Gastrointestianal SBAs

Question 1

Scenario: A 3-year-old French Bulldog presents with a history of regurgitation, especially after eating. The dog is otherwise bright, alert, and responsive.

Lead-in: Which of the following conditions is most likely to be associated with this dog’s regurgitation?

Options:

a) Oesophagitis
b) Megaesophagus
c) Hiatal hernia
d) Vascular ring anomaly
e) Oesophageal foreign body

Answer 1

Answer: c) Hiatal hernia

Explanation: Hiatal hernias are becoming increasingly common in brachycephalic breeds like French Bulldogs and can cause regurgitation.

Question 2

Scenario: A 7-year-old Golden Retriever presents with a history of chronic regurgitation and weight loss. The dog is otherwise healthy and has no other clinical signs.

Lead-in: Which of the following is the most likely cause of this dog’s clinical signs?

Options:

a) Megaesophagus
b) Oesophageal foreign body
c) Oesophagitis
d) Hiatal hernia
e) Vascular ring anomaly

Answer 2

Answer: a) Megaesophagus

Explanation: Megaesophagus is a common cause of chronic regurgitation and weight loss in dogs, particularly in breeds like Golden Retrievers.

Question 3

Scenario: A 2-year-old Labrador Retriever presents with a history of vomiting and diarrhea. The dog is otherwise healthy and has no other clinical signs.

Lead-in: Which of the following diagnostic tests would be the most appropriate next step?

Options:

a) Abdominal radiography
b) Barium swallow study
c) Endoscopy of the esophagus and stomach
d) Hematology and serum biochemistry profile
e) Exploratory laparotomy

Answer 3

Answer: a) Abdominal radiography

Explanation: Abdominal radiography can help identify signs of intestinal obstruction, such as dilated bowel loops or foreign bodies.

Question 4

Scenario: A 10-year-old cat presents with a history of chronic vomiting and weight loss. Abdominal ultrasound reveals thickening of the stomach wall.

Lead-in: Which of the following is the most likely cause of this cat’s clinical signs?

Options:

a) Inflammatory bowel disease
b) Gastric foreign body
c) Neoplasia
d) Pancreatitis
e) Hyperthyroidism

Answer 4

Answer: c) Neoplasia

Explanation: Neoplasia, or cancer, can cause thickening of the stomach wall and lead to chronic vomiting and weight loss in cats.

Question 5

Scenario: A 4-year-old West Highland White Terrier presents with a history of acute onset vomiting and anorexia. The dog is otherwise healthy and has no other clinical signs.

Lead-in: Which of the following is the most likely cause of this dog’s clinical signs?

Options:

a) Dietary indiscretion
b) Gastroenteritis
c) Oesophageal foreign body
d) Pancreatitis
e) Peritonitis

Answer 5

Answer: c) Oesophageal foreign body

Explanation: West Highland White Terriers are predisposed to oesophageal foreign bodies, which can cause acute onset vomiting and anorexia.

Question 6

Scenario: A 10-year-old Labrador Retriever presents with a history of chronic vomiting and weight loss. The dog is otherwise healthy and has no other clinical signs.

Lead-in: Which of the following is the most likely cause of this dog’s clinical signs?

Options:

a) Dietary indiscretion
b) Inflammatory bowel disease
c) Gastric foreign body
d) Neoplasia
e) Pancreatitis

Answer 6

Answer: d) Neoplasia

Explanation: Neoplasia, or cancer, is a common cause of chronic vomiting and weight loss in older dogs.

Question 7

Scenario: A 4-year-old Domestic Shorthair cat presents with a history of acute onset vomiting and anorexia following treatment for an upper respiratory infection.

Lead-in: Which of the following is the most likely cause of this cat’s clinical signs?

Options:

a) Marbofloxacin -induced oesophagitis
b) Amoxicillin-induced oesophagitis
c) Clindamycin-induced oesophagitis
d) Cefovecin-induced oesophagitis
e) Doxycycline-induced oesophagitis

Answer 7

Answer: e) Doxycycline-induced oesophagitis

Explanation: Doxycycline is a common antibiotic that can cause oesophagitis in cats, leading to acute onset vomiting and anorexia.

