Gastrointestinal Flashcards
define dysphagia
difficulty swallowing
define odynophagia
painful swallowing
define regurgitation
passive return of food
define halitosis
bad breath
what are clinical signs of oropharyngeal disease?
drooling ptyalism pseudoptyalism halitosis dysphagia odynophagia
define ptyalism
over production of saliva due to pain or disease in mouth
define pseudoptyalism
normal amount of saliva but leaves mouth not swallowed
how is oropharyngeal disease investigated?
physical exam radiographs minimum database FNA biopsy special tests
what can cause oropharyngeal disease?
foreign body ulcers burns inflammatory disease neoplasia
what are nursing considerations for oropharyngeal disease?
diagnose and treat underlying disease analgesia oral feeding of warm soft food may need tube feeding barrier nursing if infectious cause
why are anorexic patients prone to oral infections?
lack of saliva produced so low immune defence
define vomiting
acute forceful reflex ejection of gastric contents following stimulation of neural reflex
when can regurgitation happen after food intake?
immediate or delayed
what makes regurgitation different to vomiting?
passive
neutral pH as not reached stomach acid
what are secondary problems of regurgitation?
malnutrition dehydration anorexia polyphagia aspiration pneumonia
how is regurgitation investigated?
physical exam chest x-rays haematology biochemistry oesophagoscopy oesophageal fluoroscopy
what can be causes of regurgitation?
megaoesophagus
oesophagitis
oesophageal obstruction
what are the different types of oesophageal obstruction?
complete or partial
intraluminal
intramural
extraluminal
what are the types of megaoesophagus?
generalised
focal dilation
what causes generalised megaoesophagus?
idiopathic
myasthenia gravis
what causes focal dilation of oesophagus?
vascular ring abnormality
how is generalised megaoesophagus treated?
idiopathic- no cure
myasthenia gravis- pyridostigmine, neostigmine
how is focal dilation oesophagus treated?
surgery
what is nursing care for megaoesophagus?
postural feeding as no oesophageal contraction to move food
what are complications associated with megaoesophagus?
aspiration pneumonia
changes to body weight
what causes oesophagitis?
ingesting hot liquids, caustics, hot food, foreign body, irritants
gastro-oesophageal reflux causing inflammation
persistent vomiting
what are signs of oesophagitis?
regurgitation hypersalivation anorexia pain weightloss
how is oesophagitis managed?
oesophageal rest by gastrotomy tube analgesia antacid gels or coating agents for food acid blockers- omeprazole drugs to reduce reflux
how can oesophageal foreign bodies be removed?
endoscopy
surgery
how do oesophageal strictures form?
fibrosis after severe ulceration of mucosa
define emetic
substance that stimulates vomiting
define -itis
inflammation
what questions should be asked in phone triage for patients with acute vomiting and diarrhoea?
productive or non-productive vomiting frequency foreign materials present haematemesis melaena other conditions worming history demeaner appetite and drinking systemic signs
define haematemesis
vomiting blood
define melaena
faecal passage of digested blood
when are consults advised for acute vomiting and diarrhoea?
unproductive vomiting lots of fluid lost haematemesis melaena suspicion of FB ingestion inappetant hypodipsic systemic signs young animal
define emesis
vomiting
what is vomiting?
complex coordinated reflex reaction, not involving gastric contraction
list the stages of vomiting
prodromal
retching
expulsion
relaxation
what are signs of the prodromal stage of vomiting?
nausea restlessness hypersalivation gulping lip licking
what happens in the retching stage of vomiting?
inhibition of saliva
simultaneous uncoordinated spasmodic contraction of respiratory muscles, duodenal retroperistalsis and mixing of gastric contents
what happens in the expulsion stage of vomiting?
pyloric contraction fundic relaxation
relaxation of proximal stomach and lower oesophageal sphincter
airway protected by closure of glottis and nasopharynx
abdominal contraction and lowering of diaphragm to force up vomitus
oesophageal retroperistalsis
reduced upper oesophageal sphincter tone
what happens in the relaxation phase of vomiting?
abdominal, diaphragmatic and respiratory muscles, glottis and nasopharynx relax
breathing returns
define diarrhoea
high faecal water content
what are characteristics of SI diarrhoea?
large volume
watery
normal frequency
normal colour or melaena
what are characteristics of LI diarrhoea?
small volume increased urgency and frequency tenesmus dyschezia mucus or blood present
define tenesmus
straining to pass faeces
define dyschezia
difficulty passing faeces
what can cause non-fatal acute vomiting and diarrhoea?
diet
parasites
enteric infection
adverse drug event
what can cause severe acute vomiting and diarrhoea?
