in intestinal tract of dogs and cats but can also cause typically large bowel diarrhoea. usually animals younger than 6 months in group housing, also seen in dogs with raw food diet or immunosuppressed patients. mucoid diarrhoea, ocasionally haemorrhagic, sometimes also causes arnoexia or fever, usually self limiting but can cause more chronic diarrhoea. May see commas or seagull shaped organisms on direct fecal smear but normal gut inhabitant so not diagnostic for campylobacter. PCR of feces can also be performed in suspect patients where organisms are not visualized. erythromycin is most effective. B lactams are not effective. Treat past resolution of clinical signs but bacteria often not eradicated and signs may recur. good prognosis but may be difficult to clear. humans may be infected so proper disposal of feces essential.

Answer 15

Salmonella typhimurium most commonly associated with disease. may be from animals shedding or contaminated/underocoked food. Any dog or cat. young a nimals may be more severely affected. Diarrhoea is usually small bowel, may be acute or chronic. more severely affected patients may become septic and neutropenic. vomiting is not common. salmonella may be cultured from feces. (not definitive) culture from blood (sterile) would be definitive for salmonella septicaemia. Can see co infections with parvovirus. Supportive care as indicated - fluids, electrolyte supplementation as indicated, Antibiotics should not be used unless patient is septicaemic because may prolong shedding/induce a carrier state. septicaemic patients should be treated with parenteral antibiotics, ideally based on sensitivity pattern. Fluoroquinolones, potentiated sulfonamides, amoxicillin and chloramphenicol usually effective. patients should be isolated and barrier nursed.

Answer 16

Clostridium perfringens and C. difficile most commonly cause diarrhoea but also carried in normal feces of dog. C perfringens diarrhoea requires production of enterotoxin type A. C perfringens with enterotoxin may cause acute Haemorrhagic diarrhoea or chronic small or large bowel diarrhoea (more frequently large). C. difficile is typically large bowel diarrhoea, often after antibiotic therapy. Clostridial organisms can often be found on fecal smear but are not diagnostic for pathogenic infection. clostridial toxin assays are available but enterotoxin may be intermittently shed in chronically affected patients. May resolve spontaneously. Tylosin or metronidazole are usually effective. Some patients may need intravenous fluids.

Answer 17

Also known as histiocytic ulcerative colitis. this syndrome is caused by adherent and invasive E. coli which causes granulomatous inflammation of the colonic mucosa.Most frequently reported in boxers, also in french bulldogs, border colies, any breed. chronic large bowerl diarrhoea which may include hematochezia, tenesmus, mucus. endoscopic biopsies of the colon show granlulomatous /histiocytic inflammation. identification of adherent E. coli requires fluorescent in situ hybridization. Compatible breed, clinical signs and response to therapy adequate for presumptive diagnosis. Fluoroquinolones treatment of choice and usually result in improvement in clinical signs within days. Development of resistant E. coli strains so suspected patients that are non responders should have FISH performed for confirmation of E. coli before immunosuppressive therapy is attempted. culture of mucosal biopsy may be helpful for sensitivity testing.

Answer 18

Ingestion of giardia sp cysts from infected animals, especially in water. Seen in any age dog, especially that drinks water from environmental sources. outdoor cats though more common in dogs. mild to severe diarrhoea, usually small bowel but large bowel signs possible. weight loss possible. co infections may be seen with other parasites. most sensitive technique is ELISA of feces for giardia proteins. Trophozoites may be visible on zinc sulfate flotation. metronidazole is often effective. Fenbendazole and albendazole also effective. resistance and reinfection may occur so environmental decontamination should be performed. Good prognosis but some difficult to resolve due to resistance or reinfection.

Answer 19

Ingestion of cryptosporidium parvum oocysts which are from other infected animals but may be in contaminated water. affected dogs are usually less than 6 months old. cats of any age may be affected. usually chronic or intermittent small bowel diarrhoea and may include anorexia and weight loss. may be asymptomatic. oocyte may be seen using acid fast stain of direct fecal smear (very small organism), need 1000x power. ELISA is more sensitive. PCR is also available and is the most sensitive test. No reliable treatment. Paromomycin has been used with success but associated with renal failure in cats and may not stop shedding. may be self limiting infection. puppies with infection may be euthanized for lack of response. Puppies with refractory infections carry more guarded prognosis.

Answer 20

Tritrichomonas foetus colonizes surface of colonic mucosa. seen in cats, especially young cats in group housing. Large bowel diarrhoea without other systemic signs, may be self limiting after several months. trophozoites may be seen on direct fecal examination (appear similar to giardia trophozoites). Tritrichomonas can be detected with greater sensitivity by fecal culture. Co infections can occur. Ronidazole is effective but can cause neurologic signs. infections may be self limiting though can recur in times of sterss. generally good prognosis but cats can be chronic carriers.

Answer 21

Isospora are ingested (fecal-oral route) and infective oocysts destroy epithelium. Seen in young dogs and cats especially in group housing. may be asymptomatic in older patients. mild to severe large bowel diarrhoea, occasionally haematochezia. oocysts may be detected via fecal floatation. treat with sulfadimethoxine or trimethoprim sulfa for 10-20 days.

Answer 22

Trichuris vulpis is transmitted via fecal oral route. usually dogs, cats are rarely infected and generally more mildly. large bowel diarrhoea, mild to severe, which may be haemorrhagic. may also include hypoproteinaemia, hyponatraemia & hyperkalaemia so can mimic hypoadrenocorticism. Multiple fecal floatations may be needed to detect ova. Multiple anthelmintics are efficacious. fenbendazole may also be used, among others. treatment with fenbendazole is recommended in any patient with chronic large bowel diarrhea.

Answer 23

Toxacara canis (dog and cati (cat) and toxacaris leonina (dog and cat ) are infectious via fecal oral route. amy also be transplacental. (t canis) or trans mammary (t Cati). seen in young dogs and cats. small bowel diarrhoea, stunted growth, potbelly appearnce, poor hair coat and lack of weight gain in puppies and kittens. with severe worm burdens, intestinal obstruction may occur. roundworms may occasionally be found in vomitus. ova are generally readily found on fecal floatation though transplacental migration may result in infection prior to shedding of ova. pyrantel is effective and safe in young patients. other anthelmintics also effective -- repeated treatment at 2-3 week intervals recomended. Puppies & kittens should be dewormed at 2,3,4,8,12 and 16 weeks of age. Treat pregnant bitches with fenbendazole at day 40 to 2 days post whelping to reduce transmission.

Answer 24

Acylostoma caninum is transmitted via fecal oral route or occasionally via skin penetration. adult worms attach to small intestinal mucosa and ingest blood and mucosa. young dogs most frequently are affected. cat infections are uncommon. older dogs are rarely affected. transcolostral infection is possible. Melena,hematochezia, diarrhoea, stunted growht,a naemia. Fecal floatation is usually dianostic. puppies affected via colostrum may suffer severe disease before ova are shed. in these patients strong suspicion of infection can be made via compatible clinical signs and presence of iron deficiency anaemia. multiple anthelmintics may be used, including pyrantel and fenbendazole. blood transfusions may be necessary in severely anaemic patients. moxidectin treatment of bitches at day 55 reduces transcolostral infection. humans may be affected by environmental contamination and may develop visceral larval migrans so environmental contamination and appropriate handling of feces is essential. regular use of dewormer reduces infection rates. good prognosis but more guarding in severely anaemic younger animals.

Answer 25

Dipylidium caninum is most common but taenia spp are also seen with wildlife exposure. mesocestoides spp and echinoccous spp may be infective. fleas and lice are intermediate host for D caninum. Flea infestation must also be treated for control. echinococcus is zoonotic. prognosis excellent.

Answer 26

Occurs with extensive surgical resection of the small intestine. (75-90%). the remaining small intestine is unable to absorb adequate nutrition from a normal diet and may develop small intestiinal bacterial overgrowth. an y patient with extensive intestinal resection and anastomosis prone. history of extensive intestinal resection, along with weight loss and small bowel diarrhoea. appetite is usually increased. signs are most severe after resection, but with time the remaining small bowel may be able to compensate and clinical signs may decrease with time. Treatment is dietary modification with a highly digestible, low fat diet. often homemade diets are initially appropriate such as with cottage cheese and potato. small frequent meals are often better tolerated. antibiotics such as tylosin or metronidazole can decrease small intestinal bacterial overgrowth.

Answer 27

The cause is typically idiopathic and unknown but s suspected to be related to changes in smooth muscle function. additional causes of constipation that may lead to Megacolon include: pelvic canal stenosis, nerve injury or manx sacral spinal cord deformity. Initial stages of idiopathic megacolon are constipation and obstipation, recovery of colonic function at these stages may still be possible. for true dilated megacolon cats, colonic function is usually permanently decreased. most commonly middle aged cats. DSH. siamese may be overrepresented. Reduced, painful or absent defecation. tenesmus may be noted. dilated colon with very firm feces may be palpable on abdominal palpation. cats may also become anorexic and dehydrated, vomit, or develop abdominal pain. Radiographs demonstrate dilation of colon or impaction of feces. pelvic and lumbar spine should be examined for abnormalities causing secondary constipation as well as observation for possible mass lesion causing obstruction. recommended treatment upon first presentation depends on severity of disease. for mild - one or more warm water or lactulose enemas along with oral lactulose or miralax is typically sufficient. Dehydrated patients should be treated with intravenous or subcutaneous fluids, as dehydration exacerbates disease. obstipated cats may need manual de opstipation, sometimes performed in several procedures. After initial treatment and relief of the colonic impaction, medical therapy may be attempted. dietary therapy witha low reside, modified fiber diet is advised, along with oral laxative therapy with lactulose or miralax. cisapride therapy may also benefit mild to moderately affected patients. cats with severe idiopathic megacolon are typically refractory and may require subtotal colectomy for control of disease.

Answer 28

Upon weakening of the coccygeus and levator ani muscles, the rectum and other organs ocassionally are pushed externally through the pelvic canal. mostly older intact male dogs (esp boston terriers, boxers, corgis and pekinese) clinical signs:dyschezia and tenesmus which may precede the hernia. constipation and perineal swelling may also be seen. If the bladder has been herniated there may be signs of urinary obstruction. usually can be definitively diagnosed with rectal examination. radiographs can be used to confirm. if bladder is suspected to be herniated a catheter may be passed into the bladder gently and a small amount of contrast injected to confirm bladder herniation. if bladder is involved and urinary obstruction is present the bladder should be emptied and repositioned into the abdomen. IV fluids should be administered for post obstructive diuresis. Surgical reconstruction of the pelvic diaphragm is indicated. neutering is usually recommended at the same time to reduce possible benign prostatic hyperplasia and associated straining.

Answer 29

Likely immune mediated and a subset of inflammatory bowel disease, but ultimately etiology is unknown. classically GSDs. hough similar breeds may also be affected. clinical signs - constipation, rectal pain, draining tracts around the anus may be seen. diagnosis is made via physical examination including a gentle rectal examination. sedation may be necessary due to pain associated. granulomas and abscesses may be palpable. treat as for IBD. hypoallergenic hydrolyzed diets beneficial. affected dogs often need immunosuppression, cyclosporine or azathioprine are recommended. tacrolimus topically also has been described. Antibiotics such as metronidazole may also be of benefit. many patients respond well. occasionally patients refractory to treatment and carry a more guarded prognosis. because the disease is primarily immune mediated, surgery is not curative and is not usually recomended.

Answer 30

Anorexia, vomiting, diarrhoea (small or large bowel) abdominal pain, weight loss, lethargy, depression, dehydration, signs of systemic inflammatory response syndrome (abnormal blood pressure, heart rate, respiratory rate, temperature), bleeding with DIC.

Answer 31

Increased RBC count with dehydration, decreased RBC count with anaemia of chronic inflammatory disease (normocytic, normochromic). Stress or inflammatory leukogram causing neutrophilia, sepsis/SIRS causing neutropeina. Platelets - thrombocytopenia with severe pancreatitis/ DIC.

Answer 32

Elevated liver enzymes - primarily hepatocellular with neighbouring inflammation or cholestatic with biliary obstruction or some combination thereof. Azotaemia - pre renal from dehydration, renal with concurrent acute kidney injury from pancreatitis. Bilirubin and bile acids - may be elevated from biliary obstruction from pancreatitis. Amylase/lipase are not helpful in diagnosis.

Answer 33

Concentrated with dehydration, isothenuric with concurrent acute kidney injury. Prteinuria can occur with severe pancreatitis.

Answer 34

available as canine CPLI or feline FPLI specific quantitive test or SNAP. highly sensitive and specific for pancreatitis - diagnostic of choice.

Answer 35

Quantification of trypsinogen and trypsin in systemic circulation - small amount normally leaks from pancreas to blood. Decreased with exocrine pancreatic insufficiency - must be on a fasted sample or may get falsely elevated reading, diagnostic of choice with EPI. May be increased with pancreatitis but less sensitive than PLI.

Answer 36

Inflammation of the pancreas occurs when normal protective mechanisms against premature activation of trypsinogen are overwhelmed. premature activation of trypsinogen within the pancreas results in digestion of pancreatic proteins and activation of more trypsinogen. This results in release of pro inflammatory crytokines with necrosis and in severe cases severe systemic inflammation. Can ultimately lead to multi organ failure and death. certain drugs have been associated with development of pancreatitiis, including potassium bromide, azathioprine, asparaginise. hypthyroidism, obesity, hyperadrenocorticism and diabetes melltius also thought to increase risk of disease. Mostly middle aged. dogs more often get acute. terrier and miniature schnauzers seem to be predisposed.

Answer 37

There may be a recent history of ingestion of a very high fat meal or dietary indiscretion. clinical signs can vary from very mild to quite severe and can include abdominal pain, pray position, anorexia, dehydration, vomiting, and diarrhoea. more severe cases may have signs of SIRS, DIC or multi organ disease: collapse, shock, tachycardia, pale mucous membranes etc.

Answer 38

Minimum database may show hemoconcentration with dehydration,neutrophilia +- left shift or neutropenia with SIRS/sepsis, hyper or hypoglycaemia with altered glucose metabolism, pre renal or renal azotaemia, elevated liver enzymes, hypokalaemia which if present suggests poorer prognosis, concentrated or isothenuric USD, possibly proteinuria. PLI, either SNAP or quantitive should be performed in suspect cases. abdominal radiographs typically unhelpful but may show decreased cranial abdominal detail and an air filled duodenum. Abdominal ultrasound is slightly more sensitive but still not as good as PLI. changes on ultrasound could include thickened hypoechoic pancreas with bright surrounding mesentery.

Answer 39

remove any inciting cause if possible/present. remainder of therapy consists of supportive care. IV fluids and electrolyte supplementation often indicated. pain management usually necessary given parenterally usually with an opiod. nutritional support should aso be provided, tube placement mabe necessary. if vomiting is difficult to contorl, trickle feeding of very small amounts continuously via syringe driver or fluid pump is usually slow enough to not stimulate vomiting and provide adequate enteral nutrition. dogs with refractory vomiting may require parenteral nutrition. once patients are eating voluntarily a bland diet easily digestible should be fed. multiple anti emetics may be required o for control of vomiting and gastroprotectants often indicated. antibiotic therapy usually given in severe cases because it is difficult to differentiate between sepsis and SIRS. Plasma transfusions are given to patients in DIC. if pancreatic abscesses are present, surgical debridement can improve outcomes. Mild cases of pancreatitis may be treated supportively as for acute gastroenteritis and self resolves in a couple of days. severe cases may require extensive supportive care and are at high risk for developing severe complications.

Answer 40

The chronic form of pancreatitis can develop as an extension of acute inflammation that leads to permanent impairment of function or persistent low levels of inflammation. inflammatory infiltrates are usually mononuclear. chronic pancreatitis may occur as a primary autoimmune disease in english cocker spaniels. cats with chronic pancreatitis frequently also have inflammatory bowel disease, Cholangitis or both. More frequently seen in cockers and CKCS though siberian husky, collies and boxers are overrepresented as well. Generally waxing/waning or intermittent. signs can include bouts of anorexia, vomiting and abdominal pain, cats often just anorexic. chronic pancreatitis can lea too enough fibrosis to cause EPI or Dm so patients could present with corresponding clinical signs. inflammation/fibrosis may also induce signs of EHBO.

Answer 41

Overall findings with chronic pancreatitis are similar to acute disease, though changes are usually less pronounced so often difficult to diagnose. PLI still test with highest sensitivity but value typically not as high as with acute diseas.e minimum database changes may be consistent with DM or EPI. cobalamin should be measured in all cases. decreased intrinsic factor production with chronic pancreatitis can cause hypocobalaminaemia. biopsy needed for definitive diagnosis ultimately - but usually made with consistent clinical findings. Most with chronic disease will ahve intermittent flare ups or bouts of acute - should be managed as for acute. low fat diet may reduce acute episodes in dogs. cats maintained on highly digestible diet. cobalamin should be supplemented if indicated. periods of anorexia should be managed with feeding tube supplementation if necessary. If DM, EPI, or EHBO are present they should be managed appropriately.