Question 8

Scenario: A 7-year-old Persian cat presents with a history of chronic regurgitation and weight loss. The cat is otherwise healthy and has no other clinical signs.

Lead-in: Which of the following is the most likely cause of this cat’s clinical signs?

Options:

a) Megaesophagus
b) Oesophageal foreign body
c) Oesophagitis
d) Hiatal hernia
e) Pericardio-peritoneal diaphragmatic hernia (PPDH)

Answer 8

Answer: e) Pericardio-peritoneal diaphragmatic hernia (PPDH)

Explanation: PPDH is a rare condition that is more common in cats than dogs. It can cause regurgitation and other clinical signs depending on the severity of the herniation.

Question 9

Scenario: A 7-year-old Cocker Spaniel presents with a history of regurgitation of undigested food. The dog is otherwise BAR. Thoracic radiographs reveal a dilated oesophagus.

Lead-in: Which of the following treatment options is most likely to be successful in the long-term management of this dog?

Options:

a) Surgical correction of a vascular ring anomaly
b) Omeprazole (20mg, once daily)
c) Metoclopramide (5mg/kg, three times daily)
d) Dietary modification and management of aspiration pneumonia
e) Prednisolone (1mg/kg, once daily)

Answer 9

Answer: d) Dietary modification and management of aspiration pneumonia

Explanation: The dog most likely has megaoesophagus, which is often idiopathic in adult dogs. Management of this condition focuses on increasing the passage of food into the stomach by altering the consistency of food and feeding the dog from a height. Aspiration pneumonia is a common complication of megaoesophagus and should be treated promptly.

Question 10

Scenario: A 5-week-old male entire Labrador Retriever puppy presents with a 2-week history of vomiting, which occurs shortly after feeding. The puppy is losing weight.

Lead-in: Which of the following is the most likely cause of this puppy’s clinical signs?

Options:

a) Dietary indiscretion
b) Inflammatory bowel disease
c) Gastric foreign body
d) Persistent right aortic arch
e) Pancreatitis

Answer 10

Answer: d) Persistent right aortic arch

Explanation: Labrador Retrievers are predisposed to persistent right aortic arch, which causes regurgitation as the oesophagus is entrapped. This condition typically presents at the time of weaning, when the puppy transitions to solid food.

Question 11

Scenario: A 2-year-old cat presents with a history of vomiting and dullness. The cat is 8% dehydrated. Haematology reveals a PCV of 58% and TPP of 90 g/L. Biochemistry reveals a potassium of 2.2 mmol/L.

Lead-in: Which of the following treatment options is most appropriate for this cat?

Options:

a) Maropitant (1mg/kg, SC)
b) Metoclopramide (0.2 mg/kg, IV, three times daily)
c) Intravenous fluid therapy with Hartmann’s solution
d) Sucralfate (1g, three times daily)
e) Referral for surgical removal of a foreign body

Answer 11

Answer: c) Intravenous fluid therapy with Hartmann’s solution

Explanation: The cat is hypokalaemic and significantly dehydrated, so intravenous fluid therapy is the most appropriate treatment. Hartmann’s is appropriate as it is a balanced electrolyte solution.

Question 12

Scenario: A 10-year-old female spayed Domestic Shorthair cat is presented with a 3-month history of vomiting and weight loss. The cat is currently on a hypoallergenic diet, but has not shown any improvement.

Lead-in: Which of the following would be the most appropriate next step in the investigation of this cat’s vomiting?

Options:
a) Change to a different hypoallergenic diet
b) Start treatment with prednisolone
c) Perform abdominal radiography
d) Perform upper gastrointestinal endoscopy
e) Perform exploratory laparotomy

Answer 12

Answer: d) Perform upper gastrointestinal endoscopy
Explanation: Upper gastrointestinal endoscopy allows for direct visualisation of the oesophagus, stomach, and duodenum, and can help to identify any abnormalities, such as inflammatory bowel disease, foreign bodies, or masses. Biopsies can also be collected for histopathology, which can be helpful in reaching a definitive diagnosis.

