Gastroenterology Flashcards
Caused by inflammatory bowel disease restiricted to this area, Heliobacter, Physaloptera (more in dogs), Ollulanus (more in cats). Signs include chronic vomiting (daily) and anorexia
Chronic gastritis
How to diagnose intestinal lymphangiesctasia
Clinical pathology: Hypoalbuminemia, Hypocholesterolemia
Snowballs that leak chyle following biopsy when endoscope used. Full thickness biopsy may be helpful
Ascending infection from the intestinal tract up the biliary tree and sometimes invading the hepatic parynchyma
Suppurative cholangitis/ cholangiohepatitis
Normal frequency with normal to increased volume and possible melena
Small bowel diarrhea
Drugs used to prolong transit time. Used as symptomatic treatment of diarrhea
Loperamide and Diphenoxylate
First diagnostic approach to esophageal disease. If no foregin object or perforation use barium contrast
Plain cervical and thoracic radiographs
Treatment of antibiotic responsive enteropathy
Tetracycline, tylosin, or amoxicillin usually 2-4 weeks
Wearing of the teeth. If gradual reparative dentin is laid down to prevent pulp exposure.
Attrition
How to differentiate lymphosarcoma from IBD in histopath
Immunohistochemical stains show monoclonal population or there are findings in other organs. Paneoplastic hypercalcemia may be seen
Caused by gastroesophageal reflux, persistent vomiting, foreign bodies. Also common with doxycycline administration and recent anesthesia
Esophagitis
Idiopathic condition with loss of autonomic nerve function so see loss of both sympathetic and parasympathetic tone. Usually see megaesophagus with concurrent dysuria, dilated pupils, constipation. Effects any non conscious action of the ANS. Occurs more commonly in the central midwest US dogs.
Dysautonomia (Key Gaskell)
Treatment for acute gastritis
Supportive care of parenteral fluids. Withholding food for 12-24 hours. Refeed small amounts initially and water with a bland diet.
If doesnt response to conservative therapy diagnosis probably not correct.
Treatment for intestinal lymphangiectasia
Treat underlying cause.
If idiopathic: ultra-low fat diet, prednisone to decrease inflammation from granulomas.
Diagnosis of periodontal disease
Based on oral exam, both initial and under general anesthesia with probe and dental radiographs
Canine Dental Formula
2 (I 3/3 C 1/1 P 4/4 M 2/3) = 42
How to diagnose antibiotic responsive enteropathy
Response to therapy. Can be supported by low cobalamin and high folate in serum.
Developmental abnormalities of Westies, Scotties, and Cairn terriers. Can exhibit swelling of mandible and TMJ. Resolves at maturity.
Craniomandibular osteopathy
Four mechanisms of hepatic lipadosis
Increases lipid mobilization from peripheral fat (Insulin deficiency or anorexia)
Decreased oxidation of liver lipids
Reduction of lipid removal from the liver (fasting)
Excessive lipid synthesis in the liver (Not part of clinical hepatic lipadosis)
Has greatest diagnostic value in the dog and cats for pancreatitis
Pancreatic lipase immunoreactivity (PLI)
Could be due to gastroduodenal reflux induced vomiting which occurs when stomach has been empty for long period of time like overnight. Treat by feeding extra meal later at night
Bilious vomiting syndrome
Used in diarrhea to absorb toxins. Makes stool seem more firm and the salicylate may have anti-prostaglandin activity so it is bad for cats
Bismuth subsalicylate
Treatment for hiatal hernia
If symptomatic: surgery using gastropexy and reconstruction of the esophageal hiatus. Supportive care for reflux used.
If no surgery just use supportive care. Prognosis good after surgery and with aggressive medical management.
Mandibular branch of trigeminal affected. Need supportive care for 1-9 weeks of recovery
Idiopathic Trigeminal Neuritis
Fluid choice as maintenance after animals with loss from vomiting and anorexia is corrected.
Half strength saline with 5% dextrose or oral fluids. Helps prevent hypernatremia.
Chronic inflammatory disease. Suspected immunodeficiency in GSD. Characterized by fistulous tracts that form from the deeper structures to the skin around the anus and sometimes inside the rectum. Colitis may be present along with smell and pain. Diagnosis from exam
Perianal fistula
Acute care for megacolon
De-ostipation with fluids, enemas, PEG solutions. Do not use phosphate enemas or detergent.