pathogenic enteric infections acute haemorrhagic diarrhoea syndrome acute pancreatitis surgical disease intoxications
what are examples of causes of surgical acute vomiting and diarrhoea?
intussusception GDV incarceration stricture obstruction FB
define intussusception
intestine slides inside itself
list consequences of acute vomiting and diarrhoea
dehydration
hypovolaemia
acid base imbalance
aspiration
how is acute gastroenteritis diagnosed?
history physical exam electrolytes haematology biochemistry faecal sample testing imaging response to treatment
how is hydration maintained for patients with gastroenteritis?
hartmanns with KCl
water
oral rehydration solutions
what is dietary advice for acute vomiting?
rest gut but free access to water
re introduce bland diet in small quantities
transition to normal diet over 2-5 days
state dietary advice for diarrhoea
feed through to help repair intestinal cells and reduce sepsis risk
define anti-emetic
substance that inhibits vomiting
what is supportive management for gastroenteritis?
anti-emetics if no obstruction- metoclopramide, maropitant antispasmodics- buscopan barrier nurse until diagnosis of cause keep patient clean keep environment clean
how is gastroenteritis treated?
anthelmintics for young or unwormed adults
antibiotics if pyrexic or haemorrhagic diarrhoea
pro-biotics may be effective
why are NSAIDs contraindicated in treatment of gastroenteritis?
prostaglandins needed for maintenance of GI mucosa and renal blood flow
how are non-obstructive small gastric FB treated?
induce emesis
dogs- apomorphine
cats- xylazine
how are non-obstructive intestinal FB treated?
monitor passage with radiographs
how are non-obstructive gastric FB treated?
endoscopic retrieval
surgery
how are obstructive GI FB treated?
surgery
what is the consequence of GDV?
impaired venous return
compromised gastric mucosa
shock
death
what are potential causes for GDV?
deep chested, older dogs diet aerophagia delayed emptying exercise timing
how is GDV treated?
aggressive IVFT
decompression by stomach tube or needle paracentesis
IV antibiotics
surgical derotation and gastropexy
what is common after GDV?
cardiac arrhythmia
what is gastropexy?
tying stomach to wall of abdomen to reduce future risk of recurring GDV
what are some parasitic causes of acute vomiting and diarrhoea?
round worms
hook worms
whip worms
cestodes
what are some protozoal causes of acute vomiting and diarrhoea?
coccidia spp.
giardia spp.
who does tritrichomonas foetus effect and how is it spread?
young cats
faeco-orally
what is the effects of tritrichomonas foetus infection?
intractable diarrhoea
perianal oedema
faecal incontinence
how is tritrichomonas foetus diagnosed?
colonic wash
PCR
how is tritrichomonas foetus treated?
maturity provides immune response otherwise poor response to treatment
manage environment to prevent spread
what are causes of acute pancreatitis?
idiopathic
predisposing factors
what are predisposing factors for acute pancreatitis?
dietary indiscretion high fat diet hyperlipidaemia impaired perfusion truama obesity
how does acute pancreatitis effect the body?
local release of pancreatic enzymes causing pancreatic autodigestion
severe local inflammation and cell necrosis
can have systemic inflammation and death
what are signs of acute pancreatitis?
inappetence lethargy abdominal pain vomiting and diarrhoea jaundice if bile duct obstruction
how is acute pancreatitis diagnosed?
history physical exam imaging haematology biochemistry pancreatic lipase immunoreactivity sensitive test
what is treatment for acute pancreatitis?
supportive management IVFT keep up nutrition analgesia antiemetics gastroprotectants
what is prognosis for acute pancreatitis?
guarded
death and recurrence possible
what diet should be given to acute pancreatitis patients?
highly digestible
complex carbs
low fat
what causes chronic pancreatitis?
repeated acute pancreatitis
low grade chronic pancreatitis
what are signs of chronic pancreatitis?
inappetence
lethargy
vomiting
diarrhoea
what is management for chronic pancreatitis?
modify diet
manage nausea and appetite
analgesia
define hyporexia
reduced appetite
define polyphagia
excessive appetite
define pica
appetite for non-nutritional substances
define ileus
reduced GI motility
define anorexia
loss of desire to eat
what are consequences of anorexia?
weight loss impaired immune function increased risk of sepsis poor wound healing slow recovery
list signs of chronic GI disease
altered appetite dehydration vomiting BW or condition loss borborygmi flatus abdominal discomfort ascites or oedema
define borborygmi
gurgling
what causes chronic vomiting and diarrhoea?
gastric ulceration dietary sensitivity neoplasia liver disease kidney disease pancreatitis endocrine disease
how is chronic vomiting and diarrhoea diagnosed?