Answer 42

Loss of exocrine pancreatic function may occur secondary to chronic pancreatitis (dogs and cats) or pancreatic acinar atrophy (dogs only). With pancreatitis, chronic inflammation and fibrosis leads eventually to loss of enough exocrine pancreatic tissue that mal digestion occurs. with pancreatic acinar atrophy there is an auto immune reaction against pancreatic acini. EPI from pancreatic acinar atrophy is seen in young GSDS, rough coated collies and chow chows. average age at time of diagnosis is 2-3 years. EPI from chronic pancreatitis can be any age/breed, though middle age to older breeds at risk for pancreatitis (cocker, CKCs) . Most consistent finding is weight loss, which may be severe, diarrhoea is often present and may be small bowel due to maldigestion or large bowel due to bacterial overgrowth. appetite is classically increased but may also be decreased. steatorrhea may be present if over 90% of lipase production is lose. with chronic pancreatitis EPI, DM may also be present. Minimum database is usually unremarkable unless concurrent diseases are present. EPI can cause mild hypoproteinaemia, mildly Increased LE, low cholesterol and triglycerides and mild lymphopaenia.

Answer 43

TLI is the diagnostic of choice with high sensitivity and specificity. A fasted sample should be used, however, to reduce liklihood of false negatives. affected patients may ocasionally be in the normal range but are usually on the low end of normal and will be abnormally low if retested with fasted sample. if EPI s diagnosed or suspected, cobalamin should also be measured especially in cats. folate is usually measured at the same time and may be increased with bacterial overgrowth.

Answer 44

Medical management consists primarily of pacnreatic enzyme replacement, typically with pancreazyme or something similar. patients should be co administered an H2 antagonist or PPI so that enzymes are not degraaded by gastric acid. over time, pancreatic enzymes may be weaned to lowest effective dose. diet should consist of moderate fat, highly digestible diet that is not high in fibre which can absorb pancreatic enzymes. tylosin or metronidazole can help control bacterial overgrowth. cobalamin should be supplemented in all cats and most dogs depending on serum levels. any concurrent diseases should be managed appropriately. usually excellent with treatment though it may take some time to get clinical signs controlled. pancreatic enzymes are quite expensive, however so owner may elect not to treat. Swine pancreas is an alternative.

Answer 45

Pancreatic cysts occur congenitally in some breeds or occasionally in association with neoplastic disease. a pancreatic pseudocyst is a cyst like structure filled with pancreatic enzymes that is seen uncommonly with pancreatitis. they are both important most as a differential for apncreatic abscess, for which surgical debridement may be indicated. usually no clinical signs. occasionaly cysts could cause EHBO and corresponding signs. aspirate of fluid from structure will be modified transudate in a cyst or pseudocyst versus exudate with abscess. no treatment required unless there is biliary tract compression - in this case the cyst/pseudocyst may be drained with ultrasound guidance or surgery.

Answer 46

Underlyng cause usually unidentified but may be infectious or toxic insult that sets up chronic inflammation or in some cases may be primarily autoimmune. inflammation is usually mixed, most often lymphocytic-plasmacytic. Chronic inflammation leads to fibrosis which can cause portal hypertension and lead to the development of acquired portosystemic shunts. Typically occur late in the disease process when there has been over 75% functional liver capacity llost. May include vomiting, diarrhoea, anorexia, weight loss, PU/PD, jaundice, ascites and Hepatic encephalopathy. haematology is often normal but may include anaemia of chronic inflammatory disease and neutrophililc leukocytosis. early on in the disease process, liver enzymes may be mild to moderately elevated. later on with more fibrosis liver enzymes may be normal but indicators of liver function may be abnormal. Liver size may be decreased on abdominal radiographs and abdominal ultrasound, ascites may be present with portal hypertension or hypoalbuminaemia. bile acids tolerance test is abnormal once dysfunction has occured. Manage as with hepatic dysfunction. diet should be moderately restricted, high quality protein easily digestible, cottage cheese, antioxidant therapy including s-adenosylmethionine, vitamin E, milk thisle, ursodeoxycholic acid promotes choleresis and decreases toxic bile salts, antibiotics may be indicated for hepatic encephalopathy, amoxicillin if leptospirosis possible, anti inflammatory doses of gluocorticoids.

Answer 47

Copper is normally excreted in bile. with defects in copper excretion, copper accumulates leading to secondary inflammation and eventual fibrosis. copper may accumulate also as a secondary process to primary inflammatory hepatitis ( as with chronic hepatitis) but the distribution of copper within the portal triad is typically different. Multiple breeds have been identified to have suspected primary copper accumulation causing hepatitis: bedlington terrier, Labrador retriever, dalmation, doberman, WHWT, skye terrier, a mutation in copper excretion has only been identified in bedlingtons. Signs may be waxing or waning or acute on chronic- vague signs of illness chronically with sudden deteriroation. Clinical signs will be as for chronic hepatitis. susceptible breeds with elevated liver enzymes, even without clinical signs, should be investigated with biopsy because prognosis is significantly better with early intervention. Bloodwork/liver function changes will be identical to chronic hepatitis. biopsy with copper quantification is needed to differentiate. distribution is usually centrilobular, if copper accumulates secondary to chronic hepatitis is it typically milder and periportal. Treatment is general medical management as with chronic hepatitis. specific treatment for copper storage disease includes addition of zinc acetate or zinc gluconate to diet to bind dietary copper. patients that are systemically ill or have a high hepatic copper levels may need copper chelation therapy with D Penicillamine for several months but then can be maintained with hepatic diet and zinc supplementation. prognosis good with early intervention, guarded if fibrosis is present.

Answer 48

A congenital vascular anomaly remains persistently patent after birth, connecting portal circulation directly to systemic circulation (usually portal-caval or portal-azygous) bypassing the hepatic parenchyma. because the anomalous vessel is a lower pressure system than the hepatic parenchyma, blood shunts past the liver. shunts may be extrahepatic or intrahepatic. Extrahepatic shunts More common in small breed dogs, Yorkshire terriers, WHWT, maltese. Intrahepatic shunts more common in lab, irish wolfhound. typically present under 1 year, some have some normal portal circulation and have milder signs. Signs may be neurologic, gastrointestinal, urinary or general body condition, neurologic signs ay include hepatic encephalopathy, depression, lethargy, circling, blindness, seizures, GI signs include vomiting, diarrhoea, anorexia, urinary signs include PU/PD or presence of urate crystals or cystoliths. Minimum database most often shows a microcytic hypochromic anaemia, normal to mildly elevated liver enzymes, and low urea though may be unremarkable. bile acids tolerance test is extremely sensitive for PSS but not specific. abdominal ultrasound is essentially the opposite, it is specific but not sensitive. if a shunt vessel is seen with ultrasound, it confirms the presence of the anomaly but if one is not seen that does mean it is not present. CT angiography is a more sensitive imaging modality to detect abnormal shunt vessels than ultrasound but also requires GA. Treatment is attenuation of the shunt vessel via surgery (extrahepatic) or transjugular coil embolixation (intrahepatic) usually recomended. cases are usually medically managed for a period of days to weeks prior to definitive treatment to make them more stable.- hepatic diet, oral lactulose and metronidazole or amoxicillin for HE signs, anti epileptics if indicated. prognosis good with definitive treatment.

Answer 49

Another congenital vascular anomaly. the portal vasculature within the liver is underdeveloped. also known as microvascular dysplasia. signs are as with extrahepatic PSS, typically slightly older at time of presentation and signs are slightly milder, bile acids tolerance test is usually less elevated than with congenital PSS. diagnostic imaging is used to rule out PSS. hepatic biopsy is used to confirm diagnosis through often medical management. Hepatic biopsy used to confirm diagnosis though medical management is often instituted in suspected patients based on breed, clinical signs and lack of PSS. medical management treatment same as with PSS. dogs may be able to be weaned down to less aggressive medical management over time for instance only on diet or only on diet and lactulose.

Answer 50

Similar to portal vein hypoplasia but with secondary portal hypertension, may develop multiple acquired PSS but do not have cirrhosis. Usually presents as young adult 1-4 years more often large than small breed. signs as with PSS but less frequently present with HE signs. often concurrently present with ascites or signs of GI ulceration. diagnosis as with PSS though on ultrasound and CT liver is Typically small. there is usually ascites, portal hypertension and multiple acquired extrahepatic shunts visualized. ultimately liver biopsy needed for definitive diagnosis. Medical management as with PSS - gastroprotectants (H2 antagonists, PPI, sucralfate) may be indicated for increased risk of ulceration and GI signs, drainage of ascitic fluid should be avoided (unless causing resp distress), because it will exacerbate hypoalbuminaemia. generally good prognosis. no definitive treatment available apart from medical management.

Answer 51

Ingestion of hepatotoxin/treatment with hepatotoxic drug may lead to oxidant injury and subsequent inflammation eventually leading to fibrosis. common offenders include paracetamol, phenobarbital, xylitol, aflatoxin, lomustine. Usually acute signs and may include vomiting, diarrhoea, anorexia, weight loss, PU/PD, HE, jaundice, bleeding from acquired coagulopathy. Presumptive diagnosis made based on history. with acute toxic insults, liver enzyme elevated is usually moderate to severe and is usually primarily hepatocellular or mixed. bile acids and bilirubin may be normal or elevated. hypoglycaemia and hypokalaemia may be present. azotaemia either prerenal or concurrent AKI, may be present. abdomianl ultrasound can occasionally show hyperechoic hepatic parenchyma. coagulopathypotentialy present. Primarily treatment consists of supportive care including IVFT, gastroprotectants, anti oxidants (more specifically indicated for hepatotoxicosis than with other causes of liver diseasE) and vitamin K.

Answer 52

Glycogen accumulates in hepatocytes which leads to cell swelling and cholestasis. it is often secondary to corticosteroid or other drug therapy but is recognised as a primary disorder in some breeds. usually none to minimal clinical signs - differential for elevated cholestatic enzymes. elevation in ALT, GGT, bile acids. abdominal ultrasound usually shows hepatomegaly and diffusely hyperechoic liver. cytology will show vacuolar change though biopsy needed for definitive diagnosis. no definitive treatment. secondary VH usually reversible for withdrawing offending agent. no treatment for scottish terrier VH. excellent prognosis but may be a link between VH and hepatocellular carcinoma in scottish terriers.

Answer 53

Infectious causes of hepatitis are very uncommonly reportedi n the UK. leptospirosis can cause hepatitis. L grippothphosa recognised to cause hepatitis in absence of renal signs. any dog with possible exposure. may be acute or chronic, compatible with effect on liver function and presence of systemic infection. characteristic changes of acute hepatitis. Leptospirosis PCR or serology should be performed. treatment of leptospirosis is amoxicillin.

Answer 54

Bacterial or unidentified pathogen causes biliary tract inflammation/infection which is usually neutrophilic. there may be a recent history of enteritis or pancreatitis. any age or breed may be affected. signs may include anorexia jaundice, vomiting and pyrexia. Minimum database can show anaemia of chronic inflammation, neutrophilic leukocytosis and cholestatic liver enzyme elevation, including potentially elevated bilirubin and bile acids. abdominal ultrasound indicated to rule out presence of a mucocele and extrahepatic duct obstruction. Bile cytology and culture can confirm presence of neutrophilic inflammation and presence of bacterial infection. Therapy consists of appropriate antibiotics based on culture results. pending results, potentiated amoxicillin would be appropriate. if the dog is anorexic - nutritional support may be required.

Answer 55

Mucoid concretions within the gallbladder can result in biliary obstruction. Numerous endocrinopathies, including diabetes mellitus, hyperadrenocorticism, hypothyroidism and pancreatitis can result in changes to biliary secretions increasing risk of mucocele. Usually occurs in middle aged to older dogs, shetland sheepdogs, cocker spaniels, miniature schnauzers seem predisposed. Signs may be absent and mucocele can be diagnosed incidentally on abdominal ultrasound for another reason. Minimum database often shows cholestatic enzyme elevation and elevated bile acids. abdominal ultrasound shows a kiwi gallbladder. clinical sigs include anorexia, lethargy, vomiting and jaundice. Definitive treatment is cholescystectomy. if mucocoele is seen subclinically or surgery is not an option, medical therapy includes Ursodeoxycholic acid and low fat diet as well as management of any concurrent underlying endocrinopathies. guarded prognosis if bile peritonitis is present. subclinical cases can do well with surgery and sometimes with just medical management.

Answer 56

A period of anorexia induces a negative energy balances and mobilizes fat stores from peripheral fat to the liver. concurrently, dietary deficiencies of methionine, carnitine and taurine result in an inability to process fats for energy metabolism. hepatocyte swelling leads to cholestasis. Obese cats more predisposed. signs include jaundice, vomiting, diarrhoea, hepatomegaly as well as signs of HE. HE usually includes pytalism and depression in cats. there may be sign sof underlying disease that led to period of anorexia. minimum database can show anaemia of chronic inflammation alkaline phoshatase is clasically elevated, more so than GGT. alanine transferase is usually abnormal. bilirubin may be increased and urea may be decreased with hepatic dysfunction. hypokalaemia, hypophosphtaemia and hypomagnesemia may be present secondary to anorexia and hypokalaemia is associated with a poorer prognosis. coagulation panel can show elevated Pt/PTT with decreased vitamin K recycling. there may be changes indicative of underlying disease that led to anorexia. abdomain radiographs or ultrasound are used to search for concurrent diseases but may show hepatomeagly and hyperechoic hepatic parenchyma. cytology will shw vacuolar change. Most important aspect of treatment is restoration of positive energy balance, which typically requires placement of a feeding tube. if patient is a suitable candidate for anaesthesia, oesophageal feeding tubes are Preffered otherwise nasoesophageal feeding tubes are indicated. Small frequent meals are typically better tolerated. IV fluids and electrolytes appropriate. Vitamin K should be given for coagulopathy. Anti oxidants (SAM-e and vit E) used to replace deficits in glutathione.

Answer 57

Ascending bacterial infections of the biliary tract leads to neutrophilic inflammation of the bile duct an portal tracts, similar to cholangitis in dogs. most frequently isolated bacteria include E. coli, streptococcus, clostridiuum and other enteric bacteria. gallbladder may also be affected. concurrent inflammatory bowel disease/pancreatitis commonly present. Signs may include lethargy, anorexia, pyrexia and jaundice. neutrophilic leukocytosis with possible left shift, alanine transferase and bilirubin most commonly elevated. abdominal radiographs are usually normal and ultrasound may show biliary tract dilation. biliary cytology and culture can isolate infective organism and give sensitivity. Cats should be treated with an extended period of appropriate antibiotics (4-6 weeks) until there is resolution of clinical signs and bloodwork changes. potentiated amoxicilin can be used pending culture results. ursodeoxycholic acid would be appropriate to increase choleresis and reduce cell membrane damange. anorexic patients should be managed appropriately.

Answer 58

lymphocytes infiltrate portal tracts, leading to proliferation of bile ducts and portal fibrosis. it is likely immune mediated and may present similarly to FIP. affects young to middle aged cats. persians overrepresented. chronic waxing and waning illness - jaundice, weight loss, anorexia, lethargy. cats may have high protein ascites. minimum database may show neutrophilic leukocytosis. liver enzymes may be mild to moderately elevated. hyperglobinulinaemia may be present. coagulation times may be prolonged. Ultrasound could show biliary tract dilation that can appear like EHBOO and ascites may be present. Little evidence that immunosuppressives are of benefit. supportive care consists of ursodeoxycholic acid and nutritional support as indicated.

Answer 59

Compression of bile duct can occur secondary to intraluminal or extraluminal causes which can include cholangitis, duodenitis, pancreatitis or some combination thereof. biliary neoplasia can also cause EHBO. choleliths are a rare cause of EHBO. Signs are compatible with cholestasis and may include jaundice, anorexia depression and omiting. hepatomegaly may be present. minimum database is compatible with cholestasis, elevated cholestatic liver enzymes and bilirubin. coagulation panel is often abnormal due to decreased absorption of fat soluble vitamin K without adequate bile mediated fat digestion. abdominal ultrasound demonstrates dilation of gallbladder and bile duct. Underlying cause of EHBO may be visible. Recommended treatment depends on underlying cause. cats usually require vitamin K supplementation, along with UDCA and antioxidants. biliary tract surgery should be avoided - high periooperative morbidiity.

Answer 60

same etiology as dogs. purebred cats overrepresented. most cats present under 2 years of age. hepatic encephalopathy signs are more consistent in cats than dogs and may be waxing and waning. signs include hypersalivation, beahviour change. head pressing, circling, poor growth. minimum database includes decreased urea and microcytosis, remaining changes on bloodwork are less common in cats than dogs. bile acids tolerance test will be elevated. abdominal ultrasound may show microhepatica and shunt vessel may be visualised. CT angiography can detect or rule out PSS. Medical management typically less effective at controlling clinical signs than in dogs. definitive treatment is with attenuation of shunt vessel, though medical management should be used for stabilisation prior to surgery.

Answer 61

The process of emesis is complex, a wide number of triggers and pathways being able to induce the vomiting reflex. The main neurotransmitter is acetylcholine but serotonin, dopamine, substance P and histamine are also important. in cats and dogs, stimulation of alpha2 adrenoceptors also induces emesis.The emetic centre is protected by the blood brain barrier. the chemo receptor trigger zone is not so well protected by the BB, which is incomplete in this region.