Unknown syndrome with poor gastric emptying with a lack of anatomic obstruction or inflammatory lesions. In dogs. Causes vomiting several hours after eating
Idiopathic gastric hypomotility
How to diagnose acute gastritis
Exclusion based on history and PE. Radiographs and blood work should be included
Treatment for perianal fistulas
Cyclosporine and Tacrolimus for 16 weeks or until 2 weeks past resolution.
Antibiotics and hypoallergenic diet, Neuter
Requires opening (relaxation) of the lower esophageal sphincter when the food bolus arrives
Gastroesophageal phase of swallowing
How disease of the GIT causes vomiting
Through noiceptors and stretch receptors sending efferent information via vagus to the emesis center
Six sided soft steel bur on an air driven high speed hand piece scaler. Vibrates calculus off. Has potential to cause enamel injury or injury to the pulp.
Rotary Scaler
Syndrome that can accompany many GIT diseases. Intestines are “Leaky” through inflammation, infiltration, and congestion or bleeding leading to low protein states. Pan-hypoproteinemia expected. Cats are not usually effected
Protein losing enteropathy
Alveolar bone fuses to cementum of tooth in absence of periodontal ligament
Anklyosis
Can be seen in cytology and gastric washings
Ollulanus
Treatment for chronic active hepatitis
Prednisone, Ursodiol, and S-AMe
Painful condition in cats, idiopathic but could be related to excessive host response to oral flora or calci virus. Complaint includes halitosis, dysphagia, and ptylism
Lymphocytic plasmacytic stomatitis
Trauma leads to bleeding of pulp and blood travels up dentin tubules to give tooth a pink tone. May resolve but is considered irreversible damage when tooth is purple or gray.
Pulpitis
Drugs used to shorten transit time. Used as Prokinetics
Metoclopromide, Cisapride, Erythromycin, Ranitidine
Involves primary peristalsis which is triggered by swallowing and secondary peristalsis which is triggered by stretch of the esophagus to move the food to the lower esophageal sphincter.
Esophageal phase of swallowing
Fluid replacement for supportive care in severe pancreatitis cases
IV crystalloid fluid therapy (Lactated ringers)
-Colloids used if hypoproteinemia or shock due to antithrombotic effects
Dopamine receptor blockade used to prevent vomiting
Metoclopromide
A diaphragmatic abnormality that allows part of the stomach to prolapse into the thoracic cavity. Shar pei dogs are predisposed. Regurgitation is most common sign.
Hiatal hernia
Clinical pathology changes with hepatic lipadosis
Increased bilirubin, Increased ALP, Increased GGT maybe.
Increased PT/PTT and ACT because of Vit K deficiency.
Inflammation of the lips, could be immune mediated
Chelitis
How to diagnose exocrine pancreatic insufficiency
Measure trypsin-like immunoreactivity (its low in effected dogs)
Caused by ingestion of bad food, FB, toxins, and drugs. More common in dogs than cats. Signs include vomiting, and anorexia but often no clinical signs
Acute gastritis
Used where there is back diffusion of HCl acid across the mucus gel barrier causing ulceration to the gastric, esophageal or duodenal mucosa.
Antacids.
Maalox, Sulcralfate, Famotadine (H2 antagonist), PPIs, Prostoglandin E (Misoprostol)
Combination used to treat heliobacter
Metronidazole, Omeprazole, and Amoxicillin
How to diagnose IBD
Elimination of known causes of small bowel diarrhea with intestinal biopsy. Full thinkness biopsies are gold standard.
What is seen on endoscopy might not match histopathology.
Treatment for IBD
Before Biopsy: if not hypoproteinemic- dewormer, elimination diet (often home cooked 2-4 weeks), and antibiotic trial.
After Biopsy: Strict hypoallergenic diet combines with immunosuppressive therapy and possible antibiotic therapy.
Diagnosis of FORLs in cats by
Take radiograph of third left and right mandibular premolars, if affected cats whole mouth should be evaluated
How to diagnose esophageal cicatrix
Contrast esophagram or esophagoscopy
Substance P inhibitor used to prevent vomiting
Cerenia
Scaler that uses an air compressor with a high speed hand piece to generate a lower frequency vibration to produce minimal heat. Water used as an irrigant. Expensive and need good compressor for power.