history clinical exam haematology biochemistry faecal analysis absorption tests imaging gastroscopy laparotomy biopsy
how is chronic vomiting and diarrhoea treated?
treat underlying cause exclude parasites modify diet vitamin B12 steroids anti-emetics appetite stimulants
what are causes of inappetance?
pain stress dehydration hypokalaemia nausea delayed gastric emptying
how can you encourage inappetent patients to eat?
wet, warm, smelly food preferred food and method keep euhydrated and electrolyte balanced anti-emetics appetite stimulants
how can you provide nutritional support to inappetant patients?
feeding tubes
cobalamin supplements
define chronic enteropathies
chronic disease of SI
what is part of IBD complex?
food responsive diarrhoea
antibiotic responsive diarrhoea
idiopathic IBD
what is protein losing enteropathy?
severe SI disease resulting in severe malabsorption and loss of albumin and globulin
form of chronic enteropathy
what is the consequences of protein losing enteropathy?
weight loss
oedema
ascites
thromboembolism
what causes protein losing enteropathy?
IBD
lymphangiectasia
alimentary lymphoma or lymphosarcoma
how is protein losing enteropathy diagnosed?
endoscopy
what are dietary considerations for chronic enteropathies?
avoid allergens highly digestible food restrict fat supplement fibre feed little and often
what is EPI?
failure of normal exocrine secretions
what is the effects of EPI?
maldigestion
malabsorption
what causes EPI?
pancreatic acinar atrophy
common in GSD
recurrent pancreatitis
what are signs of EPI?
ravenous appetite
diarrhoea
fatty faeces as limited fat digestion
weight loss
how is EPI diagnosed?
trypsin like immunoreactivity serum test
how is EPI treated and what are downsides?
oral pancreatic extract
expensive and lifelong
describe diet for EPI
2-3 meals enzyme at every meal highly digestible good quality protein non-complex carbs cobalamin supplement
define colitis
colonic inflammation
how is colitis treated?
anti-inflammatory sulfasalazine
what can be a side effect to colitis treatment?
keratoconjunctivitis sicca
what are signs of IBS?
LI diarrhoea
occasional vomiting
what is signalment for IBS?
anxious small breed dogs
how is IBS diagnosed?
exclusion of other causes
how is IBS treated?
long term diet modification
anti-spasmodics
anti-cholinergics
list causes of GI bleeding
coagulopathy
swallowed blood
what is seen from gastric or SI bleeding?
haematemesis
melaena
what is seen from LI bleeding?
haematochezia
define haematochezia
fresh blood in faeces
what are causes of GI ulceration?
NSAIDs steroids FB gastric carcinoma hypoadrenocorticism kidney or liver disease
how is GI ulceration treated?
treat underlying cause
surgery if perforates
what is constipation?
impaction of colon or rectum with faecal matter, usually excessive hard or dry
what is consequence of prolonged constipation?
irreversible changes
obstipation
define obstipation
excess faeces accumulation that cant be passed
what are signs of constipation?
infrequent defecation dyschezia pain with defecation vomiting anorexia lethargy
what causes constipation?
ingestion of FB dehydration drugs stress lack of toileting opportunity pain preventing posturing CNS disease
how is constipation and megacolon treated?
correct underlying cause IVFT correct electrolytes oral laxatives enema surgery if needed
how can you manage and prevent constipation?
good water intake control underlying disease add fibre to diet increase exercise laxatives as needed
what causes megacolon?
idiopathic neuromuscular dysfunction
chronic underlying disease
state normal liver function
synthesis of proteins, glucose, cholesterol
clearance and detoxification of ammonia, bilirubin, bile acids, drugs
what are signs of hepatic dysfunction?
inappetence lethargy vomiting diarrhoea jaundice ascites synthesis failure persistent drug activity
what causes jaundice?
failure of clearance of bilirubin causing yellow discolouration from hyperbilirubinemia and bile pigment deposition in tissues
what are the types of jaundice?
pre-hepatic- too much bilirubin to be cleared
hepatic- failure of hepatic uptake, coagulation and transport of bilirubin
post-hepatic- failure of bile excretion
what are causes of ascites?
hypoalbuminemia
portal hypertension
sodium and water retention
what causes failure of hepatic detoxification?
hepatic dysfunction
abnormal blood supply
what is the effect of failure of conversion of ammonia to urea?
hyperammonaemia
hepatic encphalopathy
what is the impact of build up of encephalopathic toxins?
fore brain dysfunction lethargy pacing head pressing seizures coma
what precipitates hepatic encephalopathy?
high protein meal
vomiting
diarrhoea
diuretics
how is hepatic dysfunction diagnosed?