Answer 62

Drugs which induce emesis. the main reason for induction of emesis is in the managemtn of poisoning (non corrosive). Xylazine - is an alpha 2 agonist used as a sedative which induces vomiting in cats especially but also dogs after i/m. if given at lower dose should not cause sedation but may still induce vomiting. Ipecacuanha - acts as a local irritant, not terribly reliable. Opiates - apomorphine - emetic action predominant over its other opiod effects (D2 receptors in CRTZ) can be given by any route. subsequent administrations may see reduced efficacy - depression of the emetic centre, respiratory depression with overdose, not suitable for cats.

Answer 63

Licensed anti emetic for dogs. its mechanism of action is neurokinin - 1 receptor antagonist, it blocks the effect f substance P (neurotransmitter at these receptors) acts in final common pathway in emetic centre > broad spectrum anti emetic, works for motion sickness, GI irritation, pancreatitis, chemotherapy induced. It is orally bioavailable, given oral and s/c. It has low oral bioavailability - first pass hepatic metabolism, non linear kinetics, hepatic metabolism - 2 isoenzymes, one low capacity, one high capacity, hepatic clearance also, widely distributed, highly bound to plasma protein. There is a wide dose range depending on the cause of vomiting i.e higher dose for motion sickness. once daily dosing schedule. can be given orally or parenterally. oral admin give with small amount of food - for travel sickness.

Answer 64

now licensed for dogs and cats. it is both centrally and peripherally acting. mechanism of action is complex. it centrally inhibits D2 and %Ht2 receptors in the CRTZ. Peripherally inhibits D2 receptors and induces the release of local ACh. Results in increased oesophageal sphincter tone, increased gastric contractions, decreased pyloric sphincter tone, increased peristalsis of the upper intestine.. It has good oral bioavailability, can also be given parenterally, significant first pass metabolism, good distribution, short half life about 90 mins, hepatic and renal elimination. The side affects reported are - behaviour alterations, constipation with long term use, contraindicated in GI obstruction and epilepsy. atropine and the opioid analgesics antagonise the effects.

Answer 65

Motion sickness (vestibular apparatus). Histamine via h1 receptors is the key neurotransmitter. antihistamines such as cyclizine HCL, meclizine HCL and diphenhydramine Hcl. They may cause drowsiness and xerostoma. oral bioavailability is good, hepatic metabolism and renal elimination.

Answer 66

Broad spetrum anti emetics. low doses block dopamine and histamine receptors. high doses have antimuscarinic effects also. acepromazine, chlorpromazine and prochlorperazine. sedation and hypotension are also side effects - decrease desirability in older/sck animals..

Answer 67

They block the effect of serotonin on %ht2 receptors. Examples include cyproheptadine and ondansetron. ondansetron used especially for human patients to control vomiting associated with chemotherapy. Ondansetron can be given orally or parenterally. it has a short half life and undergoes hepatic metabolism.

Answer 68

Protectants, anticholinergics, prokinetics.

Answer 69

H2 receptor antagonists. examples include cimetidine, ranitidine and famotidine. Cimetidine is orally bioavailable, food decreases boavailability, hepatic metabolism and renal elimination of conjugated and active drug, half like 1 hour, decreases gastric acid and pepsin production. It is an inhibitor of microsomal enzymes and will decrease hepatic blood flow b y about 20% - decrease metabolism of flow dependent on drugs e.g lidocaine and propranolol. May get rebound and hypersecretion on cessation. Famotidine > ranitidine> cimetidine. Famotidine does not inhibit liver enszymes, can be given IV, longer half life vs cimetidine, SID- BID dosing, dose reduction in renal failure. Basic drug give slowly over 5 mins. Ranitidine - does not inhibit liver enzymes, can be given i/v, longer half life vs cimetidine, BID dosing, has prokinetic activity, also dose reduction in renal failure.

Answer 70

An anti ulcer drug - proton pump inhibitor. It is a substituted benzimidazole, more potent than the H2 blockers. it irreversibly inhibits the potassium ATPase pump in the luminal surface of the parietal cell. basic drug that requires enteric coated formulation. dissolution and absorption occurs in the small intestine. On absorption the drug is ion trapped in the parietal cells (pH is much lower compared to other cells) absorption improves over first 4-5 days as PH in the GI tract increases. enzyme is permanently inhibited so HCL production only resumes when new enzyme molecule has been formed. high plasma protein binding (about 96%), hepatic metabolism and short half life about 1 hour. safe drug with few side effects.

Answer 71

A synthetic analogue of PGE1. it acts locally - absorbed drug is rapidly metabolised. decreases cAMP in the parietal cell. it increases bicarbonate and mucous production and enhances mucosal blood flow and mucosal epithelialisation. anti ulcer and cytoprotective agent, reduces secretion of histamine from mast cells. Unabsorbed drug in the SI can cause diarrhoea, generally resolves after a few days, used primarily to prevent and treat gastric ulceration caused by NSAIDS.

Answer 72

Other agents that neutralise gastric acid. examples include sodium bicarbonate and aluminium hydroxide. not especially efficaceous. need to be administered very frequently e.g 6 x daily or with every meal. can get hypersecretion of HCL. AIOH also binds phosphates and used in renal failure to help reduce blood phosphate levels.

Answer 73

Misoprostol, antacids and sucralfate. Antacids e.g aluminium hydroxide - inactivate HCl, binds pepsiin and bile salts also, binds intestinal phosphate (renal disease), a more prolonged antacid effect than some, can cause constipation (mix with magnesium salts), alkalinize urine - ion trapping and increase elimination of acidic drugs. Sucralfate is a dissacharide alminium hydroxide product. in acidic environment acquires negative charge and binds to positively charged elements of exposed epithelial cells at sites of ulceration- seals the ulcer, prevents leakage of protein and electrolyte, binds epidermal growth factor. It requires an acid environment to work, binds to bile acids and pepsin, increases local blood flow perhaps by increasing prostaglandin or NO locally. it acts locally - is not absorbed. binds and inactivates cimetidine and other orally administered drugs.

Answer 74

They act locally and are unchanged. they lubricate and soften the faecal mass, include mineral oils and yellow and white soft paraffins , prolonged use may reduce absorption of fat soluble vitamins. local absorption may cause granulomatous lesions, may reduce bowel irritability leading to constipation.

Answer 75

These are not absorbed but act locally. they are hydrophilic and absorb water. increasing faecal bulk and water content and stimulating peristaltic movement. examples include sterculia, isphagula and bran. adequate water intake is crucial.

Answer 76

Examples include magnesium sulfate (Epsom salts,) sodium sulfate (Glauber's salt) and lactulose. these hypertonic solutions draw water into the intestine causing bowel distension and peristalsis. water availability is crucial in the case of lactulose, intestinal ph is reduced, ammonia producing gut flora are reduced. this is useful in the management of hepatic encephalopathy. Phosphates and sodium citrate are also used as osmotic laxatives - they are administered as enema preparations. phosphate enemas should not be given to small dogs and cats as this can induce hyperphosphataemia.

Answer 77

Should never be used if obstruction is suspected. examples include Bisacodyl and phenopthalein. these are diphenylmethane stimulants. precise mechanism of activity is not clear but they appear to stimulate colonic smooth muscle and the myenteric plexus. Phenopthalein undergoes some degree of enterohepatic recycling.

Answer 78

Prokinetics and spasmolytics. Some agents used in the management of diarrhoea may increase segmental contractions and decrease peristaltic contractions.

Answer 79

Metoclopramide - used as an anti emetic, also used to prevent post op ileus in horses. 2. Parasympathomimetics such as carbachol - QAC and can cause intestinal rupture. 3. Antimicrobial eerythromycin - has prokinetic effects through stimulation of ACh release 4. Ranitidine 5. Cisapride - acts primarily as an agonist at 5HT4 receptors in the GI tract. Increases lower oesophageal sphincter pressure, gastric emptying, SI motility and colonic motility. More potent than metoclopramide. administered orally - food enhances absorption. withdrawn from marked in the UK and US for human use due to cardiac toxicity associated with concurrent use f Cyp 3A4 inhibiitors. Need an STC.

Answer 80

Spasmolytics - drugs to treat diarrhoea. Antimuscarinics; Atropine sulphate, propantheline and hyoscine (buscopan compositum). Propantheline less lipid soluble than atropine so reduced CNS effects. Opioids - diphenoxylate HCL, codeine and loperamide. Increase segmental contractions and decrease perisalsis. Diphenoxylate and loperamide are both metabolised in the liver. diphenoxylate is more completely absorbed following oral administration. take care in cats. loperamide may be used in horses. diphenoxylate combined with atropine available. (lomotil)

Answer 81

Thought to adsorb toxins from the GI tract, may also prevent the absorption of other dugs, examples include kaolin, pectin, bismuth salts, activated charcoal, calcium carbonate. Often used in combination in commercial products. Bismuth can come in a variety of forms - bismuth suubnitrate, subcarbinate and subsalicylate. the subsalicylate form is cleaved into bismuth and salicylate. the latter is systemically available and has anti prostaglandin effects - care in cats. has been shown to have antimicrobial and anti secretary effects in some species. Activated charcoal is very effective adsorbent, used in the treatment of ingested toxins pore size is important. powder more efficacious than tablets. forms a stable complex with the substance which is then evacuated from the body.

Answer 82

A drug used in human medicine to lower cholesterol. it stays in the GI tract and binds bile acids, preventing their reabsorption. in rabbits it can be used in antibiotic induced diarrhoea as it binds and absorbs clostridia toxiin.

Answer 83

Appetite mainly controlled by the ventral and lateral nuclei of the hypothalamus. neurotransmitters involved - noradrenaline, dopamine and GABA stimulatory, serotonin inhibitory. neuropeptides CCK, CRF and Calcitonin inhibit appetite, while pancreatic polypeptides and opiates stimulate appetite. Benzodiazepines - diazepam most effective, used mainly in cats, inhibits satiety centre and GABAminergic effects, administered IV. Cyproheptadine - anti serotonin effects, good oral bioavailability with a half life about 13 hours. given orally once or twice daiily in cats.

Answer 84

A naturally occuring bile acid. it has less cellular toxicity than many other bile acids (i.e hydrophobiic membranocytolytic BAs). It is preferentially absorbed from the GI tract. it is also acholoretic agent increasing the elimination of toxic bile acids from the liver. it thereby helps protect the diseased liver from toxic bile acids. it is given orally once daily and should be avoided in biliary obstruction.

Answer 85

Acts as a methyl donor. it has been shown to improve hepatic parameters in a number of disease conditions . it is important for a large number of processes within the liver including the formation of glutathione. glutathione s important as an antioxidant and for the scavenging of ROS. glutathione often deficient in liver disease. Good oral bioavailability but extensive first pass effect.

Answer 86

thought to have an antioxidant anti inflammatory anti fibrotic effect. thought to promote regeneration. experimentally protects dogs from amanita mushroom poisoning. dosing is empirical - clinical efficacy not well established.

Answer 87

Used in copper hepatotoxicosis. Penicillamine is an anti arthritic drug and also a chelating agent. it binds copper. should be given on an empty stomach. Variable bioavailability, mainly renal elimination but also hepatic, elimination is slow. Trientine - alternative to penicillamine, has been shown to be associated acute renal failure in dogs.

Answer 88

Oral > ptyalism, dspyhagia, halitosis Oesophageal > regurgitation, dullness, anorexia Gastric > dullness, weight loss, vomiting Small intestine, malaenia, diarrhoea, weight loss, Colon - diarrhoea, weight loss, tenesmus, haematochezia Perianal - mass lesion, tenesmus

Answer 89

The most common oral tumours in dogs include malignant melanoma, squamous cell carcinoma, fibrosarcoma and the epulides. SCC is the most common feline oral tumour. Fibrosarcoma and melanoma occur but less commonly. Clinical sigs oral tumours include ptyalism, sometimes bloody. inappetance, dysphagia, weight loss, halitosis, exopthalmus, epistaxis and loose teeth. biologic behaviour and prognosis of oral tumours are best predicted by histologic type and tumour location, tumour size and stage of disease.

Answer 90

Most common canine oral tumour, golden retrievers, scottish terriers, poodles, and dachshunds over represented. Immunohistochemistry may be necessary to diagnose some melanomas, especially amelanotic tumours. Locally invasive and highly metastatic. true metastatic rate is dependent on size, location and the grade of the tumour. common sites of metastasis: regional lymph nodes and lungs.

Answer 91

second most common canine oral tumour. locally invasive. metastatic rate is variable and dependent on location. Tonsillar SCC has a much higher metastatic rate than more rostral tumours. at diagnosis 10-20% patients of with tonsillar SCC have overt evidence of metastatic disease while 90% have micrometastatic disease, sites of metastasis include tonsils, regional lymph nodes and lungs.

Answer 92

Occurs less commonly than OMM and SCC. there is a specific variant - histologically low grade, biologically high grade FSA which appears benign histologically but is very locally aggressive and grows rapidly. metastatic rate of FSA is <_20%. Lungs are most common site of metastasis but spread to regional lymph nodes can occur.

Answer 93

Arise from the periodontal ligament. tend to be slow growing and firm. may appear similar to gingival hyperplasia. Subtypes include acanthomatous - locally aggressive that frequently invades the underlying bone. most common site is the rostral mandible. Fibromatous - slow growing firm masses - often found around the maxillary premolar teeth. ossifying - slow growing firm masses often found around maxillary premolar teeth. giant cel - rare form. Bony invasion is typically dependent on type of epulis. they never metastasize.

Answer 94

surgical excision for tumours easily excised with wide margins. removal of bone often required for good local control. consider carboplatin chemotherapy, immunotherapy. vaccines currently under clinical investigation. Overall prognosis is poor however size and stage of disease are important predictors. one year survival rate : 25-30%. MMetastasis is commonly the cause of death.

Answer 95

Surgical excision for tumours easily excised with wide margins. removal of bone often reuquired for good local control. rostral tumours easier to excise. consider piroxicam. cisplatin in combination with piroxicam also been reported. cabrolatin alternative to cisplatin chemotherapy and less nephrotoxic. prognosis is good for completely excised rostral tumours. for tonsillar scc metastatic rate is high and prognosis is poor.

Answer 96

SCC most common. risk factors include: use of flea products, diet (canned food, especially tua) and possibly second hand tobacco smoke. extremely locally incasive. Successful treatment often difficult due to advanced nature of local disease at the time of diagnosis. Fibrosarcoma - second most common feline oral tumour. locally aggressive but metastatic rate typically low. lungs are most common site of metastasis but spread to regional lymph nodes can occur. Malignant melanoma rare in cats.

Answer 97

The most common gastric tumour in the dog is adenocarcinoma and the most common gastric tumour in the cat is lymphoma. Other gastric tumour types include: leiomyosarcoma, gastrointestinal stromal tumour and mast cell tumour . clinical signs include vomiting, weight loss and inappetance. microcytic hypochromic anaemia is common due to chronic GI blood loss. typically surgery is the treatment of choice, resection is often difficult in this location.

Answer 98

Most common histologic type in dogs. commonly occurs along the lesser curvature of stomach and at the gastric antrum. reported metastatic rate 74-80%. Sites of metastasis include regional lymph nodes, liver, omentum, spleen and lungs. surgical excision is the treatment of choice, however successful treatment is often difficult due to tumour location and advanced nature of disease at time of diagnosiis. role of chemotherapy is unknown. prognosis is good for benign tumours, but poor for malignant tumours.

Answer 99

Leiomyomas are more common in very old dogs - over 15 years. Paraneoplastic hypoglycaemia reported. reported metastatic rate is high. sites of metastasis include: liver and duodenum. Surgical excision is the treatment of choice, complete excision is curative for leiomyoma. successful treatment of leiomyosarcoma is more difficult due to tumour location and advanced nature of disease at the time of diagnosis. prognosis is good for benign tumours but guarded to poor for malignant tumours.

Answer 100

19% of GIST occur in the stomach. 50% of GIST stain positively for CD117. (ckit). Surgical excision is the treatment of choice. Prognosis is guarded to poor.

Answer 101

While lymphoma is the most common intestinal tumour in dogs and cats, other intestinal tumours include adenocarcinoma, leiomyoma, leiomyosarcoma, gastrointestinal stromal tumour and mast cell tumour. Leiomyoma/leiomyosarcoma occurs more commonly in male dogs. clinical signs include weight loss, inappetance, vomiting, diarrhoea, melena or hematochezia. microcytic hypochromic anaemia also common due to chronic GI blood loss. smooth muscle tumours have been associated with paraneoplastic hypoglycaemia. Surgery is the treatment of choice.

Answer 102

Most commonly occurs in the large intestine. in the small intestine the most common location is the jejunum. metastatic rate is moderate. most common site of metastasis is regional lymph nodes. other sites include mesentery, omentum and lungs. Surgical exciision with wide margins is treatment of choice, chemotherapy for systemic disease is reasonable, however exact role of chemotherapy is unknown. reported MST or canine SI adenocarcinoma without mets: 15 months, with mets: 3 months. In the cat it most commonly occurs in the small nestine. sites of metastasis include regional lymph nodes and lungs. Poor prognosis.