Sonic Scaler
May be indicative of abnormal bacterial population in the small intestine
Decreased cobalamin but increases folate
Congenital causes of esophageal weakness
Idiopathic megaesophagus and myasthenia gravis
Severe portal fibrosis, nodular hyperplasia and bile duct hyperplasia probably end stage of the previous inflammatory processes if the cat survives
Biliary cirrhosis
Etiology unknown but Clostridial enterotoxin suspected. Usually small breed dogs. Signs include perfuse hematemesis and hematochezia with systemic signs.
Hemorrhagic Gastroenteritis (HGE)
Lymphocytes and plasma cells are the major inflammatory cell consituent. Hyperplasia of the biliary ductules and fibroplasia of the periductal tissues is a prominent feature.
Chronic nonsuppurative cholangitis or lymphocytic cholangitis
Treatment of esophageal cicatrix
Balloon dilation or bougienage followed by intralesional/systemic corticosteroids. Usually referral. Use same therapies for esophagitis.
How to diagnose esophagitis
Esophagoscopy with or without biopsy are needed.
Minimum data base for ill vomiting animals without obvious cause
CBC, Chemistry, and Urinaylasis
Antihelmetics used empirically in acute or chronic diarrhea
Fenbendazole or Drontal Plus both for 21 days
A stricture that may result from esophageal mucosal injury. Clinical signs are regurgitation.
Esophageal cicatrix
Feline Dental Formula
2 (I 3/3 C 1/1 P 3/2 M1/1) = 30
Drug that helps liquefy bile
Ursodeoxycholic acid
Treatment for HGE
Aggressive fluid therapy and parenteral antibiotics (ampicillin)
Can be detected by placing biopsy in medium that detects urease production
Heliobacter
When doing this do not use >3000rpm, and spend more than 15 sec on each tooth. Removes microscopic etches in the enamel.
Polishing
In dogs permanent canines are in
16-24 weeks
Treatment for copper storage disease
Chelate (d-penicillamine) and decrease further copper uptake from GI tract by giving zinc
When do you use local antimicrobials such as Doxirobe or Clindoral
If areas of periodontal attachment loss after cleaning the region.
Malabsorptive disease in the intestines. Idiopathic in cause. Can effect any area of GIT. Usually a response to bcterial or dietery antigens. Abnormal inflammatory cell infiltrate found on histopath usually predominated by cell type like lymphoplasmacytic or eosinophilic. Some breeds have own version of disease. Signs depend on area of GIT effected.
Inflammatory bowel disease
Treatment for EPI
Pancreatic enzyme supplementation with a low fat diet (<15%) forever. Response should be within 1 week but if not consider antibiotic responsive diarrhea or us H2 blocker
Pathogenesis of periodontal disease
Combination of oral flora and host defenses and periodontal ligament loss. Microorganisms mix with salivary proteins and extracellular polysaccharides to form soft plaque which adheres to dental surfaces and mineralized.
Maldigestive disease in the intestines. Caused by pancreatic acinar atrophy. Common in German Shepherds 1-5 years old. Signs include weight loss and good appetite with chronic small bowel disease
Exocrine pancreatic insufficiency
Autoimmune to 2M myofibrils found in masticatory muscles leads to pain, swelling, and atrophy.
Masticatory myositis
Used for patients with severe periodontal disease. Often started prior to cleaning and extended after for 7- 10 days
Systemic antimicrobials
Normal bite is
Upper incisors rostral to lower incisors, lower canine between upper canine and 3rd incisor
Pitting and discoloration of enamel in young dogs and is indicitive of systemic fever or inflammation prior to eruption
Enamel hypocalcification and hypoplasia
Physiology of enzymes from pancreas
Enzymes are secreted in inactive state and activated in the lumen of SI by action of the brush border enzyme enterokinase which converts trypsinogen to trypsin. Trypsin initiates separation of the other proteolytic enzymes from their inactive precursors.
Ineffectual straining to urinate or defecate and dyschezia or painful bowel movements. Indicative of issue in distal colon and lower urinary tract
Tenesmus
Increased frequency, decreased volume and often hematochezia, mucus, and tenesmus
Large Bowel Diarrhea
Feline Odontoclastic Resorptive Lesions
Progressive disorder in cats, begins with enamel resorption that extends to dentin eventually reaching the pulp cavity. Crown my easily fracture off leaving roots that are cause of ongoing inflammation. With type two lesions crown amputation preferred
How to diagnose HGE
Hemoconcentration (PCV >55%) and normal total protein combined with clinical signs.