liver enzymes bilirubin bile acids blood glucose blood clotting imaging liver cytology liver biopsy
what can cause acute liver disease?
hepatotoxins
infection
medication side effects
what are nursing considerations for acute liver disease?
manage hepatic encephalopathy lactulose to reduce ammonia absorption seizure management monitor hydration and electrolytes anti-emetics manage hypoglycaemia leg veins used as may be coagulopathic antioxidants antibiotics barrier nursing
how is nutrition managed for acute liver disease patients?
restrict animal protein
hepatic prescription diet
restrict copper
antioxidant supplements
what are causes of chronic inflammatory liver disease?
chronic hepatitis lymphocytic cholangitis infectious cholangitis leptospirosis chronic FIP
how is chronic inflammatory liver disease treated?
de-coppering therapy antibiotics if indicated modify diet anti-oxidants steroids hepatic encephalopathy therapy manage ascites
what is gall bladder mucocoeles?
gall bladder full of insipidated bile and mucus
what are signs of gall bladder mucocoeles?
asymptomatic
obstructed bile flow
rupture
how is gall bladder mucocoeles treated?
medication
gall bladder removal
what is feline hepatic lipidosis?
hepatocyte triglyceride deposition
when anorexic fat stores mobilise for energy then accumulate in liver
what predisposes to feline hepatic lipidosis?
obesity
high fat or carb diet
systemic illness
diabetes mellitus
what are the effects of feline hepatic lipidosis?
intracellular fat accumulation liver failure encephalopathy coagulopathy death
how is feline hepatic lipidosis treated?
treat underlying diseases nutritional support enough protein antioxidants often 6-8 weeks tube feeding
state the types of portosystemic shunt
single
acquired/multiple
list signs of portosystemic shunt
dullness
lethargy
inappetance
history of GI signs
how are portosystemic shunts diagnosed?
abnormal liver function low albumin low cholerterol high bile acids high ammonia
what is the effects of portovascular abnormalities?
blood from GIT bypasses liver to systemic circulation so lack of nutrients delivered to liver causing dysfunction
blood from GIT not filtered by liver so accumulation of toxins cause hepatic encephalopathy and brain dysfunction
how are portosystemic shunts treated?
hydrated and normal blood potassium restrict protein lactulose to trap ammonia in colon antibiotics to minimise ammonia produced by gut flora close surgically
what are signs of hepatic neoplasia?
asymptomatic
hepatic or obstructive signs
rupture causing haemoabdomen
what are types of hepatic neoplasia and how are they treated?
primary- surgery
infiltrive, lymphomas- chemo
metastatic, carcinomas- none
why are dry food diets reccomended?
balanced nutrients
convenient
good for dental hygiene
state the most important nutrient
water
how much water is needed a day?
50ml/kg/day
affected by factors such as exercise, weather
list fat soluble vitamins
A
D
E
K
why is it important not to have too many fat soluble vitamins in the diet?
they get stored in fat reserves and not excrete
state the water soluble vitamins
B
C
are water soluble vitamins stored in the body?
no
why is it important to get the right amount of vitamins?
energy metabolism
biochemical reactions
deficiency syndromes
list macrominerals
calcium phosphorus magnesium sodium potassium chloride sulphur
list microminerals
iron copper zinc manganese iodine selenium
which type of minerals are most important?
microminerals
what is an essential amino acid?
amino acid not synthesised by the body
why are cats obligate carnivores?
need to take in taurine through diet as cant synthesise it
how many amino acids are there?
23
state the function of protein
regulate metabolism
cell and muscle fibre structure
tissue growth and repair
energy
define biological value
amount of protein utilisable
how is biological value assessed?
acceptable
digestible
utilisable
bioavailability
what is the consequence of excess protein?
liver and kidney issues
list effects of protein deficiency
poor growth muscle loss weight loss dull hair reduced immunity oedema death
what is the function of fats?
energy
absorption of fat soluble vitamins
enhance palatability
source of EFA
what is the effect of lack of fat in diet?
energy deficiency
impaired reproduction
impaired wound healing
dry coat and skin
what are the types of carbohydrates and examples of each?
monosaccharide- glucose, fructose
disaccharides- maltose, lactose, sucrose
polysaccharides- starch, glycogen, fibre
what is the function of carbohydrates?
energy
fat stores
precursor for AA and glycerol
what is dietary fibre and examples?
indigestible polysaccharides
cellulose, lignin, pectin
what is the function of fibre?
bulk faeces
prevent constipation and diarrhoea
keep full for longer
blood glucose regulation in diabetes
what is meant by metabolizable energy?