Answer 103

second most commoon intestinal tumour in dogs, most common intestinal locations are jejunum and cecum. polyuria, polydipsia, anaemia and hypoglycaemia are common clinical findings. metastatic rate for leiomyosarcoma is low to moderate. metastasis most commonly occurs to abdominal viscera. sites include mesentery, spleen liver and lymph nodes. Surgical excision with wide margins (5cm on either side) is the treatment of choice. complete excision is curative for leiomyoma. chemotherapy for systemic disease is raesonable however exact role is unknown.

Answer 104

52% express ckit gene. large intestine most common location. metastatic rate moderate. metastasis most commonly occurs on abdominal viscera. sites include, liver, lymph nodes and other abdominal organs. Surgical excision with wide margins is the treatment of choice. chemotherapy for systemic disease is reasonable however exact role of chemotherapy is unknown. prognosis is guarded.

Answer 105

Hepatoid tumours arise from sebaceous glands located in the dermis around the anus. apocrine gland adenocarcinomas arise from the anal sacs locatead at thr 4 oclock and 8 clock positions on either side of the anus. perianal adenoma is the most common histologic type in intact male dogs. Perianal adenocarcinoma occur less commonly in both sexes. apocrine gland adenocarcinomas most common type in female dogs. Apocrine gland adenocarcinomas are frequently associated with paraneoplastic hypercalcaemia. castration is treatment of choice for perianal adenomas in intact male dogs, otherwise conservative excision is often adequate. Wide surgical excision is the treatment of choice for perianal adenocarcinomas. High rates of local recurrence and metastasis. perianal tumours are rare in cats.

Answer 106

most common perianal tumour in older intact male dogs. development is thought to be androgen dependent. these tumours tend to grow slowly and do not metastasize.. prognosis is good. rare in cats. recommend castration for intact male dogs. most tumours will regress over time. for neutered males or female dogs, recommend conservative surgical excision with histopathology of perianal mass.

Answer 107

Occurs in older intact and neutered male and female dogs. metastatic rate at diagnosis is low but tumours may metastasize more frequntly later in the course of the disease. sites of metastasis include regional lymph nodes, lungs, liver and bone, rare in cats. recommend surgical excision for tumours easily excised with wide margins. even with surgical treatment, local recurrence is common. post operative radiation therapy may help reduce the likelihood of local recurrence. the role of chemotherapy and radiation in the treatment of perianal adenocarcinoma unknown.

Answer 108

Most common perianal tumour in older female dogs occurs in older dogs, equal sex distribuution. paraneoplastic hypercalcaemia commonly occurs with this tumour type. reported incidence is 25-53%. presenting complaints include tenesmus or constipation secondary to mass effect from the tumour. PU PD may also occur secondary to hypercalcaemia. they are locally invasive with a moderate to high metastatic rate. signs of metastasis include sublumbar lymph nodes, lungs, liver and bone. rare in cats. recommend surgical excision for tumours easily excised. metastatic sublumbarlymh nodes may also be removed but referral to a specialist is recommended. for narrowly excised, incompletely excised or non resectable tumours, consider post operative or radiation therapy. to control metastatic disease, consider chemotherapy. various drugs have been used including cisplatin, carboplatin, doxorubicin, mitoxantrone and melphalan. older studies reported MST of 6-12 months, more recent reports using multi modality treatment suggest that MST is longed. Dogs treated with surgery as a part of their treatment protocol appear to live longer. negative prognostic indicators include: tumour size >10cm, treatment with chemotherapy alone, hypercalcaemia and pulmonary metastasis.

Answer 109

small soft pliable catheter. the pros are they can be inserted conscious (or with light sedation) no incision is needed. only liquid diet can be given through the tube; enteral care - limit 3-4 days because nasal mucosal necrosis ma occur.

Answer 110

12-22F plastic feeding tube. Pros - simple to place, allows feeding blenderized diet and medicating, longer term (days t weeks). Cons - require GA, incision made in neck - possible increased risk with bleeding disorders.

Answer 111

16-22F plastic feeding tube with mushroom tip. placed surgically or by specialist endoscopically. allows feeding blenderized diet and medicating - can be left for weeks to years. cons - require GA, incision in left flank. Higher risk in deep chested dogs placed endoscopically.

Answer 112

They are similar size to Nasooesophgeal tubes. Pros - can be used with refractory vomiing. cons - require GA, increased risk of complications versus other feeding tubes. Leakage > peritonitis.recommend placement by ST surgeon only.

Answer 113

Lipids, amino acids, glucose via intravenous access. Pros - allows restoration of positive energy balance with severe malabsorptive disease. Can be used with refractory vomiting. Cons - no nutrition to enterocytes. complications possible: glucose, electrolytes need regular monitoring.

Answer 114

primary hepatobilliary tumours are more common in cats, metastatic hepatobilliary tumours, malignant tumours are more common in dogs, and benign tumours are more common in cats. primary malignant hepatobiliary tumours in dogs and cats include hepatocellular carcinoma, biliary carcinoma, neuroendocrine tumour and sarcoma. Clinical signs include weight loss, inappetance, vomiting, polyuria, polydipsia and possibly ascites. animals with extensive disease may also present with icterus and signs of hepatoencephalopathy.. typically surgery is treatment of choice.

Answer 115

Most common primary hepatobiliary tumour in dogs. araneoplastic hypoglycaemia has been reported. may be massive, nodular or diffuse. metastatic rate is dependent upon morphology and is low for massive HCC but high for nodular and diffuse HCC. common sites of metastasis: regional lymph nodes, peritoneum and lungs. Recommend surgical excision for massive tumours easily excised with liver lobectomy. with surgical treatment, prognosis for massive HCC is good. local recurrence and metastatic rates are generally low. nodular and diffuse HCC are typically non resectable due to extent of disease.

Answer 116

Frequently an incidental finding. more common in cats than in dogs. benign tumour. remove if problematic. prognosis is good.

Answer 117

Second most common primary hepatobiliary tumour in dogs. of malignant hepatobiliary tumours in cats, BC is the most common. Intrahepatic BC appears to be more common in dogs, whereas extrahepatic BC is more common in cats. May be massive, nodular or diffuse. very aggressive biologic behaviour with a high metastatic rate. common sites of metastasis: regional lymph nodes, peritoneum and lungs. Recommend surgical excision for massive tumours. easily excised with liver lobectomy. even with surgical treatment, prognosis is guarded to poor. local recurrence and metastatic rates are generally high and survival times are short. nodular and diffuse BC are typically non resectable due to extent of disease.

Answer 118

Frequently an incidental finding. common in cats. benign tumour remove if problematic

Answer 119

Rare in dogs an cats. often are locally Aggresive with nodular or diffuse morphology. metastatic rate is high. common sites of metastasis: regional lymph nodes, peritoneum and lungs. rare in dogs and cats. recommend surgical excision for tumours easily excised with liver lobectomy. the majority are non resectable due to extent of disease. prognosis is poor because this disease is highly metastatic survival times are short.

Answer 120

Rare. comon primary hepatic sarcoma include haemangiosarcoma, leiomyosarcoma,histiocytic sarcoma and fibrosarcoma. often are locally aggresive with nodular or massive morphology. very aggressive biologic behaviour with high metastatic rate. common sites of metastasis: spleen and lung. recommend surgical excision for massive tumour easily excised with liver lobectomy. even with surgical treatment, prognosis is guarded to poor, local recurrence and metastatic rates are generally high and survival times are short. the role of chemotherapy and radiation nuknown.

Answer 121

Exocrine pancreatic tumours are rare in dogs the incidence is slightly higher in cats. Adenocarcinoma is most common histologi type. benign exocrine pancreatic masses include adenomas and pseudocysts. surgical resection is the treatment of choice. however many animals have evidence of metastatic disease at the time of diagnosis. in these cases surgery should be only performed for palliative reasons. the role of chemotherapy is unknown. pancreatic tumours are locally invasive and the metastatic rate is very high. common metastatic sites include regional lymph nodes, liver, peritoneal cavity.

Answer 122

Gastrointestinal signs including anorexia, vomiting, diarrhoea, weight loss. Diarrhoea usually small bowel. may be as a result of secondary gastrointestinal ulceration. malabsorption due to gut oedema from portal hypertension, toxin production/absorption, hepatic encephalopathy. weight loss may occur due to anorexia or decreased absorption (with gut oedema) or changes in normal metabolic metabolism due to liver dysfunction. Jaundice/icterus - due to hyperbilirubinaemia - pre hepatic from haemolysis, hepatic from decreased liver procesesing/excretion of bilirubin, post hepatic decreased excretion due to biliary obstruction.

Answer 123

Prolonged clotting times (PT, PTT) can occur. due to decreased production of clotting factors or decreased activation/inactivation of vitamin K. Polyuria polydipsia occur due to decreased urea production with liver dysfunction leads to renal medullary washout, decreasing concentration ability and resulting in primary polyuria. altered steroid metabolism can cause partial nephrogenic diabetes Insipidus causing primary polyuria. Hepatic encephalopathy can lead to primary polydipsia.

Answer 124

Via decreased oncotic pressure, decreased hepatic production of albumiin which provides the majority of colloid pressure in the blood may lead to pure transudate ascites. albumin must be moderate to severe for this to occur. increased hydrostatic pressure : portal hypertension increases hydrostatic pressure within portal circulation (including gut and spleen) leading to modified transudate ascites. Bile peritonitis can occur secondary to gallbladder or biliary tract rupture causing modified transudate or exudative ascites- usually milder in quantity than previous two mechanisms.

Answer 125

Ammonia and other bacterial metabolites from gut are normally filtered by liver. with hepatic dysfunction or shunting around liver, levels of these toxins that reach systemic circulation and brain are increased leading to signs classic for HE. signs include head pressing, focal or generalised seizures, fly catching, blindness, star gazing, aggerssion, depression, pytalism

Answer 126

Drugs that are hepatically metabolized have increased plasma levels with hepatic dysfunction. Any drug given to a dog or cat with liver dysfunction should be investigated for whether it is hepatically metabolised and if so, alternative should be sought or dose reduced if toxicity is a possibility. drugs that are highly protein bound may reach toxic levels if there is moderate to severe hypoalbuminaemia, which is major protein binding protein bound drugs. Decreased albumin means more freely available drug, which increases effect of drug.

Answer 127

RBCs are increased with dehydration, decreased with anaemia of chronic inflammatory disease, or chronic GI blood loss or PSS. PSS might have mcrocytosis without anaemia. schistocytes, acanthocytes can be seen with liver disease. WBC - stress or inflammatory leukogram. Platelets - mild to moderately decreased with chronic GI blood loss. moderate to severely decreased with DIC.

Answer 128

Elevated ALT - alanine aminotransferase - relatively liver specific - in hepatocyte cytoplasm > indicates hepatocellular damage. MArked loss of normal cells with advanced disease ALT may be normal. half life dogs: 60h, cats > indicates biliary hyperplasia/stasis. Usually normal in causes of cholestasis that are outside of biliary tree (hepatic lipidosis in cats), more consistently elevated with primary biliary disease (neoplasia, cholangitis). Glucose - decreased with impaired gluconeogenesis or glycogenolsys by liver, usually lost late in disease process. Cholesterol -- decreased with impaired hepatic production. urea - decreased with impaired protein metabolism by liver, earlier indicator of liver dysfunction. Albumin - decreased with impaired hepatic production usually lost late in the disease process. Bilirubin - increased with: pre hepatic: haemolysis. hepatic: decreased conjugation and excretion. 3. post hepatic: decreased excretion. Bile acids secreted with bile into duodenum > resorbed in ileum and recycled via portal circulation to the liver> absorbed from portal circulation within liver. 90 - 95% recycled. with PSS or liver dysfunction, there is decreased recycling of vile acids> increased serum bile acids. Post prandial bile acids more sensitive for liver dysfunction than fasting . Bile acids tolerance test is test of liver function - fasting sample and a 2 hour post prandial sample.

Answer 129

Urine specific gravity - increased with dehyration, decreased with PUPD. bilirubinuria - dogs normally conjugate some bilirubin in kidneys that reacts with urine test so small amounts can be normal. moderate to high amounts indicate increased bilirubin. cats do not have that capacity so always abnormal in cats. urate/bilirubin crystals or stones may be present in bladder and can be supportive of liver disease.

Answer 130

PT/PTT - increased due to decreased production of clottin factors and decreased recycling of vitamin K. Fibrinogen - decreased due to impaired hepatic production or increased consumption (indicative of DIC), increased in some chronic inflammatory diseases. D dimers - increased with liver disease or DIC.

Answer 131

Normally produced by gut bacteria and absorbed in portal ccirculation > removed by first pass metabolism > converted to urea by liver > excreted via kidneys. Increased with PSS or severe liver dysfunction, often causes HE - HE can occur without hyperammonemia. lactulose used to treat elevated ammonia orally or rectally. it traps ammonia in gut as ammonium to reduce absorption. given as enema will work fairly quickly (10-15 mins)

Answer 132

Protein C is an anticoagulant protein produced by the liver. it s decreased with liver dysfunction - degree of derangement may help differentiate between PSS and non PSS liver disease dogs. may also differentiate between congenital PSS and portal vein hypoplasia. improves with correction of congenital PSS.

Answer 133

liver size is approximated by looking at gastric axis. normal > approximately parralell to last ribs (slightly diagonal) hepatomegaly > higher angle of gastric axis (closer to horizontal) microhepatica > decreased angle of axis (closer to vertical). may see hepatic masses or choleliths. Decreased abdominal detail may indicate ascites. overall relatively insensitive for liver disease.

Answer 134

Allow for assessment of hepatic and biliary tract size, architecture and presence of masses/tumours. variable sensitivity to detect portosystemic shunts. fairly good with trained ultrasonographers for extrahepatic PSS, relatively insensitive, even with trained imagers for intrahepatic PSS or acquired PSS. allows for FNA for cytology.

Answer 135

May be diagnostic for infiltrative neoplastic diseases (lymphoma). may be suggestive of infiltrative non neolastic diseases (hepatic lipidosis, vacuolar hepatopathy) but does not rule out concurrent separate liver diseases. quite poor /insensitive for cirrhosis, some liver tumours, copper storage disease, many forms of hepatitis/cholangitis.

Answer 136

May be diagnostic for bacterial cholangiohepatitis. bile more sensitive - more likely to give positive result than liver, t hough infection may be present without positive culture.

Answer 137

Radioisotope injected into colonic lumen via catheter or splenic parenchyma. > absorption of isotope tracked > degree of shunting of isotope bypassing liver directly to heart is quantified. shunt fraction can be diagnostic for PSS. does not differentiate acquired from congenital. may be normal with smaller degree of shunting. largely replaced by CT angiography but may be done with sedation in referral centres.

Answer 138

Ct scan of abdomen with injection of contrast to delineate portal vasculature. usually confirms presence or absence of PSS. Allows for assessment of hepatic/biliary size/architective.

Answer 139

performed laparoscopically or via laparotomy. transjugular approach may be available soon at referral centres. allows for collection of liver and bile for histology, culture and copper quantification which often gives definitive diagnosis.

Answer 140

This is generally considered the mildesst in the inflammatory bowel disease spectrum. most likely related to a food related hyper sensitivity causing inflammation in the intestinal mucosa. usually middle aged to older dogs and cats. chronic vomiting and diarrhoea. could include weight loss and hypoalbuminaemia though patients more mildly affected than with IBD. may be small or large bowel diarrhoea. patients may exhibit signs of atopic dermatitis. Diagnosis of dietary responsive diarrhoea is made presumptively based on a history of chronic GI signs and response to dietary therapy with an elimination diet, typically a hydrolyzed protein diet. Treatment is strict feeding of hydrolyzed protein diet. if these diets are not palatable other novel protein diets may be tried. response typically seen within weeks.

Answer 141

Diarrhoea may be responsive to antibiotics without a confirmed overgrowth of bacteria. Due to various environmental and genetic facotrs, there is a derangement in the normal GI flora , favouring a more pro inflammatory population of bacteria. This results in secondary inflammation in the intestinal mucoa. Presumptive diagnosis made based on response to antibiotic therapy. treatment is with broad spectrum antibiotics with aerobic and anaerobic coverage. treatment with Tylosin or metronidazole is most effective. these antibiotics amy have some immuno modulatory properties as well. there may be better response to one over the other so courses of each should be attempted. Good prognosis for responders.

Answer 142

Idiopathic inflammation of the gastrointestinal mucosa that may affect any segment of the intestine. likely a result of a complex series of factors including patient susceptiility, gut microbiome and diet. Lymphocytic plasmacytic infiltration of the intestinal mucosa is most frequently described. eosinophilic infiltration may also be present. chronic vomiting and diarrhoea seen. may also see weight loss, loss of protein into the gut (protein losing enteropathy), if protein loss is severe> may develop ascites or be at risk for thromboembolic disease due to loss of anti coagulant proteins into the gut. Rule out all other causes of inflammation. Confirm infiltrative inflammatory cells by biopsy. Small cell lymphoma appears very similarly. Immunosuppressive doses of prednisolone. Refractory cases may be treated additionally with azathioprine or cyclosporine.