Question 13

Scenario: A 3-year-old male neutered domestic shorthair cat presents with a history of chronic small bowel diarrhoea.

Lead-in: Which finding on histopathology would support a diagnosis of inflammatory bowel disease?

Options:

Answer 13

Answer: a) Villous blunting and fusion

Explanation: IBD is histopathologically confirmed by the presence of inflammatory cells in the intestinal mucosa, which can lead to architectural changes like villous blunting and fusion.

Question 14

Scenario: A 5-year-old Labrador Retriever presents with chronic diarrhoea and weight loss despite polyphagia.

Lead-in: Which diagnostic test would be most helpful in determining the underlying cause of the dog’s diarrhoea?

Options:
a) Faecal flotation
b) Abdominal radiography
c) Serum trypsin-like immunoreactivity (TLI)
d) Colonoscopy
e) ACTH stimulation test

Answer 14

Answer: c) Serum trypsin-like immunoreactivity (TLI)

Explanation: The dog’s clinical signs are suggestive of exocrine pancreatic insufficiency (EPI), and a low serum TLI is highly sensitive and specific for diagnosing EPI.

Question 15

Scenario: A 7-year-old German Shepherd Dog presents with a history of chronic small bowel diarrhoea.

Lead-in: Which of the following is the most likely primary cause of the dog’s diarrhoea?

Options:
a) Food responsive enteropathy
b) Lymphoma
c) Pancreatitis
d) Hypoadrenocorticism
e) Campylobacter infection

Answer 15

Answer: a) Food responsive enteropathy

Explanation: Food responsive enteropathy is the most common primary cause of chronic diarrhoea in dogs

Question 16

Scenario: A 2-year-old Boxer presents with a history of chronic large bowel diarrhoea and haematochezia.

Lead-in: Which of the following diagnostic tests would be most helpful in determining the underlying cause of the dog’s diarrhoea?

Options:
a) Faecal culture for Clostridium perfringens
b) Colonoscopy with histopathology
c) Serum folate and cobalamin levels
d) ACTH stimulation test
e) Abdominal ultrasound

Answer 16

Answer: b) Colonoscopy with histopathology

Explanation: Colonoscopy with histopathology is the most direct way to visualise the colonic mucosa and identify any abnormalities, such as inflammatory bowel disease or neoplasia.

Question 17

Scenario: A 6-month-old kitten presents with a history of chronic small bowel diarrhoea and weight loss.

Lead-in: Which of the following is the most likely cause of the kitten’s diarrhoea?

Options:
a) Intestinal parasites
b) Inflammatory bowel disease
c) Exocrine pancreatic insufficiency
d) Hypoadrenocorticism
e) Dietary indiscretion

Answer 17

Answer: a) Intestinal parasites

Explanation: Intestinal parasites are a common cause of chronic diarrhoea in kittens.

Question 18

Scenario: A 9-year-old Labrador Retriever presents with a history of chronic small bowel diarrhoea and weight loss.

Lead-in: Which of the following is the most important initial step in the management of the dog’s diarrhoea?

Options:
a) Start treatment with prednisolone
b) Perform abdominal radiography
c) Change to a hypoallergenic diet
d) Perform faecal culture and sensitivity
e) Start treatment with metronidazole

Answer 18

Answer: c) Change to a hypoallergenic diet

Explanation: A significant proportion of dogs with chronic enteropathy will respond to a hypoallergenic diet, so this is an important initial step in management.

Question 19

Scenario: A 12-year-old Yorkshire Terrier presents with a history of chronic small bowel diarrhoea and weight loss.

Lead-in: Which of the following diagnostic tests would be most helpful in determining the underlying cause of the dog’s diarrhoea?

Options:
a) Faecal flotation
b) Abdominal radiography
c) Serum trypsin-like immunoreactivity (TLI)
d) Colonoscopy
e) ACTH stimulation test

Answer 19

Answer: e) ACTH stimulation test

Explanation: The dog’s age and clinical signs raise the suspicion of hypoadrenocorticism, which can be diagnosed with an ACTH stimulation test.