kcal/100g food
what is gross energy of food?
all energy of the food by not all available to the animal
define BER
amount exerted in sleep 12-18 hours after feeding in thermoneutral environment
define RER
includes energy for recovery from activity and feeding
define MER
energy required by moderately active animal not including growth, lactation, work
what needs considering when calculating MER?
life stage factors
state the calculation of RER
70 x BW^0.75 if less than 2kg or over 45kg
otherwise (30 x BW) + 70
how do you calculate how much to feed an animal?
calculate energy requirement
choose suitable diet
divide energy content of diet by energy requirement for amount of feed needed daily
divide by times wanting to feed
which energy requirements are used for sick and healthy animals?
sick- RER
healthy- MER
how is MER calculated?
RER x appropriate life stage factor
define obesity
excess accumulation of body fat
what predisposes to obesity?
neutering
overfeeding
poor owner knowledge
list consequences of obesity
hepatic lipidosis joint disease exercise intolerance diabetes mellitus skin disease cardiorespiratory disease risk in surgery FLUTD
what is ideal amount of weight to lose a week?
1-2% BW
describe how to implement weight loss for patients
change diet
gradually build up exercise
base MER of ideal weight
individually tailored
what is the effect of starvation when trying to lose weight?
excess loss of muscle mass
body function problems
hepatic lipidosis
what are features of obesity diet?
nutritionally balanced
high protein to keep satiated and preserve lean body mass
joint diet in some cases
L-carnitine to encourage fat for energy rather than storage
what problems GI diets be used to treat?
diarrhoea gastritis enteritis IBD maldigestion EPI
what are features of GI diets?
highly digestible protein and starch
MOS and FOS prebiotics
EPA/DHA highly digestible unsaturated fatty acids and omega 3
psyllium to aid removal from GI tract
what are hypoallergenic diets used for?
manage food allergy
food elimination trials
EPI
IBD
what are features of hypoallergenic diets?
hypoallergenic and highly digestible hydrolysed or novel proteins
nutrients support skin, GI mucosa and healthy intestinal environment
what are the effects of pancreatitis if not treated?
renal failure acute lung injury chronic pancreatitis EPI death
what is the feature of convalescent diets?
protein provides 30-50% total energy source
state consideration for use of convalescent diets
due to high protein care with renal failure or hepatic encephalopathy as reduced ability to deal with protein
why do critical care patients have high risk of malnutrition?
catabolism and rapid breakdown of protein and energy stores
what nutrition should be given to critical care nutrition?
oral nutrition as early as possible
enough energy sources
EFAs
micronutrients
how do dental diets help dental health?
mechanically remove plaque if hard food
phosphate salts reduce mineralisation of plaque
chews reduce plaque
what nutrients are needed for skeletal development and maintenance?
calcium
phosphorus
vitamin D
what are examples of conditions that can be helped by orthopaedic diets?
osteoarthritis
joint dysplasia
CCLR
luxating patella
how do orthopaedic diets help?
manage weight
omega 3s to manage inflammation
help cartilage repair or slow degeneration
how can diets help diabetes mellitus?
achieve and maintain normal serum glucose levels
decrease peaks of glucose post feeding
help normal metabolism
normalise body weight
what are features of diabetes diets?
high protein
low fat
low soluble carbs
fibre
describe diet for hyperthyroidism
0.2ppm iodine dry matter base
hills y/d
exclusive feeding
what are feeding considerations for cardiac diets?
mild sodium restriction
maintain ideal BCS
monitor for cachexia
define cachexia
muscle loss in presence of disease
what are features of cardiac diets?
taurine as deficiency linked to DCM
L-carnitine for myocardial energy requirement
arginine for vascular tone
omega 3s
define -otomy
cutting open tissue which is then repaired to allow normal healing
define -ostomy
creation of opening to outside of skin
if device removed keeping open wound either heals closed or as permanent stoma
define -oscopy
device to visualise inside cavity
define -ectomy
removal of part or all of structure
list roles of vet nurse in GI surgery
pre op care of animal surgical prep of animal equipment prep assistance in surgery anaesthetic monitoring post op care
what are pre op considerations for GI surgery?
usually emergency and unwell
stabilise fluids and electrolytes before anaesthesia
how are GI patients prepared for surgery?
starve for 12 hours ideally but not always possible if emergency
specific condition management
flush mouth with sterile saline if oral surgery
what are other considerations for GI surgery?
antibiotics during and post op
keep warm as lose lots of heat from abdomen
seal ETT as high risk of regurgitation
list equipment used in GI surgery
laparotomy swabs suction histopathology swabs retractors bowel clamps 2 surgical kits to prevent contamination pre-warmed saline stomach tube endoscope
state role of vet nurses in GI surgery
clamp bowels
keep GI contents moist with saline
separate contaminated instruments
suction
what type of suture materials are used for GI surgery and why?