Answer 143

Obstruction of the lymphatic system of the intestinal mucosa causes lacteal dilation and rupture with secondary inflammation. Subsequent proteins and fats leak into the intestinal submucosa and lumen and may lead to granuloma formation. because lymphocytic plasmacytic inflammation occurs secondary ot IL, and primary inflammatory diseases such as IBD can lead to secondary lacteal obstruction, can be difficult to differentiate from IBD. Presence of diarrhoea is varable but will be small bowel and chronic if present.w eight loss typically occurs. ascites may be present. typically panhypoproteinaemic and hypocholesterolaemic. hypocalcaemia and lymphopenia also fairly common. Faecel a-1 protease inhibitor quantification in the feces may be consistent with intestinal protein loss but is not specific for intestinal llymphangiectasia. abdominal ultrasound may show a thickened mucosal later with hyperechoic mucosal striations. ultimately biopsies are required for diagnosis either via full thickness biopsy by laparotomy or endoscopic biopsies. dilated lacteals may be seen as white dots on the mucosal surface. it is difficult to differentiate between primary intestinal llymphangiectasia and primary IBV. lower fat, hydrolyzed protein diets suc as hills or purina are indicated. if primary lymphangiectasia truly suspected, a non hydrolyzed fat restricted diet may be tried. diets must not be calorie restricted. glucocorticoid therapy also recommended.

Answer 144

Any ingested object that is too large to pass may cause intestinal obstruction. most common area is ileo caecal junction but any small intestinal segment may be affected. linear foreign bodies may also cause obstruction. May include vomiting, diarrhoea, abdominal pain, or may be minimal - anorexia, decreased appetite. signs are usually acute but intermittently obstructive foreign bodies may cause more chronicity to signs. if perforation occurs more severe signs of systemic disease may develop such as shock, collapse, hyptension, distended or plicated loops of owel. Check under tongue in cats. Abdominal radiographs may show two populations of bowel or markedly distended bowel. linear foreign bodies may appearas bunched, plicated bowel. abdominal ultrasound may also show segmental intestinal distension. foreign bodies may also be visualised. exploratory laparotomy may be required for diagnosis, if hypochloremic, metabolic alkalosis is noted on pre anaesthetic bloodwork, this is supportive of gastric outflow obstruction. complete intestinal obstructions typicaly considered surgical emergencies, so relief of obstruction before perforation or devitalization of bowel. IV fluids and stabilisation of patient usually warranted.

Answer 145

One segment of bowel telescopes into adjacent section resulting in intestinal obstruction. can be intermittent or persistent. ileocolic intussusceptions are most common. most frequently seen as a complication of acute enteritis. more frequent in young dogs/puppies with acute enteritis of various etiologies. diarrhoea with/without melena or melatochezia, vomiting , abdominal pain, may see Hypoalbuminaemia due to mucosal congestion. elongated tubular structure may be palpable. Abdominal ultrasound more sensitive than radiograph. surgical reduction requited or intestinal resection and anastomosis. sometimes surgical plication performed.

Answer 146

Canine parvovirus 1 is relatively non pathogenic, may affect puppies 1-3 weeeks, canine parvovirus 2 causes classic parvovirus, feline parvovirus caused by feline panleukopenia virus (cats can be infected with canine parvovirus) virus attacks crypt cells of intestinal villus causing villus atrophy and collapse. usually puppies and kittens or poorly vaccinated/unvaccinated animals. dobermans, rottweilers, stafs, labs, GSDS. Signs develop 5-12 days after infection, include moderate to severe diarrhoea, inestinal bleeding, vomiting , secondary bacterial translocation, may become severely hypoprotinaemic, neutropenia, fever and septic shosck. In utero infections can cause cerebellar hypoplasia in cats. ELIA for CP2 in feces most sensitive. shedding may be undetectable within 10-14 days of infection. shedding time for feline parvo only a couple of days. Treatment: IV fluids, electrolytes, supportive care, anti emetic therapy, acid suppressant therapy, H2 antagonists or proton pump inhibitors, broad spectrum antibiotic, potentiated amoxicillin or cephalosporin, Plasma indicated in cases of moderate to severe hypoalbuminaemia. Intussusception reported as a sequealae. Recovered patients should be isolated. virus may persist in environment.

Answer 147

Coronavirus infects mature epithelial cells at the villus tip, so signs are less severe than with parvovirus. there is also no effect on bone marrow. as with parvovirus signalment. rarely causes haemorrhagic diarrhoea. similar signs but milder than parvo. signs last 1-2 weeks. usually not definitively diagnosed but treated symptomatically. symptomatic care including IV fluids, anti emetics and nutritional support.

Answer 148

Campylobacter jejuni and upsaliensis are most common. noramally found in intestinal tract of dogs and cats but can also cause typically large bowel diarrhoea. usually animals younger than 6 months in group housing, also seen in dogs with raw food diet or immunosuppressed patients. mucoid diarrhoea, ocasionally haemorrhagic, sometimes also causes arnoexia or fever, usually self limiting but can cause more chronic diarrhoea. May see commas or seagull shaped organisms on direct fecal smear but normal gut inhabitant so not diagnostic for campylobacter. PCR of feces can also be performed in suspect patients where organisms are not visualized. erythromycin is most effective. B lactams are not effective. Treat past resolution of clinical signs but bacteria often not eradicated and signs may recur. good prognosis but may be difficult to clear. humans may be infected so proper disposal of feces essential.

Answer 149

Salmonella typhimurium most commonly associated with disease. may be from animals shedding or contaminated/underocoked food. Any dog or cat. young a nimals may be more severely affected. Diarrhoea is usually small bowel, may be acute or chronic. more severely affected patients may become septic and neutropenic. vomiting is not common. salmonella may be cultured from feces. (not definitive) culture from blood (sterile) would be definitive for salmonella septicaemia. Can see co infections with parvovirus. Supportive care as indicated - fluids, electrolyte supplementation as indicated, Antibiotics should not be used unless patient is septicaemic because may prolong shedding/induce a carrier state. septicaemic patients should be treated with parenteral antibiotics, ideally based on sensitivity pattern. Fluoroquinolones, potentiated sulfonamides, amoxicillin and chloramphenicol usually effective. patients should be isolated and barrier nursed.

Answer 150

Clostridium perfringens and C. difficile most commonly cause diarrhoea but also carried in normal feces of dog. C perfringens diarrhoea requires production of enterotoxin type A. C perfringens with enterotoxin may cause acute Haemorrhagic diarrhoea or chronic small or large bowel diarrhoea (more frequently large). C. difficile is typically large bowel diarrhoea, often after antibiotic therapy. Clostridial organisms can often be found on fecal smear but are not diagnostic for pathogenic infection. clostridial toxin assays are available but enterotoxin may be intermittently shed in chronically affected patients. May resolve spontaneously. Tylosin or metronidazole are usually effective. Some patients may need intravenous fluids.

Answer 151

Also known as histiocytic ulcerative colitis. this syndrome is caused by adherent and invasive E. coli which causes granulomatous inflammation of the colonic mucosa.Most frequently reported in boxers, also in french bulldogs, border colies, any breed. chronic large bowerl diarrhoea which may include hematochezia, tenesmus, mucus. endoscopic biopsies of the colon show granlulomatous /histiocytic inflammation. identification of adherent E. coli requires fluorescent in situ hybridization. Compatible breed, clinical signs and response to therapy adequate for presumptive diagnosis. Fluoroquinolones treatment of choice and usually result in improvement in clinical signs within days. Development of resistant E. coli strains so suspected patients that are non responders should have FISH performed for confirmation of E. coli before immunosuppressive therapy is attempted. culture of mucosal biopsy may be helpful for sensitivity testing.

Answer 152

Ingestion of giardia sp cysts from infected animals, especially in water. Seen in any age dog, especially that drinks water from environmental sources. outdoor cats though more common in dogs. mild to severe diarrhoea, usually small bowel but large bowel signs possible. weight loss possible. co infections may be seen with other parasites. most sensitive technique is ELISA of feces for giardia proteins. Trophozoites may be visible on zinc sulfate flotation. metronidazole is often effective. Fenbendazole and albendazole also effective. resistance and reinfection may occur so environmental decontamination should be performed. Good prognosis but some difficult to resolve due to resistance or reinfection.

Answer 153

Ingestion of cryptosporidium parvum oocysts which are from other infected animals but may be in contaminated water. affected dogs are usually less than 6 months old. cats of any age may be affected. usually chronic or intermittent small bowel diarrhoea and may include anorexia and weight loss. may be asymptomatic. oocyte may be seen using acid fast stain of direct fecal smear (very small organism), need 1000x power. ELISA is more sensitive. PCR is also available and is the most sensitive test. No reliable treatment. Paromomycin has been used with success but associated with renal failure in cats and may not stop shedding. may be self limiting infection. puppies with infection may be euthanized for lack of response. Puppies with refractory infections carry more guarded prognosis.

Answer 154

Tritrichomonas foetus colonizes surface of colonic mucosa. seen in cats, especially young cats in group housing. Large bowel diarrhoea without other systemic signs, may be self limiting after several months. trophozoites may be seen on direct fecal examination (appear similar to giardia trophozoites). Tritrichomonas can be detected with greater sensitivity by fecal culture. Co infections can occur. Ronidazole is effective but can cause neurologic signs. infections may be self limiting though can recur in times of sterss. generally good prognosis but cats can be chronic carriers.

Answer 155

Isospora are ingested (fecal-oral route) and infective oocysts destroy epithelium. Seen in young dogs and cats especially in group housing. may be asymptomatic in older patients. mild to severe large bowel diarrhoea, occasionally haematochezia. oocysts may be detected via fecal floatation. treat with sulfadimethoxine or trimethoprim sulfa for 10-20 days.

Answer 156

Trichuris vulpis is transmitted via fecal oral route. usually dogs, cats are rarely infected and generally more mildly. large bowel diarrhoea, mild to severe, which may be haemorrhagic. may also include hypoproteinaemia, hyponatraemia & hyperkalaemia so can mimic hypoadrenocorticism. Multiple fecal floatations may be needed to detect ova. Multiple anthelmintics are efficacious. fenbendazole may also be used, among others. treatment with fenbendazole is recommended in any patient with chronic large bowel diarrhea.

Answer 157

Toxacara canis (dog and cati (cat) and toxacaris leonina (dog and cat ) are infectious via fecal oral route. amy also be transplacental. (t canis) or trans mammary (t Cati). seen in young dogs and cats. small bowel diarrhoea, stunted growth, potbelly appearnce, poor hair coat and lack of weight gain in puppies and kittens. with severe worm burdens, intestinal obstruction may occur. roundworms may occasionally be found in vomitus. ova are generally readily found on fecal floatation though transplacental migration may result in infection prior to shedding of ova. pyrantel is effective and safe in young patients. other anthelmintics also effective -- repeated treatment at 2-3 week intervals recomended. Puppies & kittens should be dewormed at 2,3,4,8,12 and 16 weeks of age. Treat pregnant bitches with fenbendazole at day 40 to 2 days post whelping to reduce transmission.

Answer 158

Acylostoma caninum is transmitted via fecal oral route or occasionally via skin penetration. adult worms attach to small intestinal mucosa and ingest blood and mucosa. young dogs most frequently are affected. cat infections are uncommon. older dogs are rarely affected. transcolostral infection is possible. Melena,hematochezia, diarrhoea, stunted growht,a naemia. Fecal floatation is usually dianostic. puppies affected via colostrum may suffer severe disease before ova are shed. in these patients strong suspicion of infection can be made via compatible clinical signs and presence of iron deficiency anaemia. multiple anthelmintics may be used, including pyrantel and fenbendazole. blood transfusions may be necessary in severely anaemic patients. moxidectin treatment of bitches at day 55 reduces transcolostral infection. humans may be affected by environmental contamination and may develop visceral larval migrans so environmental contamination and appropriate handling of feces is essential. regular use of dewormer reduces infection rates. good prognosis but more guarding in severely anaemic younger animals.

Answer 159

Dipylidium caninum is most common but taenia spp are also seen with wildlife exposure. mesocestoides spp and echinoccous spp may be infective. fleas and lice are intermediate host for D caninum. Flea infestation must also be treated for control. echinococcus is zoonotic. prognosis excellent.

Answer 160

Occurs with extensive surgical resection of the small intestine. (75-90%). the remaining small intestine is unable to absorb adequate nutrition from a normal diet and may develop small intestiinal bacterial overgrowth. an y patient with extensive intestinal resection and anastomosis prone. history of extensive intestinal resection, along with weight loss and small bowel diarrhoea. appetite is usually increased. signs are most severe after resection, but with time the remaining small bowel may be able to compensate and clinical signs may decrease with time. Treatment is dietary modification with a highly digestible, low fat diet. often homemade diets are initially appropriate such as with cottage cheese and potato. small frequent meals are often better tolerated. antibiotics such as tylosin or metronidazole can decrease small intestinal bacterial overgrowth.

Answer 161

The cause is typically idiopathic and unknown but s suspected to be related to changes in smooth muscle function. additional causes of constipation that may lead to Megacolon include: pelvic canal stenosis, nerve injury or manx sacral spinal cord deformity. Initial stages of idiopathic megacolon are constipation and obstipation, recovery of colonic function at these stages may still be possible. for true dilated megacolon cats, colonic function is usually permanently decreased. most commonly middle aged cats. DSH. siamese may be overrepresented. Reduced, painful or absent defecation. tenesmus may be noted. dilated colon with very firm feces may be palpable on abdominal palpation. cats may also become anorexic and dehydrated, vomit, or develop abdominal pain. Radiographs demonstrate dilation of colon or impaction of feces. pelvic and lumbar spine should be examined for abnormalities causing secondary constipation as well as observation for possible mass lesion causing obstruction. recommended treatment upon first presentation depends on severity of disease. for mild - one or more warm water or lactulose enemas along with oral lactulose or miralax is typically sufficient. Dehydrated patients should be treated with intravenous or subcutaneous fluids, as dehydration exacerbates disease. obstipated cats may need manual de opstipation, sometimes performed in several procedures. After initial treatment and relief of the colonic impaction, medical therapy may be attempted. dietary therapy witha low reside, modified fiber diet is advised, along with oral laxative therapy with lactulose or miralax. cisapride therapy may also benefit mild to moderately affected patients. cats with severe idiopathic megacolon are typically refractory and may require subtotal colectomy for control of disease.

Answer 162

Upon weakening of the coccygeus and levator ani muscles, the rectum and other organs ocassionally are pushed externally through the pelvic canal. mostly older intact male dogs (esp boston terriers, boxers, corgis and pekinese) clinical signs:dyschezia and tenesmus which may precede the hernia. constipation and perineal swelling may also be seen. If the bladder has been herniated there may be signs of urinary obstruction. usually can be definitively diagnosed with rectal examination. radiographs can be used to confirm. if bladder is suspected to be herniated a catheter may be passed into the bladder gently and a small amount of contrast injected to confirm bladder herniation. if bladder is involved and urinary obstruction is present the bladder should be emptied and repositioned into the abdomen. IV fluids should be administered for post obstructive diuresis. Surgical reconstruction of the pelvic diaphragm is indicated. neutering is usually recommended at the same time to reduce possible benign prostatic hyperplasia and associated straining.

Answer 163

Likely immune mediated and a subset of inflammatory bowel disease, but ultimately etiology is unknown. classically GSDs. hough similar breeds may also be affected. clinical signs - constipation, rectal pain, draining tracts around the anus may be seen. diagnosis is made via physical examination including a gentle rectal examination. sedation may be necessary due to pain associated. granulomas and abscesses may be palpable. treat as for IBD. hypoallergenic hydrolyzed diets beneficial. affected dogs often need immunosuppression, cyclosporine or azathioprine are recommended. tacrolimus topically also has been described. Antibiotics such as metronidazole may also be of benefit. many patients respond well. occasionally patients refractory to treatment and carry a more guarded prognosis. because the disease is primarily immune mediated, surgery is not curative and is not usually recomended.

Answer 164

Anorexia, vomiting, diarrhoea (small or large bowel) abdominal pain, weight loss, lethargy, depression, dehydration, signs of systemic inflammatory response syndrome (abnormal blood pressure, heart rate, respiratory rate, temperature), bleeding with DIC.

Answer 165

Increased RBC count with dehydration, decreased RBC count with anaemia of chronic inflammatory disease (normocytic, normochromic). Stress or inflammatory leukogram causing neutrophilia, sepsis/SIRS causing neutropeina. Platelets - thrombocytopenia with severe pancreatitis/ DIC.

Answer 166

Elevated liver enzymes - primarily hepatocellular with neighbouring inflammation or cholestatic with biliary obstruction or some combination thereof. Azotaemia - pre renal from dehydration, renal with concurrent acute kidney injury from pancreatitis. Bilirubin and bile acids - may be elevated from biliary obstruction from pancreatitis. Amylase/lipase are not helpful in diagnosis.

Answer 167

Concentrated with dehydration, isothenuric with concurrent acute kidney injury. Prteinuria can occur with severe pancreatitis.

Answer 168

available as canine CPLI or feline FPLI specific quantitive test or SNAP. highly sensitive and specific for pancreatitis - diagnostic of choice.

Answer 169

Quantification of trypsinogen and trypsin in systemic circulation - small amount normally leaks from pancreas to blood. Decreased with exocrine pancreatic insufficiency - must be on a fasted sample or may get falsely elevated reading, diagnostic of choice with EPI. May be increased with pancreatitis but less sensitive than PLI.