Before biopsy of intestines is performed these therapies are tried
Hypoallergenic or high fiber diet, Antibiotic trial and Response to broad spectrum deworming
How to diagnose hiatal hernia
Plain films or esophagram or films taken with pressure on the abdomen (paddle) or fluoroscopy or occasional endoscopic visualization.
Which antibiotic would you use for suppurative cholangiohepatitis
Clavamox
Common electrolyte issue with vomiting or anorexic patients.
Hypokalemia. K+ supplements often needed. Use oral supplements if able to as they are most effective.
Can occur due to hyperparathyroidism (primary or renal failure) or from nutritional causes. Treat by taping muzzle for 3 weeks.
Rubber jaw
Treatment for esophagitis
Decrease gastric acidity (omeprazole) and reducing reflux (cisapride) and protecting esophagus (sucralfate). May need gastrotomy tube to bypass esophagus so it can heal.
How to diagnose Idiopathic gastric hypomotility
Exclusion of other lesions and fluoroscopic studies showing decreased motility.
Often idiopathic. May be abnormal colonic neurotransmitters. Principally in cats. Signs include anorexia, vomiting and dehydration, with history of inappropriate defecation. Fecal mass usually palpable and massively dilated colon.
Megacolon
Immunosuppressive therapy for IBD includes
Prenisone (do not taper until clinical remission)
Azathioprine (in large breeds in beginning)
In cats: Prednisolone, methylprendnisolone or budesonide with Chlorambucil if need more than steroids (Cannot use Azathioprine in cats)
Contagious papilloma virus induced warts resolve spontaneously in 6-12 weeks usually by might need treatment.
Oral Papillomatosis
How to feed nasoesophageal diet for hepatic lipadosis
Use clinicare at 1/3- 1/2 the resting energy requirements once emesis under control.
Serotonin receptor antagonist used to prevent vomiting
Ondanestron
How to diagnose chronic gastritis
Gastric biopsy
Most common type of scaler. Uses linear pattern. Water used as a coolant. Minimize time on each tooth to less than 15 sec to prevent heat damage.
Ultrasonic scaler
Liver condition associated with significant ptylism
Hepatic encephalopathy
Intestinal lymphatic obstruction leading to dilation, rupture of lacteals, and loss of protein, lymphocytes, and chylomicrons at the same time granulomas occur. Usually idiopathic but can be congenital or acquired from malformation or disease. Occurs in dogs (Wheatons, Yorkies). Can have diarrhea but usually present for ascities
Intestinal lymphangiectasia
How to monitor for refeeding syndrome when treating hepatic lipadosis
Measure PCV q12h and phosphorus. (Drop in phosphorus and hemolytic crisis are signs)
Supportive care for mildly affected cases of pancreatitis
Keep NPO for at least 12 hours and begin oral alimentation
SC fluids until vomiting ceases for 12 hours
Re-asses frequently for more aggressive care
Analgesia
Chronic care for megacolon
Altered fibre of low or high, stool softeners, cisapride, and possibly a subtotal colectomy as last resort
Frank blood in the feces. If on the surface its from distal colon, if mixed its higher up
Hematochezia
Benign overgrowth, leads to psuedopocket formation where periodontal disease can proliferate. Risk factors are boxers ad cyclosporine therapy.
Gingival Hyperplasia
Syndrome where duodenum/jejunum have higher than normal bacterial count and host has abnormal response to the bacteria. Causes impaired motility, mucosal disease, and impaired host defense. Bacteria thought to injure mucosa through deconjugation of bile acids, fatty acid hydroxylation, and generation of alcohols.
Antibiotic responsive enteropathy
Drug used to prevent bacterial translocation
Ampicillin IV
Involves forming a food bolus at the base of the tongue with subsequent opening of the upper esophageal sphincter and pharyngeal peristalsis to move the food into the esophagus.
Oropharyngeal phase of swallowing
Only way to accurately diagnose pancreatitis in the cat
Pancreatic biopsy
In cats permanent canines are in
16-20 weeks