short duration absorbable as quick healing
synthetic monofilament to prevent wicking in infection
what needles are used for GI surgery suturing and why?
round body
least traumatic
why are antibiotics used in GI surgery?
considered clean contaminated procedure
contaminated if questionable tissue viability or contamination occurs
what is oral surgery used for?
oral tumours oronasal fistula cleft palette foreign body penetrating injuries
what are pre-op considerations for oral surgery?
saline flush to remove debris
positioning
anaesthesia
what are post op considerations for oral surgery?
ensure can eat and drink
soft food
feeding tube as needed
what conditions is oesophageal surgery used for?
FB by endoscope or surgical removal from stomach
stricture
what are pre-op considerations for oesophageal surgery?
manage dehydration and hypovolaemia
IVFT
state post op considerations for oesophageal surgery
feeding tubes to allow oesophagus to heal
liquid diet
what are reasons for gastric surgery?
FB pyloric obstruction neoplasia GDV tube gastrotomy
what are pre-op and intra-op considerations for gastric surgery?
IVFT for dehydration and hypovolaemia
prepare surgical site
monitor heat loss
what are post op considerations for gastric surgery?
low fat bland diet
liquid diet if obstruction
IVFT
monitor for arrhythmia if GDV
describe treatment plan for GDV
treat shock with rapid IVFT IV antibiotics decompress stomach with stomach tube radiographs to confirm ECG to check for dysrhythmia surgical decompression and derotation gastropexy
what are types of SI surgery?
biopsy
enterotomy for FB removal
enterectomy to removed section
intussusception repair or resection
what are pre- and intra-op considerations for SI surgery?
IVFT keep abdomen moist during surgery prepare wide surgical site monitor temperature surgical assistant
what are post-op considerations for LI surgery?
manage biopsy samples
encourage eating low fat diet
encourage drinking
why does LI surgery have more risk than SI surgery?
increased bacterial load
slower healing
what are examples of LI surgery?
biopsy
colectomy
list intra-op considerations for LI surgery
avoid enemas as slurry more likely to spill
antibiotics
what are post op considerations for LI surgery?
manage biopsy samples
nutrition to support healing
when is anal and rectal surgery performed?
polyps or tumours prolapse imperforate anus anal sac removal anal furcunculosis
what is imperforate anus?
congential condition where anus doesnt join rectum
why is anal sac removal performed?
chronic sacculitis, impaction and abscessation
what are signs of rectal polyps or tumours?
tenesmus
bleeding
discomfort
what is anal furcunculosis?
inflammatory disease almost exclusively in GSD
what are pre-op considerations for anal surgery?
positioning
keep prolapses moist and lubricated
purse string placement
state post op considerations for anal surgery
nutritional support to aid healing
how does peritonitis happen?
irritation or contamination to peritoneum causing inflammatory response
why is peritonitis life threatening?
infection develops and rapidly causes severe illness, sepsis, shock, CV collapse
list signs of peritonitis
pyrexia anorexia depression tachycardia vomiting ascites abdominal pain
how is peritonitis treated?
exploration to find source of contamination lavage abdomen provide open peritoneal drainage IVFT monitor blood albumin and electrolytes
what are common complications following GI surgery?
hypothermia hypovolaemia hypotension hypoglycaemia nausea dehydration
what is post op care for GI surgery?
wound care
analgesia
monitor for dysphoria
list some immediate post op complications following GI surgery
physiological abnormalities worsening pain haemorrhage drug reaction vomiting and regurgitation wound breakdown
what are longer term post op complications for GI surgery?
pain haemorrhage aspiration pneumonia ileus infection
what are features of GI post op care plans?
tailored to individual
3-5 careful observation in or out of hospital
monitor for abnormalities
manage hydration with IVFT until eating and drinking normlly
describe nutrition plans for post GI surgery
lower GIT surgical patients encouraged to eat straight away to prevent ileus and help intestine function
upper GIT patients start water after 2 hours, food after 12 hours
aid gut motility by keeping ambulatory
consider feeding tubes
what are signs of nausea?
salivation
swallowing
lip-licking
what drugs can help prevent nausea?
maropitant
metoclopramide
ranitidine
omeprazole
what types of medications can be used post GI surgery?
prokinetics probiotics appetite stimulants analgesia anti-emetics
why are NSAIDs not recommended post GI surgery?
cause GI ulceration and upset
define dehiscence
disruption of wound edges
when is dehiscence mostly seen?