Answer 170

Inflammation of the pancreas occurs when normal protective mechanisms against premature activation of trypsinogen are overwhelmed. premature activation of trypsinogen within the pancreas results in digestion of pancreatic proteins and activation of more trypsinogen. This results in release of pro inflammatory crytokines with necrosis and in severe cases severe systemic inflammation. Can ultimately lead to multi organ failure and death. certain drugs have been associated with development of pancreatitiis, including potassium bromide, azathioprine, asparaginise. hypthyroidism, obesity, hyperadrenocorticism and diabetes melltius also thought to increase risk of disease. Mostly middle aged. dogs more often get acute. terrier and miniature schnauzers seem to be predisposed.

Answer 171

There may be a recent history of ingestion of a very high fat meal or dietary indiscretion. clinical signs can vary from very mild to quite severe and can include abdominal pain, pray position, anorexia, dehydration, vomiting, and diarrhoea. more severe cases may have signs of SIRS, DIC or multi organ disease: collapse, shock, tachycardia, pale mucous membranes etc.

Answer 172

Minimum database may show hemoconcentration with dehydration,neutrophilia +- left shift or neutropenia with SIRS/sepsis, hyper or hypoglycaemia with altered glucose metabolism, pre renal or renal azotaemia, elevated liver enzymes, hypokalaemia which if present suggests poorer prognosis, concentrated or isothenuric USD, possibly proteinuria. PLI, either SNAP or quantitive should be performed in suspect cases. abdominal radiographs typically unhelpful but may show decreased cranial abdominal detail and an air filled duodenum. Abdominal ultrasound is slightly more sensitive but still not as good as PLI. changes on ultrasound could include thickened hypoechoic pancreas with bright surrounding mesentery.

Answer 173

remove any inciting cause if possible/present. remainder of therapy consists of supportive care. IV fluids and electrolyte supplementation often indicated. pain management usually necessary given parenterally usually with an opiod. nutritional support should aso be provided, tube placement mabe necessary. if vomiting is difficult to contorl, trickle feeding of very small amounts continuously via syringe driver or fluid pump is usually slow enough to not stimulate vomiting and provide adequate enteral nutrition. dogs with refractory vomiting may require parenteral nutrition. once patients are eating voluntarily a bland diet easily digestible should be fed. multiple anti emetics may be required o for control of vomiting and gastroprotectants often indicated. antibiotic therapy usually given in severe cases because it is difficult to differentiate between sepsis and SIRS. Plasma transfusions are given to patients in DIC. if pancreatic abscesses are present, surgical debridement can improve outcomes. Mild cases of pancreatitis may be treated supportively as for acute gastroenteritis and self resolves in a couple of days. severe cases may require extensive supportive care and are at high risk for developing severe complications.

Answer 174

The chronic form of pancreatitis can develop as an extension of acute inflammation that leads to permanent impairment of function or persistent low levels of inflammation. inflammatory infiltrates are usually mononuclear. chronic pancreatitis may occur as a primary autoimmune disease in english cocker spaniels. cats with chronic pancreatitis frequently also have inflammatory bowel disease, Cholangitis or both. More frequently seen in cockers and CKCS though siberian husky, collies and boxers are overrepresented as well. Generally waxing/waning or intermittent. signs can include bouts of anorexia, vomiting and abdominal pain, cats often just anorexic. chronic pancreatitis can lea too enough fibrosis to cause EPI or Dm so patients could present with corresponding clinical signs. inflammation/fibrosis may also induce signs of EHBO.

Answer 175

Overall findings with chronic pancreatitis are similar to acute disease, though changes are usually less pronounced so often difficult to diagnose. PLI still test with highest sensitivity but value typically not as high as with acute diseas.e minimum database changes may be consistent with DM or EPI. cobalamin should be measured in all cases. decreased intrinsic factor production with chronic pancreatitis can cause hypocobalaminaemia. biopsy needed for definitive diagnosis ultimately - but usually made with consistent clinical findings. Most with chronic disease will ahve intermittent flare ups or bouts of acute - should be managed as for acute. low fat diet may reduce acute episodes in dogs. cats maintained on highly digestible diet. cobalamin should be supplemented if indicated. periods of anorexia should be managed with feeding tube supplementation if necessary. If DM, EPI, or EHBO are present they should be managed appropriately.

Answer 176

Loss of exocrine pancreatic function may occur secondary to chronic pancreatitis (dogs and cats) or pancreatic acinar atrophy (dogs only). With pancreatitis, chronic inflammation and fibrosis leads eventually to loss of enough exocrine pancreatic tissue that mal digestion occurs. with pancreatic acinar atrophy there is an auto immune reaction against pancreatic acini. EPI from pancreatic acinar atrophy is seen in young GSDS, rough coated collies and chow chows. average age at time of diagnosis is 2-3 years. EPI from chronic pancreatitis can be any age/breed, though middle age to older breeds at risk for pancreatitis (cocker, CKCs) . Most consistent finding is weight loss, which may be severe, diarrhoea is often present and may be small bowel due to maldigestion or large bowel due to bacterial overgrowth. appetite is classically increased but may also be decreased. steatorrhea may be present if over 90% of lipase production is lose. with chronic pancreatitis EPI, DM may also be present. Minimum database is usually unremarkable unless concurrent diseases are present. EPI can cause mild hypoproteinaemia, mildly Increased LE, low cholesterol and triglycerides and mild lymphopaenia.

Answer 177

TLI is the diagnostic of choice with high sensitivity and specificity. A fasted sample should be used, however, to reduce liklihood of false negatives. affected patients may ocasionally be in the normal range but are usually on the low end of normal and will be abnormally low if retested with fasted sample. if EPI s diagnosed or suspected, cobalamin should also be measured especially in cats. folate is usually measured at the same time and may be increased with bacterial overgrowth.

Answer 178

Medical management consists primarily of pacnreatic enzyme replacement, typically with pancreazyme or something similar. patients should be co administered an H2 antagonist or PPI so that enzymes are not degraaded by gastric acid. over time, pancreatic enzymes may be weaned to lowest effective dose. diet should consist of moderate fat, highly digestible diet that is not high in fibre which can absorb pancreatic enzymes. tylosin or metronidazole can help control bacterial overgrowth. cobalamin should be supplemented in all cats and most dogs depending on serum levels. any concurrent diseases should be managed appropriately. usually excellent with treatment though it may take some time to get clinical signs controlled. pancreatic enzymes are quite expensive, however so owner may elect not to treat. Swine pancreas is an alternative.

Answer 179

Pancreatic cysts occur congenitally in some breeds or occasionally in association with neoplastic disease. a pancreatic pseudocyst is a cyst like structure filled with pancreatic enzymes that is seen uncommonly with pancreatitis. they are both important most as a differential for apncreatic abscess, for which surgical debridement may be indicated. usually no clinical signs. occasionaly cysts could cause EHBO and corresponding signs. aspirate of fluid from structure will be modified transudate in a cyst or pseudocyst versus exudate with abscess. no treatment required unless there is biliary tract compression - in this case the cyst/pseudocyst may be drained with ultrasound guidance or surgery.

Answer 180

Underlyng cause usually unidentified but may be infectious or toxic insult that sets up chronic inflammation or in some cases may be primarily autoimmune. inflammation is usually mixed, most often lymphocytic-plasmacytic. Chronic inflammation leads to fibrosis which can cause portal hypertension and lead to the development of acquired portosystemic shunts. Typically occur late in the disease process when there has been over 75% functional liver capacity llost. May include vomiting, diarrhoea, anorexia, weight loss, PU/PD, jaundice, ascites and Hepatic encephalopathy. haematology is often normal but may include anaemia of chronic inflammatory disease and neutrophililc leukocytosis. early on in the disease process, liver enzymes may be mild to moderately elevated. later on with more fibrosis liver enzymes may be normal but indicators of liver function may be abnormal. Liver size may be decreased on abdominal radiographs and abdominal ultrasound, ascites may be present with portal hypertension or hypoalbuminaemia. bile acids tolerance test is abnormal once dysfunction has occured. Manage as with hepatic dysfunction. diet should be moderately restricted, high quality protein easily digestible, cottage cheese, antioxidant therapy including s-adenosylmethionine, vitamin E, milk thisle, ursodeoxycholic acid promotes choleresis and decreases toxic bile salts, antibiotics may be indicated for hepatic encephalopathy, amoxicillin if leptospirosis possible, anti inflammatory doses of gluocorticoids.

Answer 181

Copper is normally excreted in bile. with defects in copper excretion, copper accumulates leading to secondary inflammation and eventual fibrosis. copper may accumulate also as a secondary process to primary inflammatory hepatitis ( as with chronic hepatitis) but the distribution of copper within the portal triad is typically different. Multiple breeds have been identified to have suspected primary copper accumulation causing hepatitis: bedlington terrier, Labrador retriever, dalmation, doberman, WHWT, skye terrier, a mutation in copper excretion has only been identified in bedlingtons. Signs may be waxing or waning or acute on chronic- vague signs of illness chronically with sudden deteriroation. Clinical signs will be as for chronic hepatitis. susceptible breeds with elevated liver enzymes, even without clinical signs, should be investigated with biopsy because prognosis is significantly better with early intervention. Bloodwork/liver function changes will be identical to chronic hepatitis. biopsy with copper quantification is needed to differentiate. distribution is usually centrilobular, if copper accumulates secondary to chronic hepatitis is it typically milder and periportal. Treatment is general medical management as with chronic hepatitis. specific treatment for copper storage disease includes addition of zinc acetate or zinc gluconate to diet to bind dietary copper. patients that are systemically ill or have a high hepatic copper levels may need copper chelation therapy with D Penicillamine for several months but then can be maintained with hepatic diet and zinc supplementation. prognosis good with early intervention, guarded if fibrosis is present.

Answer 182

A congenital vascular anomaly remains persistently patent after birth, connecting portal circulation directly to systemic circulation (usually portal-caval or portal-azygous) bypassing the hepatic parenchyma. because the anomalous vessel is a lower pressure system than the hepatic parenchyma, blood shunts past the liver. shunts may be extrahepatic or intrahepatic. Extrahepatic shunts More common in small breed dogs, Yorkshire terriers, WHWT, maltese. Intrahepatic shunts more common in lab, irish wolfhound. typically present under 1 year, some have some normal portal circulation and have milder signs. Signs may be neurologic, gastrointestinal, urinary or general body condition, neurologic signs ay include hepatic encephalopathy, depression, lethargy, circling, blindness, seizures, GI signs include vomiting, diarrhoea, anorexia, urinary signs include PU/PD or presence of urate crystals or cystoliths. Minimum database most often shows a microcytic hypochromic anaemia, normal to mildly elevated liver enzymes, and low urea though may be unremarkable. bile acids tolerance test is extremely sensitive for PSS but not specific. abdominal ultrasound is essentially the opposite, it is specific but not sensitive. if a shunt vessel is seen with ultrasound, it confirms the presence of the anomaly but if one is not seen that does mean it is not present. CT angiography is a more sensitive imaging modality to detect abnormal shunt vessels than ultrasound but also requires GA. Treatment is attenuation of the shunt vessel via surgery (extrahepatic) or transjugular coil embolixation (intrahepatic) usually recomended. cases are usually medically managed for a period of days to weeks prior to definitive treatment to make them more stable.- hepatic diet, oral lactulose and metronidazole or amoxicillin for HE signs, anti epileptics if indicated. prognosis good with definitive treatment.

Answer 183

Another congenital vascular anomaly. the portal vasculature within the liver is underdeveloped. also known as microvascular dysplasia. signs are as with extrahepatic PSS, typically slightly older at time of presentation and signs are slightly milder, bile acids tolerance test is usually less elevated than with congenital PSS. diagnostic imaging is used to rule out PSS. hepatic biopsy is used to confirm diagnosis through often medical management. Hepatic biopsy used to confirm diagnosis though medical management is often instituted in suspected patients based on breed, clinical signs and lack of PSS. medical management treatment same as with PSS. dogs may be able to be weaned down to less aggressive medical management over time for instance only on diet or only on diet and lactulose.

Answer 184

Similar to portal vein hypoplasia but with secondary portal hypertension, may develop multiple acquired PSS but do not have cirrhosis. Usually presents as young adult 1-4 years more often large than small breed. signs as with PSS but less frequently present with HE signs. often concurrently present with ascites or signs of GI ulceration. diagnosis as with PSS though on ultrasound and CT liver is Typically small. there is usually ascites, portal hypertension and multiple acquired extrahepatic shunts visualized. ultimately liver biopsy needed for definitive diagnosis. Medical management as with PSS - gastroprotectants (H2 antagonists, PPI, sucralfate) may be indicated for increased risk of ulceration and GI signs, drainage of ascitic fluid should be avoided (unless causing resp distress), because it will exacerbate hypoalbuminaemia. generally good prognosis. no definitive treatment available apart from medical management.

Answer 185

Ingestion of hepatotoxin/treatment with hepatotoxic drug may lead to oxidant injury and subsequent inflammation eventually leading to fibrosis. common offenders include paracetamol, phenobarbital, xylitol, aflatoxin, lomustine. Usually acute signs and may include vomiting, diarrhoea, anorexia, weight loss, PU/PD, HE, jaundice, bleeding from acquired coagulopathy. Presumptive diagnosis made based on history. with acute toxic insults, liver enzyme elevated is usually moderate to severe and is usually primarily hepatocellular or mixed. bile acids and bilirubin may be normal or elevated. hypoglycaemia and hypokalaemia may be present. azotaemia either prerenal or concurrent AKI, may be present. abdomianl ultrasound can occasionally show hyperechoic hepatic parenchyma. coagulopathypotentialy present. Primarily treatment consists of supportive care including IVFT, gastroprotectants, anti oxidants (more specifically indicated for hepatotoxicosis than with other causes of liver diseasE) and vitamin K.

Answer 186

Glycogen accumulates in hepatocytes which leads to cell swelling and cholestasis. it is often secondary to corticosteroid or other drug therapy but is recognised as a primary disorder in some breeds. usually none to minimal clinical signs - differential for elevated cholestatic enzymes. elevation in ALT, GGT, bile acids. abdominal ultrasound usually shows hepatomegaly and diffusely hyperechoic liver. cytology will show vacuolar change though biopsy needed for definitive diagnosis. no definitive treatment. secondary VH usually reversible for withdrawing offending agent. no treatment for scottish terrier VH. excellent prognosis but may be a link between VH and hepatocellular carcinoma in scottish terriers.

Answer 187

Infectious causes of hepatitis are very uncommonly reportedi n the UK. leptospirosis can cause hepatitis. L grippothphosa recognised to cause hepatitis in absence of renal signs. any dog with possible exposure. may be acute or chronic, compatible with effect on liver function and presence of systemic infection. characteristic changes of acute hepatitis. Leptospirosis PCR or serology should be performed. treatment of leptospirosis is amoxicillin.

Answer 188

Bacterial or unidentified pathogen causes biliary tract inflammation/infection which is usually neutrophilic. there may be a recent history of enteritis or pancreatitis. any age or breed may be affected. signs may include anorexia jaundice, vomiting and pyrexia. Minimum database can show anaemia of chronic inflammation, neutrophilic leukocytosis and cholestatic liver enzyme elevation, including potentially elevated bilirubin and bile acids. abdominal ultrasound indicated to rule out presence of a mucocele and extrahepatic duct obstruction. Bile cytology and culture can confirm presence of neutrophilic inflammation and presence of bacterial infection. Therapy consists of appropriate antibiotics based on culture results. pending results, potentiated amoxicillin would be appropriate. if the dog is anorexic - nutritional support may be required.

Answer 189

Mucoid concretions within the gallbladder can result in biliary obstruction. Numerous endocrinopathies, including diabetes mellitus, hyperadrenocorticism, hypothyroidism and pancreatitis can result in changes to biliary secretions increasing risk of mucocele. Usually occurs in middle aged to older dogs, shetland sheepdogs, cocker spaniels, miniature schnauzers seem predisposed. Signs may be absent and mucocele can be diagnosed incidentally on abdominal ultrasound for another reason. Minimum database often shows cholestatic enzyme elevation and elevated bile acids. abdominal ultrasound shows a kiwi gallbladder. clinical sigs include anorexia, lethargy, vomiting and jaundice. Definitive treatment is cholescystectomy. if mucocoele is seen subclinically or surgery is not an option, medical therapy includes Ursodeoxycholic acid and low fat diet as well as management of any concurrent underlying endocrinopathies. guarded prognosis if bile peritonitis is present. subclinical cases can do well with surgery and sometimes with just medical management.