Question 20

Scenario: A 6-year-old German Shepherd Dog presents with a history of chronic small bowel diarrhoea and weight loss.

Lead-in: Which of the following is the most important initial step in the management of the dog’s diarrhoea?

Options:
a) Start treatment with prednisolone
b) Perform abdominal radiography
c) Change to a hypoallergenic diet
d) Perform faecal culture and sensitivity
e) Start treatment with metronidazole

Answer 20

Answer: c) Change to a hypoallergenic diet

Explanation: A hypoallergenic diet trial is the most important initial step in managing chronic diarrhoea in dogs, as it can help identify food responsive enteropathy.

Question 21

Scenario: A 3-year-old Miniature Schnauzer presents with acute onset of profuse bloody diarrhoea and haemoconcentration.

Lead-in: Which of the following is the most likely diagnosis?

Options:
a) Parvovirus enteritis
b) Haemorrhagic gastroenteritis (HGE)
c) Intussusception
d) Inflammatory bowel disease
e) Pancreatitis

Answer 21

Answer: b) Haemorrhagic gastroenteritis (HGE)

Explanation: HGE is characterized by acute profuse bloody diarrhoea and haemoconcentration, often with a high PCV.

Question 22

Scenario: A 4-month-old kitten presents with acute onset of diarrhoea.

Lead-in: Which of the following is the most likely infectious cause of the kitten’s diarrhoea?

Options:
a) Campylobacter jejuni
b) Clostridium perfringens
c) Feline panleucopenia virus
d) Salmonella species
e) Tritrichomonas foetus

Answer 22

Answer: c) Feline panleucopenia virus

Explanation: Feline panleucopenia virus is a common cause of acute diarrhoea in kittens.

Question 23

Scenario: A 1-year-old dog is diagnosed with parvovirus enteritis.

Lead-in: Which of the following is the most important component of the treatment plan?

Options:
a) Antibiotic therapy
b) Corticosteroid therapy
c) Dietary change
d) Fluid therapy
e) Probiotic therapy

Answer 23

Answer: d) Fluid therapy

Explanation: Fluid therapy is crucial for correcting dehydration and electrolyte imbalances in dogs with parvovirus enteritis

Question 24

Scenario: A dog presents with chronic diarrhoea. Blood tests reveal hypoalbuminemia and hypocholesterolemia.

Lead-in: Which of the following is the most likely cause of these findings?

Options:
a) Acute pancreatitis
b) Dietary indiscretion
c) Giardia infection
d) Protein-losing enteropathy (PLE)
e) Salmonellosis

Answer 24

Answer: d) Protein-losing enteropathy (PLE)

Explanation: PLE is characterized by the loss of both albumin and globulins through the gastrointestinal tract, leading to hypoalbuminemia and hypocholesterolemia.

Question 25

Scenario: A cat presents with chronic small bowel diarrhoea.

Lead-in: Which of the following biochemistry results would be most consistent with this condition?

Options:
a) Hypercalcemia
b) Hypokalemia
c) Hyponatremia
d) Hypoalbuminemia
e) Hyperglycemia

Answer 25

Answer: d) Hypoalbuminemia

Explanation: Chronic diarrhoea can lead to protein loss through the gastrointestinal tract, resulting in hypoalbuminemia.

Question 26

Scenario: A 2-year-old German Shepherd Dog presents with a 6-month history of intermittent small bowel diarrhoea. Multiple faecal flotations have been negative for parasites.

Lead-in: Which of the following is the most likely reason for the negative faecal results?

Options:
a) Giardia cysts are too small to be detected by flotation.
b) Giardia trophozoites are the only diagnostic stage.
c) Giardia cysts are shed intermittently.

d) The dog has been treated for giardia previously.
e) The dog is not infected with giardia.

Answer 26

Answer: c) Giardia cysts are shed intermittently.

Explanation: Giardia cysts can be shed intermittently, making diagnosis challenging even with repeated faecal flotations.

Question 27

Scenario: A 5-year-old cat presents with a 3-month history of large bowel diarrhoea. A diagnosis of giardia infection is confirmed.