3-5 days post op
list most common areas affected by dehiscence
skin
abdominal wall
intestines
what are clinical signs of dehiscence?
serosanguinous or purulent discharge from suture line
swelling
necrosis of edges
what is the effect of abdominal wall dehiscence?
hernia
what are clinical signs of abdominal wall dehiscence?
oedema
inflammation
serosanguinous drainage
painless swelling
what is the effect of intestinal dehiscence?
septic peritonitis
list clinical signs of intestinal wall dehiscence?
depression anorexia vomiting abdominal pain acute collapse
list risk factors for dehiscence
wound tension suture choice self trauma underlying neoplasia closing non-viable skin endocrine disease obesity immunocompromise hypovolemia
how can dehiscence be prevented?
bandaging to immobilise
collar to prevent trauma
confined and exercise restricted
what is primary cause of peritonitis?
cats with FIP
what are secondary types of peritonitis?
aseptic
septic
what are causes of peritonitis?
dehiscence
ischaemic necrosis
infection
list complications associated with oesophageal surgery
regurgitation
oesophagitis
strictures
swallowing affecting healing
list complications associated with gastric surgery
vomiting anorexia ulceration gastric obstruction pancreatitis
list common gastric surgery performed in first opinion
gastrotomy for FB
gastropexy
list complications associated with SI surgery
adhesions from excess handling ileus perforation stenosis intestinal strictures diarrhoea anorexia
define stenosis
constriction of lumen
what are common SI surgery performed in first opinion?
enterotomy for FB
enterectomy for intussucception
list complications associated with LI surgery
haemorrhage faecal contamination leakage stricture stenosis incontinence
list complications associated with perineum, rectal and anal surgery
tenesmus rectal prolapse incontinence anal stricture urethral obstruction stenosis
define colic
abdominal pain of any origin
what is significant about colic?
clinical signs of many GI conditions
most die of colic
list signs of colic
rolling
pawing
flank watching
lip curling
what is the purpose of clinical exam for colic patients?
determine if needs emergency surgery
list what is assessed in clinical exam for colic
CV status HR RR temperature haematocrit TP lactate abdominal exam rectal exam ultrasound abdominoparacentesis oral exam gastroscopy radiography
why is assessment of CV status important in colic patients?
acute GI conditions can lead to endotoxemia, dehydration, shock, coagulation disorders
describe how abdominal exam in horses is done
auscultate 4 quadrants
observe for distension
what can be identified from rectal exam of horses?
distension
impaction
displacement
limited one part of abdomen
why are stomach tubes lifesaving in horses?
they cant vomit so prevents stomach rupture if outflow is obstructed
what is a risk of stomach tubing in horses?
nose bleed
what is the disadvantage of ultrasounding horses abdomens?
can only see 15cm deep so doesnt prove no issues
what is an abdominoparacentesis?
belly tap of peritoneal fluid
what can abdominoparacentesis in horses show?
intestinal damage hamoperitoneum rupture inflammatory cells neoplasia
what are gastroscopy in horses used for?
look for ulceration
look for outflow obstruction and impactions
biopsies
list tests that are done on horses with colic
bloods peritoneal fluid cytology and appearance FEC faecal culture glucose absorption test laparoscopy
why do horse teeth need rasping once a year?
less grinding than wild horses so can form sharp edges
if not corrected can cause dysphagia and impaction
list examples of dental disease in horses
eruption disorders dental decay peritoneal disease fractured tooth diastema
how are equine dental diseases examined?
watch eating
palpate
sedate and wash out mouth to examine
list some treatment options for dental disease in horses
filling or widening to prevent things getting stuck
removal of teeth
what are downsides of tooth extraction in horses?
opposite tooth wont be ground down
hard to remove
define oesphageal choke
obstruction
list causes of oesophageal choke in horses
eating to fast dry concentrate poor dentition oesophageal damage from previous choke mass
state clinical signs of oesophageal choke in horses
neck extended food coming from food gag cough dehydration weight loss acid base imbalance aspiration pneumonia
what are problems associated with oesophageal choke in horses?
damaged oesophagus
acute oesophageal rupture
strictures
how is oesophageal choke diagnosed in horses?
auscultation CV parameters bloods gastroscopy imaging stomach tube to determine site of blockage
how is oesophageal choke treated in horses?
relieve obstruction
stomach tube to lavage obstruction
buscopan and oxytocin to relax oesophagus
check obstruction cleared with gastroscope or stomach tube
check no mucosal damage
check for underlying issues
rest from feeding
what are stages of gastroduodenal ulceration in horses?
inflammation
erosion
ulceration
perforation
how are gastroduodenal ulcers graded in horses?