Answer 190

A period of anorexia induces a negative energy balances and mobilizes fat stores from peripheral fat to the liver. concurrently, dietary deficiencies of methionine, carnitine and taurine result in an inability to process fats for energy metabolism. hepatocyte swelling leads to cholestasis. Obese cats more predisposed. signs include jaundice, vomiting, diarrhoea, hepatomegaly as well as signs of HE. HE usually includes pytalism and depression in cats. there may be sign sof underlying disease that led to period of anorexia. minimum database can show anaemia of chronic inflammation alkaline phoshatase is clasically elevated, more so than GGT. alanine transferase is usually abnormal. bilirubin may be increased and urea may be decreased with hepatic dysfunction. hypokalaemia, hypophosphtaemia and hypomagnesemia may be present secondary to anorexia and hypokalaemia is associated with a poorer prognosis. coagulation panel can show elevated Pt/PTT with decreased vitamin K recycling. there may be changes indicative of underlying disease that led to anorexia. abdomain radiographs or ultrasound are used to search for concurrent diseases but may show hepatomeagly and hyperechoic hepatic parenchyma. cytology will shw vacuolar change. Most important aspect of treatment is restoration of positive energy balance, which typically requires placement of a feeding tube. if patient is a suitable candidate for anaesthesia, oesophageal feeding tubes are Preffered otherwise nasoesophageal feeding tubes are indicated. Small frequent meals are typically better tolerated. IV fluids and electrolytes appropriate. Vitamin K should be given for coagulopathy. Anti oxidants (SAM-e and vit E) used to replace deficits in glutathione.

Answer 191

Ascending bacterial infections of the biliary tract leads to neutrophilic inflammation of the bile duct an portal tracts, similar to cholangitis in dogs. most frequently isolated bacteria include E. coli, streptococcus, clostridiuum and other enteric bacteria. gallbladder may also be affected. concurrent inflammatory bowel disease/pancreatitis commonly present. Signs may include lethargy, anorexia, pyrexia and jaundice. neutrophilic leukocytosis with possible left shift, alanine transferase and bilirubin most commonly elevated. abdominal radiographs are usually normal and ultrasound may show biliary tract dilation. biliary cytology and culture can isolate infective organism and give sensitivity. Cats should be treated with an extended period of appropriate antibiotics (4-6 weeks) until there is resolution of clinical signs and bloodwork changes. potentiated amoxicilin can be used pending culture results. ursodeoxycholic acid would be appropriate to increase choleresis and reduce cell membrane damange. anorexic patients should be managed appropriately.

Answer 192

lymphocytes infiltrate portal tracts, leading to proliferation of bile ducts and portal fibrosis. it is likely immune mediated and may present similarly to FIP. affects young to middle aged cats. persians overrepresented. chronic waxing and waning illness - jaundice, weight loss, anorexia, lethargy. cats may have high protein ascites. minimum database may show neutrophilic leukocytosis. liver enzymes may be mild to moderately elevated. hyperglobinulinaemia may be present. coagulation times may be prolonged. Ultrasound could show biliary tract dilation that can appear like EHBOO and ascites may be present. Little evidence that immunosuppressives are of benefit. supportive care consists of ursodeoxycholic acid and nutritional support as indicated.

Answer 193

Compression of bile duct can occur secondary to intraluminal or extraluminal causes which can include cholangitis, duodenitis, pancreatitis or some combination thereof. biliary neoplasia can also cause EHBO. choleliths are a rare cause of EHBO. Signs are compatible with cholestasis and may include jaundice, anorexia depression and omiting. hepatomegaly may be present. minimum database is compatible with cholestasis, elevated cholestatic liver enzymes and bilirubin. coagulation panel is often abnormal due to decreased absorption of fat soluble vitamin K without adequate bile mediated fat digestion. abdominal ultrasound demonstrates dilation of gallbladder and bile duct. Underlying cause of EHBO may be visible. Recommended treatment depends on underlying cause. cats usually require vitamin K supplementation, along with UDCA and antioxidants. biliary tract surgery should be avoided - high periooperative morbidiity.

Answer 194

same etiology as dogs. purebred cats overrepresented. most cats present under 2 years of age. hepatic encephalopathy signs are more consistent in cats than dogs and may be waxing and waning. signs include hypersalivation, beahviour change. head pressing, circling, poor growth. minimum database includes decreased urea and microcytosis, remaining changes on bloodwork are less common in cats than dogs. bile acids tolerance test will be elevated. abdominal ultrasound may show microhepatica and shunt vessel may be visualised. CT angiography can detect or rule out PSS. Medical management typically less effective at controlling clinical signs than in dogs. definitive treatment is with attenuation of shunt vessel, though medical management should be used for stabilisation prior to surgery.

Answer 195

The process of emesis is complex, a wide number of triggers and pathways being able to induce the vomiting reflex. The main neurotransmitter is acetylcholine but serotonin, dopamine, substance P and histamine are also important. in cats and dogs, stimulation of alpha2 adrenoceptors also induces emesis.The emetic centre is protected by the blood brain barrier. the chemo receptor trigger zone is not so well protected by the BB, which is incomplete in this region.

Answer 196

Drugs which induce emesis. the main reason for induction of emesis is in the managemtn of poisoning (non corrosive). Xylazine - is an alpha 2 agonist used as a sedative which induces vomiting in cats especially but also dogs after i/m. if given at lower dose should not cause sedation but may still induce vomiting. Ipecacuanha - acts as a local irritant, not terribly reliable. Opiates - apomorphine - emetic action predominant over its other opiod effects (D2 receptors in CRTZ) can be given by any route. subsequent administrations may see reduced efficacy - depression of the emetic centre, respiratory depression with overdose, not suitable for cats.

Answer 197

Licensed anti emetic for dogs. its mechanism of action is neurokinin - 1 receptor antagonist, it blocks the effect f substance P (neurotransmitter at these receptors) acts in final common pathway in emetic centre > broad spectrum anti emetic, works for motion sickness, GI irritation, pancreatitis, chemotherapy induced. It is orally bioavailable, given oral and s/c. It has low oral bioavailability - first pass hepatic metabolism, non linear kinetics, hepatic metabolism - 2 isoenzymes, one low capacity, one high capacity, hepatic clearance also, widely distributed, highly bound to plasma protein. There is a wide dose range depending on the cause of vomiting i.e higher dose for motion sickness. once daily dosing schedule. can be given orally or parenterally. oral admin give with small amount of food - for travel sickness.

Answer 198

now licensed for dogs and cats. it is both centrally and peripherally acting. mechanism of action is complex. it centrally inhibits D2 and %Ht2 receptors in the CRTZ. Peripherally inhibits D2 receptors and induces the release of local ACh. Results in increased oesophageal sphincter tone, increased gastric contractions, decreased pyloric sphincter tone, increased peristalsis of the upper intestine.. It has good oral bioavailability, can also be given parenterally, significant first pass metabolism, good distribution, short half life about 90 mins, hepatic and renal elimination. The side affects reported are - behaviour alterations, constipation with long term use, contraindicated in GI obstruction and epilepsy. atropine and the opioid analgesics antagonise the effects.

Answer 199

Motion sickness (vestibular apparatus). Histamine via h1 receptors is the key neurotransmitter. antihistamines such as cyclizine HCL, meclizine HCL and diphenhydramine Hcl. They may cause drowsiness and xerostoma. oral bioavailability is good, hepatic metabolism and renal elimination.

Answer 200

Broad spetrum anti emetics. low doses block dopamine and histamine receptors. high doses have antimuscarinic effects also. acepromazine, chlorpromazine and prochlorperazine. sedation and hypotension are also side effects - decrease desirability in older/sck animals..

Answer 201

They block the effect of serotonin on %ht2 receptors. Examples include cyproheptadine and ondansetron. ondansetron used especially for human patients to control vomiting associated with chemotherapy. Ondansetron can be given orally or parenterally. it has a short half life and undergoes hepatic metabolism.

Answer 202

Protectants, anticholinergics, prokinetics.

Answer 203

H2 receptor antagonists. examples include cimetidine, ranitidine and famotidine. Cimetidine is orally bioavailable, food decreases boavailability, hepatic metabolism and renal elimination of conjugated and active drug, half like 1 hour, decreases gastric acid and pepsin production. It is an inhibitor of microsomal enzymes and will decrease hepatic blood flow b y about 20% - decrease metabolism of flow dependent on drugs e.g lidocaine and propranolol. May get rebound and hypersecretion on cessation. Famotidine > ranitidine> cimetidine. Famotidine does not inhibit liver enszymes, can be given IV, longer half life vs cimetidine, SID- BID dosing, dose reduction in renal failure. Basic drug give slowly over 5 mins. Ranitidine - does not inhibit liver enzymes, can be given i/v, longer half life vs cimetidine, BID dosing, has prokinetic activity, also dose reduction in renal failure.

Answer 204

An anti ulcer drug - proton pump inhibitor. It is a substituted benzimidazole, more potent than the H2 blockers. it irreversibly inhibits the potassium ATPase pump in the luminal surface of the parietal cell. basic drug that requires enteric coated formulation. dissolution and absorption occurs in the small intestine. On absorption the drug is ion trapped in the parietal cells (pH is much lower compared to other cells) absorption improves over first 4-5 days as PH in the GI tract increases. enzyme is permanently inhibited so HCL production only resumes when new enzyme molecule has been formed. high plasma protein binding (about 96%), hepatic metabolism and short half life about 1 hour. safe drug with few side effects.

Answer 205

A synthetic analogue of PGE1. it acts locally - absorbed drug is rapidly metabolised. decreases cAMP in the parietal cell. it increases bicarbonate and mucous production and enhances mucosal blood flow and mucosal epithelialisation. anti ulcer and cytoprotective agent, reduces secretion of histamine from mast cells. Unabsorbed drug in the SI can cause diarrhoea, generally resolves after a few days, used primarily to prevent and treat gastric ulceration caused by NSAIDS.

Answer 206

Other agents that neutralise gastric acid. examples include sodium bicarbonate and aluminium hydroxide. not especially efficaceous. need to be administered very frequently e.g 6 x daily or with every meal. can get hypersecretion of HCL. AIOH also binds phosphates and used in renal failure to help reduce blood phosphate levels.

Answer 207

Misoprostol, antacids and sucralfate. Antacids e.g aluminium hydroxide - inactivate HCl, binds pepsiin and bile salts also, binds intestinal phosphate (renal disease), a more prolonged antacid effect than some, can cause constipation (mix with magnesium salts), alkalinize urine - ion trapping and increase elimination of acidic drugs. Sucralfate is a dissacharide alminium hydroxide product. in acidic environment acquires negative charge and binds to positively charged elements of exposed epithelial cells at sites of ulceration- seals the ulcer, prevents leakage of protein and electrolyte, binds epidermal growth factor. It requires an acid environment to work, binds to bile acids and pepsin, increases local blood flow perhaps by increasing prostaglandin or NO locally. it acts locally - is not absorbed. binds and inactivates cimetidine and other orally administered drugs.

Answer 208

They act locally and are unchanged. they lubricate and soften the faecal mass, include mineral oils and yellow and white soft paraffins , prolonged use may reduce absorption of fat soluble vitamins. local absorption may cause granulomatous lesions, may reduce bowel irritability leading to constipation.

Answer 209

These are not absorbed but act locally. they are hydrophilic and absorb water. increasing faecal bulk and water content and stimulating peristaltic movement. examples include sterculia, isphagula and bran. adequate water intake is crucial.

Answer 210

Examples include magnesium sulfate (Epsom salts,) sodium sulfate (Glauber's salt) and lactulose. these hypertonic solutions draw water into the intestine causing bowel distension and peristalsis. water availability is crucial in the case of lactulose, intestinal ph is reduced, ammonia producing gut flora are reduced. this is useful in the management of hepatic encephalopathy. Phosphates and sodium citrate are also used as osmotic laxatives - they are administered as enema preparations. phosphate enemas should not be given to small dogs and cats as this can induce hyperphosphataemia.

Answer 211

Should never be used if obstruction is suspected. examples include Bisacodyl and phenopthalein. these are diphenylmethane stimulants. precise mechanism of activity is not clear but they appear to stimulate colonic smooth muscle and the myenteric plexus. Phenopthalein undergoes some degree of enterohepatic recycling.

Answer 212

Prokinetics and spasmolytics. Some agents used in the management of diarrhoea may increase segmental contractions and decrease peristaltic contractions.

Answer 213

Metoclopramide - used as an anti emetic, also used to prevent post op ileus in horses. 2. Parasympathomimetics such as carbachol - QAC and can cause intestinal rupture. 3. Antimicrobial eerythromycin - has prokinetic effects through stimulation of ACh release 4. Ranitidine 5. Cisapride - acts primarily as an agonist at 5HT4 receptors in the GI tract. Increases lower oesophageal sphincter pressure, gastric emptying, SI motility and colonic motility. More potent than metoclopramide. administered orally - food enhances absorption. withdrawn from marked in the UK and US for human use due to cardiac toxicity associated with concurrent use f Cyp 3A4 inhibiitors. Need an STC.

Answer 214

Spasmolytics - drugs to treat diarrhoea. Antimuscarinics; Atropine sulphate, propantheline and hyoscine (buscopan compositum). Propantheline less lipid soluble than atropine so reduced CNS effects. Opioids - diphenoxylate HCL, codeine and loperamide. Increase segmental contractions and decrease perisalsis. Diphenoxylate and loperamide are both metabolised in the liver. diphenoxylate is more completely absorbed following oral administration. take care in cats. loperamide may be used in horses. diphenoxylate combined with atropine available. (lomotil)

Answer 215

Thought to adsorb toxins from the GI tract, may also prevent the absorption of other dugs, examples include kaolin, pectin, bismuth salts, activated charcoal, calcium carbonate. Often used in combination in commercial products. Bismuth can come in a variety of forms - bismuth suubnitrate, subcarbinate and subsalicylate. the subsalicylate form is cleaved into bismuth and salicylate. the latter is systemically available and has anti prostaglandin effects - care in cats. has been shown to have antimicrobial and anti secretary effects in some species. Activated charcoal is very effective adsorbent, used in the treatment of ingested toxins pore size is important. powder more efficacious than tablets. forms a stable complex with the substance which is then evacuated from the body.

Answer 216

A drug used in human medicine to lower cholesterol. it stays in the GI tract and binds bile acids, preventing their reabsorption. in rabbits it can be used in antibiotic induced diarrhoea as it binds and absorbs clostridia toxiin.

Answer 217

Appetite mainly controlled by the ventral and lateral nuclei of the hypothalamus. neurotransmitters involved - noradrenaline, dopamine and GABA stimulatory, serotonin inhibitory. neuropeptides CCK, CRF and Calcitonin inhibit appetite, while pancreatic polypeptides and opiates stimulate appetite. Benzodiazepines - diazepam most effective, used mainly in cats, inhibits satiety centre and GABAminergic effects, administered IV. Cyproheptadine - anti serotonin effects, good oral bioavailability with a half life about 13 hours. given orally once or twice daiily in cats.

Answer 218

A naturally occuring bile acid. it has less cellular toxicity than many other bile acids (i.e hydrophobiic membranocytolytic BAs). It is preferentially absorbed from the GI tract. it is also acholoretic agent increasing the elimination of toxic bile acids from the liver. it thereby helps protect the diseased liver from toxic bile acids. it is given orally once daily and should be avoided in biliary obstruction.

Answer 219

Acts as a methyl donor. it has been shown to improve hepatic parameters in a number of disease conditions . it is important for a large number of processes within the liver including the formation of glutathione. glutathione s important as an antioxidant and for the scavenging of ROS. glutathione often deficient in liver disease. Good oral bioavailability but extensive first pass effect.

Answer 220

thought to have an antioxidant anti inflammatory anti fibrotic effect. thought to promote regeneration. experimentally protects dogs from amanita mushroom poisoning. dosing is empirical - clinical efficacy not well established.

Answer 221

Used in copper hepatotoxicosis. Penicillamine is an anti arthritic drug and also a chelating agent. it binds copper. should be given on an empty stomach. Variable bioavailability, mainly renal elimination but also hepatic, elimination is slow. Trientine - alternative to penicillamine, has been shown to be associated acute renal failure in dogs.

Answer 222

Oral > ptyalism, dspyhagia, halitosis Oesophageal > regurgitation, dullness, anorexia Gastric > dullness, weight loss, vomiting Small intestine, malaenia, diarrhoea, weight loss, Colon - diarrhoea, weight loss, tenesmus, haematochezia Perianal - mass lesion, tenesmus

Answer 223

The most common oral tumours in dogs include malignant melanoma, squamous cell carcinoma, fibrosarcoma and the epulides. SCC is the most common feline oral tumour. Fibrosarcoma and melanoma occur but less commonly. Clinical sigs oral tumours include ptyalism, sometimes bloody. inappetance, dysphagia, weight loss, halitosis, exopthalmus, epistaxis and loose teeth. biologic behaviour and prognosis of oral tumours are best predicted by histologic type and tumour location, tumour size and stage of disease.

Answer 224

Most common canine oral tumour, golden retrievers, scottish terriers, poodles, and dachshunds over represented. Immunohistochemistry may be necessary to diagnose some melanomas, especially amelanotic tumours. Locally invasive and highly metastatic. true metastatic rate is dependent on size, location and the grade of the tumour. common sites of metastasis: regional lymph nodes and lungs.

Answer 225

second most common canine oral tumour. locally invasive. metastatic rate is variable and dependent on location. Tonsillar SCC has a much higher metastatic rate than more rostral tumours. at diagnosis 10-20% patients of with tonsillar SCC have overt evidence of metastatic disease while 90% have micrometastatic disease, sites of metastasis include tonsils, regional lymph nodes and lungs.

Answer 226

Occurs less commonly than OMM and SCC. there is a specific variant - histologically low grade, biologically high grade FSA which appears benign histologically but is very locally aggressive and grows rapidly. metastatic rate of FSA is <_20%. Lungs are most common site of metastasis but spread to regional lymph nodes can occur.