Lead-in: Which of the following is the most appropriate treatment?

Options:
a) Fenbendazole
b) Metronidazole
c) Prednisolone
d) Ronidazole
e) Tylosin

Answer 27

A is the licenced treatment.

Question 28

Based off the findings of this image, which differential is most likely:

a) Canine parvovirus.
b) Guardia.
c) Clostridial spp.
d) Salmonella spp.
e) Adenovirus

Answer 28

Parvo

Question 29

Scenario: A 9-week-old Labrador Retriever puppy presents with a 2-day history of profuse haemorrhagic diarrhoea, vomiting, and lethargy. The puppy is pyrexic (40°C) and tachycardic (160 bpm). Mucous membranes are pale with a prolonged capillary refill time (3 seconds).

Lead-in: Which of the following is the most appropriate treatment plan for this puppy?

Options:
a) Hartmann’s solution to effect, metoclopramide CRI, amoxicillin-clavulanate IV, maropitant SC
b) 0.9% saline to effect, ondansetron IV, metronidazole IV, omeprazole PO
c) Hartmann’s solution to effect, maropitant SC, amoxicillin-clavulanate IV, sucralfate PO
d) Plasma transfusion, metoclopramide CRI, enrofloxacin IV, omeprazole PO
e) Hartmann’s solution to effect, ondansetron IV, amoxicillin-clavulanate IV, maropitant SC

Answer 29

Answer: e) Hartmann’s solution to effect, ondansetron IV, amoxicillin-clavulanate IV, maropitant SC

Explanation: The puppy’s clinical presentation is consistent with severe parvovirus enteritis with potential sepsis. The treatment plan should include aggressive fluid therapy with Hartmann’s solution to correct dehydration, electrolyte imbalances, and acidosis. Ondansetron is a potent antiemetic that can be administered intravenously to control vomiting and nausea. Broad-spectrum antibiotics like amoxicillin-clavulanate are crucial to address potential secondary bacterial infections due to the compromised GI mucosal barrier. Maropitant is another effective antiemetic that can be given subcutaneously for prolonged control of vomiting.

Why the other options are incorrect:

a) Hartmann’s solution to effect, metoclopramide CRI, amoxicillin-clavulanate IV, maropitant SC: Metoclopramide, a prokinetic drug, may be contraindicated in severe gastroenteritis due to the risk of exacerbating intestinal inflammation and potential perforation.
b) 0.9% saline to effect, ondansetron IV, metronidazole IV, omeprazole PO: While 0.9% saline is suitable for rehydration, metronidazole is not the first-line antibiotic for secondary bacterial infections in parvovirus enteritis. Omeprazole, a proton pump inhibitor, is not indicated in the acute management of parvovirus.
c) Hartmann’s solution to effect, maropitant SC, amoxicillin-clavulanate IV, sucralfate PO: Sucralfate is not as effective as other antiemetics in controlling vomiting in parvovirus enteritis.
d) Plasma transfusion, metoclopramide CRI, enrofloxacin IV, omeprazole PO: While plasma transfusion may be considered in cases of severe hypoproteinaemia or extensive blood loss, it is not the most important initial component of the treatment plan. Metoclopramide and enrofloxacin are not the preferred choices in this case.

Question 30

Scenario: A 4-year-old male neutered Jack Russell Terrier presents with a 2-day history of profuse watery diarrhoea, vomiting, and anorexia. He has a packed cell volume (PCV) of 65% and a total protein (TP) of 54 g/L. A complete blood count reveals no leukopenia.

Lead-in: Which of the following is the most likely diagnosis?

Options:
a) Canine parvovirus enteritis
b) Acute haemorrhagic diarrhoea syndrome (AHDS)
c) Hypoadrenocorticism
d) Pancreatitis
e) Intussusception

Answer 30

Answer: b) Acute haemorrhagic diarrhoea syndrome (AHDS)

Explanation: The dog’s clinical presentation of acute onset profuse watery diarrhoea, vomiting, and haemoconcentration (elevated PCV) with normal TP and no leukopenia is most consistent with AHDS (also known as HGE).