Answer 227

Arise from the periodontal ligament. tend to be slow growing and firm. may appear similar to gingival hyperplasia. Subtypes include acanthomatous - locally aggressive that frequently invades the underlying bone. most common site is the rostral mandible. Fibromatous - slow growing firm masses - often found around the maxillary premolar teeth. ossifying - slow growing firm masses often found around maxillary premolar teeth. giant cel - rare form. Bony invasion is typically dependent on type of epulis. they never metastasize.

Answer 228

surgical excision for tumours easily excised with wide margins. removal of bone often required for good local control. consider carboplatin chemotherapy, immunotherapy. vaccines currently under clinical investigation. Overall prognosis is poor however size and stage of disease are important predictors. one year survival rate : 25-30%. MMetastasis is commonly the cause of death.

Answer 229

Surgical excision for tumours easily excised with wide margins. removal of bone often reuquired for good local control. rostral tumours easier to excise. consider piroxicam. cisplatin in combination with piroxicam also been reported. cabrolatin alternative to cisplatin chemotherapy and less nephrotoxic. prognosis is good for completely excised rostral tumours. for tonsillar scc metastatic rate is high and prognosis is poor.

Answer 230

SCC most common. risk factors include: use of flea products, diet (canned food, especially tua) and possibly second hand tobacco smoke. extremely locally incasive. Successful treatment often difficult due to advanced nature of local disease at the time of diagnosis. Fibrosarcoma - second most common feline oral tumour. locally aggressive but metastatic rate typically low. lungs are most common site of metastasis but spread to regional lymph nodes can occur. Malignant melanoma rare in cats.

Answer 231

The most common gastric tumour in the dog is adenocarcinoma and the most common gastric tumour in the cat is lymphoma. Other gastric tumour types include: leiomyosarcoma, gastrointestinal stromal tumour and mast cell tumour . clinical signs include vomiting, weight loss and inappetance. microcytic hypochromic anaemia is common due to chronic GI blood loss. typically surgery is the treatment of choice, resection is often difficult in this location.

Answer 232

Most common histologic type in dogs. commonly occurs along the lesser curvature of stomach and at the gastric antrum. reported metastatic rate 74-80%. Sites of metastasis include regional lymph nodes, liver, omentum, spleen and lungs. surgical excision is the treatment of choice, however successful treatment is often difficult due to tumour location and advanced nature of disease at time of diagnosiis. role of chemotherapy is unknown. prognosis is good for benign tumours, but poor for malignant tumours.

Answer 233

Leiomyomas are more common in very old dogs - over 15 years. Paraneoplastic hypoglycaemia reported. reported metastatic rate is high. sites of metastasis include: liver and duodenum. Surgical excision is the treatment of choice, complete excision is curative for leiomyoma. successful treatment of leiomyosarcoma is more difficult due to tumour location and advanced nature of disease at the time of diagnosis. prognosis is good for benign tumours but guarded to poor for malignant tumours.

Answer 234

19% of GIST occur in the stomach. 50% of GIST stain positively for CD117. (ckit). Surgical excision is the treatment of choice. Prognosis is guarded to poor.

Answer 235

While lymphoma is the most common intestinal tumour in dogs and cats, other intestinal tumours include adenocarcinoma, leiomyoma, leiomyosarcoma, gastrointestinal stromal tumour and mast cell tumour. Leiomyoma/leiomyosarcoma occurs more commonly in male dogs. clinical signs include weight loss, inappetance, vomiting, diarrhoea, melena or hematochezia. microcytic hypochromic anaemia also common due to chronic GI blood loss. smooth muscle tumours have been associated with paraneoplastic hypoglycaemia. Surgery is the treatment of choice.

Answer 236

Most commonly occurs in the large intestine. in the small intestine the most common location is the jejunum. metastatic rate is moderate. most common site of metastasis is regional lymph nodes. other sites include mesentery, omentum and lungs. Surgical exciision with wide margins is treatment of choice, chemotherapy for systemic disease is reasonable, however exact role of chemotherapy is unknown. reported MST or canine SI adenocarcinoma without mets: 15 months, with mets: 3 months. In the cat it most commonly occurs in the small nestine. sites of metastasis include regional lymph nodes and lungs. Poor prognosis.

Answer 237

second most commoon intestinal tumour in dogs, most common intestinal locations are jejunum and cecum. polyuria, polydipsia, anaemia and hypoglycaemia are common clinical findings. metastatic rate for leiomyosarcoma is low to moderate. metastasis most commonly occurs to abdominal viscera. sites include mesentery, spleen liver and lymph nodes. Surgical excision with wide margins (5cm on either side) is the treatment of choice. complete excision is curative for leiomyoma. chemotherapy for systemic disease is raesonable however exact role is unknown.

Answer 238

52% express ckit gene. large intestine most common location. metastatic rate moderate. metastasis most commonly occurs on abdominal viscera. sites include, liver, lymph nodes and other abdominal organs. Surgical excision with wide margins is the treatment of choice. chemotherapy for systemic disease is reasonable however exact role of chemotherapy is unknown. prognosis is guarded.

Answer 239

Hepatoid tumours arise from sebaceous glands located in the dermis around the anus. apocrine gland adenocarcinomas arise from the anal sacs locatead at thr 4 oclock and 8 clock positions on either side of the anus. perianal adenoma is the most common histologic type in intact male dogs. Perianal adenocarcinoma occur less commonly in both sexes. apocrine gland adenocarcinomas most common type in female dogs. Apocrine gland adenocarcinomas are frequently associated with paraneoplastic hypercalcaemia. castration is treatment of choice for perianal adenomas in intact male dogs, otherwise conservative excision is often adequate. Wide surgical excision is the treatment of choice for perianal adenocarcinomas. High rates of local recurrence and metastasis. perianal tumours are rare in cats.

Answer 240

most common perianal tumour in older intact male dogs. development is thought to be androgen dependent. these tumours tend to grow slowly and do not metastasize.. prognosis is good. rare in cats. recommend castration for intact male dogs. most tumours will regress over time. for neutered males or female dogs, recommend conservative surgical excision with histopathology of perianal mass.

Answer 241

Occurs in older intact and neutered male and female dogs. metastatic rate at diagnosis is low but tumours may metastasize more frequntly later in the course of the disease. sites of metastasis include regional lymph nodes, lungs, liver and bone, rare in cats. recommend surgical excision for tumours easily excised with wide margins. even with surgical treatment, local recurrence is common. post operative radiation therapy may help reduce the likelihood of local recurrence. the role of chemotherapy and radiation in the treatment of perianal adenocarcinoma unknown.

Answer 242

Most common perianal tumour in older female dogs occurs in older dogs, equal sex distribuution. paraneoplastic hypercalcaemia commonly occurs with this tumour type. reported incidence is 25-53%. presenting complaints include tenesmus or constipation secondary to mass effect from the tumour. PU PD may also occur secondary to hypercalcaemia. they are locally invasive with a moderate to high metastatic rate. signs of metastasis include sublumbar lymph nodes, lungs, liver and bone. rare in cats. recommend surgical excision for tumours easily excised. metastatic sublumbarlymh nodes may also be removed but referral to a specialist is recommended. for narrowly excised, incompletely excised or non resectable tumours, consider post operative or radiation therapy. to control metastatic disease, consider chemotherapy. various drugs have been used including cisplatin, carboplatin, doxorubicin, mitoxantrone and melphalan. older studies reported MST of 6-12 months, more recent reports using multi modality treatment suggest that MST is longed. Dogs treated with surgery as a part of their treatment protocol appear to live longer. negative prognostic indicators include: tumour size >10cm, treatment with chemotherapy alone, hypercalcaemia and pulmonary metastasis.

Answer 243

small soft pliable catheter. the pros are they can be inserted conscious (or with light sedation) no incision is needed. only liquid diet can be given through the tube; enteral care - limit 3-4 days because nasal mucosal necrosis ma occur.

Answer 244

12-22F plastic feeding tube. Pros - simple to place, allows feeding blenderized diet and medicating, longer term (days t weeks). Cons - require GA, incision made in neck - possible increased risk with bleeding disorders.

Answer 245

16-22F plastic feeding tube with mushroom tip. placed surgically or by specialist endoscopically. allows feeding blenderized diet and medicating - can be left for weeks to years. cons - require GA, incision in left flank. Higher risk in deep chested dogs placed endoscopically.

Answer 246

They are similar size to Nasooesophgeal tubes. Pros - can be used with refractory vomiing. cons - require GA, increased risk of complications versus other feeding tubes. Leakage > peritonitis.recommend placement by ST surgeon only.

Answer 247

Lipids, amino acids, glucose via intravenous access. Pros - allows restoration of positive energy balance with severe malabsorptive disease. Can be used with refractory vomiting. Cons - no nutrition to enterocytes. complications possible: glucose, electrolytes need regular monitoring.

Answer 248

primary hepatobilliary tumours are more common in cats, metastatic hepatobilliary tumours, malignant tumours are more common in dogs, and benign tumours are more common in cats. primary malignant hepatobiliary tumours in dogs and cats include hepatocellular carcinoma, biliary carcinoma, neuroendocrine tumour and sarcoma. Clinical signs include weight loss, inappetance, vomiting, polyuria, polydipsia and possibly ascites. animals with extensive disease may also present with icterus and signs of hepatoencephalopathy.. typically surgery is treatment of choice.

Answer 249

Most common primary hepatobiliary tumour in dogs. araneoplastic hypoglycaemia has been reported. may be massive, nodular or diffuse. metastatic rate is dependent upon morphology and is low for massive HCC but high for nodular and diffuse HCC. common sites of metastasis: regional lymph nodes, peritoneum and lungs. Recommend surgical excision for massive tumours easily excised with liver lobectomy. with surgical treatment, prognosis for massive HCC is good. local recurrence and metastatic rates are generally low. nodular and diffuse HCC are typically non resectable due to extent of disease.

Answer 250

Frequently an incidental finding. more common in cats than in dogs. benign tumour. remove if problematic. prognosis is good.

Answer 251

Second most common primary hepatobiliary tumour in dogs. of malignant hepatobiliary tumours in cats, BC is the most common. Intrahepatic BC appears to be more common in dogs, whereas extrahepatic BC is more common in cats. May be massive, nodular or diffuse. very aggressive biologic behaviour with a high metastatic rate. common sites of metastasis: regional lymph nodes, peritoneum and lungs. Recommend surgical excision for massive tumours. easily excised with liver lobectomy. even with surgical treatment, prognosis is guarded to poor. local recurrence and metastatic rates are generally high and survival times are short. nodular and diffuse BC are typically non resectable due to extent of disease.

Answer 252

Frequently an incidental finding. common in cats. benign tumour remove if problematic

Answer 253

Rare in dogs an cats. often are locally Aggresive with nodular or diffuse morphology. metastatic rate is high. common sites of metastasis: regional lymph nodes, peritoneum and lungs. rare in dogs and cats. recommend surgical excision for tumours easily excised with liver lobectomy. the majority are non resectable due to extent of disease. prognosis is poor because this disease is highly metastatic survival times are short.

Answer 254

Rare. comon primary hepatic sarcoma include haemangiosarcoma, leiomyosarcoma,histiocytic sarcoma and fibrosarcoma. often are locally aggresive with nodular or massive morphology. very aggressive biologic behaviour with high metastatic rate. common sites of metastasis: spleen and lung. recommend surgical excision for massive tumour easily excised with liver lobectomy. even with surgical treatment, prognosis is guarded to poor, local recurrence and metastatic rates are generally high and survival times are short. the role of chemotherapy and radiation nuknown.

Answer 255

Exocrine pancreatic tumours are rare in dogs the incidence is slightly higher in cats. Adenocarcinoma is most common histologi type. benign exocrine pancreatic masses include adenomas and pseudocysts. surgical resection is the treatment of choice. however many animals have evidence of metastatic disease at the time of diagnosis. in these cases surgery should be only performed for palliative reasons. the role of chemotherapy is unknown. pancreatic tumours are locally invasive and the metastatic rate is very high. common metastatic sites include regional lymph nodes, liver, peritoneal cavity.

Answer 256

Gastrointestinal signs including anorexia, vomiting, diarrhoea, weight loss. Diarrhoea usually small bowel. may be as a result of secondary gastrointestinal ulceration. malabsorption due to gut oedema from portal hypertension, toxin production/absorption, hepatic encephalopathy. weight loss may occur due to anorexia or decreased absorption (with gut oedema) or changes in normal metabolic metabolism due to liver dysfunction. Jaundice/icterus - due to hyperbilirubinaemia - pre hepatic from haemolysis, hepatic from decreased liver procesesing/excretion of bilirubin, post hepatic decreased excretion due to biliary obstruction.

Answer 257

Prolonged clotting times (PT, PTT) can occur. due to decreased production of clotting factors or decreased activation/inactivation of vitamin K. Polyuria polydipsia occur due to decreased urea production with liver dysfunction leads to renal medullary washout, decreasing concentration ability and resulting in primary polyuria. altered steroid metabolism can cause partial nephrogenic diabetes Insipidus causing primary polyuria. Hepatic encephalopathy can lead to primary polydipsia.

Answer 258

Via decreased oncotic pressure, decreased hepatic production of albumiin which provides the majority of colloid pressure in the blood may lead to pure transudate ascites. albumin must be moderate to severe for this to occur. increased hydrostatic pressure : portal hypertension increases hydrostatic pressure within portal circulation (including gut and spleen) leading to modified transudate ascites. Bile peritonitis can occur secondary to gallbladder or biliary tract rupture causing modified transudate or exudative ascites- usually milder in quantity than previous two mechanisms.

Answer 259

Ammonia and other bacterial metabolites from gut are normally filtered by liver. with hepatic dysfunction or shunting around liver, levels of these toxins that reach systemic circulation and brain are increased leading to signs classic for HE. signs include head pressing, focal or generalised seizures, fly catching, blindness, star gazing, aggerssion, depression, pytalism

Answer 260

Drugs that are hepatically metabolized have increased plasma levels with hepatic dysfunction. Any drug given to a dog or cat with liver dysfunction should be investigated for whether it is hepatically metabolised and if so, alternative should be sought or dose reduced if toxicity is a possibility. drugs that are highly protein bound may reach toxic levels if there is moderate to severe hypoalbuminaemia, which is major protein binding protein bound drugs. Decreased albumin means more freely available drug, which increases effect of drug.

Answer 261

Keep dog on low fat diet with moderate amounts of protein and carbs. the key to successful treatment is to give pancreatic enzyme replacer so animal can digest and absorb food. this will allow return of normal fecal consistency in 48-72 hours and put on weight in a steady manner while curving its appetite. may need to give vit B12 and Vit E to those patients with reduced levels.

Answer 262

restrict proteins that would cause aromatic amino acids and give dairy and vegetable source proteins. give normal amounts of carbohydrates as dog uses this as main energy source and restricts glycogenolysis and gluconeogenesis to reserve liver energy. Gie moderate levels of fat for calorie source and palatibility unless there is hcolestais. offer glutathione precursors to help reduce free radical damage. Vit, E, SAMe, Zinc. add fibre to diet to decrease urease producing bacteria and promote ion trapping of ammonia to ammonium so it reduces ammonia absorption and less work is done by the liver to convert ammonia to urea.

Answer 263

Increase hydrolyzed proteins in the diet for the animal will most likely be hypoproteinamic. diet should be highly digestable, lactose free, low to moderate levels of fat and lower levels of fibre. you can add pro and pre biotics. omega 3 FAs may actually be helpful to reduce inflammation (decreae prostaglandin and interleukin production).

Answer 264

Bile acid stimulation test (liver function test for liver disease), Ultrasound will show either liver damage or bile duct obstruction, urine deposits such as urobilinogen indicates normal bile flow and bilirubate crystals indicate liver disease.

Answer 265

Ulcers and helicobacter. Cimetidine - a H2 antagonist - will cause a reduction in hepatic blood flow by 20% and reduces microsomal enzymes so drugs are prolonged in the body and rebound hypersecretion of gastric acid and pepsin when stop using cimetidine aruptly. Amoxycillin - one of three drugs used to treat helicobacter, can cause vomitin episodes, may induce hypersensitivity in animal but relatively safe.

Answer 266

Most of the time peritonitis is secondary due to ruptured GI tract, ruptured bladder (urine leak), penetrating trauma and or bile leakage after trauma. most secondary causes are from bacterial infection from GIT leakage contents. Primary peritonitis - FIP viral infection. the signs would be shock and sepsis.

Answer 267

History - acute/chronic, scavenger? toxin, fb, pupd?, frequency, relationship to eating, diarrhoea, appearance of vomit - volume, colour, consistency, presence of blood, physical exam - check condition score, mucous membranes, CRT, lymphadenopathy, thoracic auscultation, HR, palpate abdomen, bladder, take temp. DDX for vomiting - uraemia, hypoadrenocorticism, hepatic disease, lead, ethylene glycol, pancreatitis, peritonitis, neoplasia, dietary causes, gastric ulceration, gastritis, IBD, intussusception, parvo, obstipation, parasites. Take haematology, biochemistry, urinalysis, faecal exam, parvo and PLI snap test, abdominal radiographs, ultra sound and ceoliotomy if identify FB.