0-4
none to bleeding
what causes gastroduodenal ulcers in horses?
imbalance between inciting and protective factors
list inciting factors in equine stomach
HCl
bile acids
pepsin
list protective factors in equine stomach
mucus-bicarbonate layer mucosal blood flow mucosal prostaglandin E epidermal growth factor production gastroduodenal motility
state risk factors for gastroduodenal ulcers in horses
empty stomach exercise diet stress NSAIDs hospitalisation
list clinical signs of gastroduodenal ulcers in horses
poor appetite colic tooth grinding diarrhoea poor performance
how is gastroduodenal ulcers diagnosed in horses?
gastroscopy
interpretation as presence doesn’t mean significance
how are gastroduodenal ulcers in horses treated?
dependent on cause
general management
omeprazole for adults
sucralfate for foals
list causes of primary gastric dilation and rupture in horses
gastric impaction grain engorgement colic unknown cause idiopathic
list secondary causes of gastric dilation and rupture in horses
SI or LI obstruction
ileus
functional obstruction
list clinical signs of gastric dilation and rupture in horses
over filling of stomach acute colic tachycardia fluid from nose just before rupture dehydration
how is gastric dilation and rupture in horses diagnosed?
clinical signs
reflux
colic work up
gastroscopy
how do you treat gastric over filling and rupture in horses?
stomach tubing
treat underlying cause
IVFT
IV nutrition if needed
what is anterior enteritis in horses?
inflammatory condition affecting proximal SI
what is a risk factor for anterior enteritis in horses?
diet change to high concentrate
list clinical signs of anterior enteritis in horses
hypersecretion
functional ileus secondary to inflammation
distended SI and stomach
pyrexia
how is anterior enteritis diagnosed in horses?
colic investigation
peritoneal fluid with raised protein
culture reflux
ex-lap
how is anterior enteritis treated in horses?
repeated stomach tubing antibiotics IVFT no feeding by mouth analgesia ex-lap SI decompression
what is prognosis for anterior enteritis in horses?
varies survival as treatment expensive and long but those that do have it is good prognosis
what can cause malabsorption and maldigestion in horses?
inflammatory type diseases
lymphosarcoma
what is the clinical sign of malabsorption and maldigestion in horses?
weight loss
how is malabsorption and maldigestion in horses diagnosed?
abdominoparacentesis
ultrasound
oral glucose tolerance test
laparoscopic biposy
how is malabsorption and maldigestion in horses treated?
depends on diagnosis
resection
corticosteroids
no treatment
what is a simple obstruction in horses?
obstruction of intestinal lumen without obstruction to blood flow
what can cause simple SI obstructions in horses?
food
ileal hypertrophy
adhesions
what is strangulation of intestines in horses?
occlusion of lumen and blood supply so intestine dies
what are causes of strangulation in horses?
lipoma SI volvulus mesenteric rent inguinal diaphragmatic hernia intussucception
list effects of SI obstruction in horses
gastric overfilling deterioration of intestinal mucosa intestinal death sepsis endotoxemia
what are signs of SI obstruction in horses?
colic, eases when gut dead reflux tachycardia hypovolaemia distended SI serosanguinous, protein and lactate in peritoneal fluid
how are SI obstructions in horses treated?
surgery with 3-4 months rest
euthanasia
what is prognosis for SI obstructions in horses?
80% short term survival
60-70% long term survival depending on severity of presentation
what are causes of caecal impaction in horses?
underlying motility disorder
after ortho procedures in young horses
list clinical signs of caecal impaction in horses
colic
rupture
severe shock
death
how is caecal impaction in horses diagnosed?
clinical signs
history
rectal exam
abdominoparacentesis
how are ceacal impactions in horses treated?
medical
surgery
IVFT
what is prognosis for caecal impactions in horses?
90% success as most caught early
what are the types of caecal intussusception in horses?
ileo-caecal
caeco-ceacal
what is signalment for caecal intusucception in horses?
young horses
tapeworms causing inflammation
reduced motility
list clinical signs of caecal intussusception in horses
varies
colic
can be chronic
how is caecal intussusception diagnosed in horses?
rectal exam
ultrasound
how is caecal intussusception in horses treated?
surgery
treat tapeworms
what are causes of simple LI obstructions in horses?
impaction
displacement
what are causes of LI strangulation in horses?
torsion
where are LI obstructions in horses normally?
pelvic flexure
what are causes of LI obstruction in horses?
poor teeth
ingesting long fibre
motility disorder
box rest
list clinical signs of LI obstruction in horses
mild colic
reduced faecal output
how are LI obstructions in horses diagnosed?
rectal exam
abdominoparacentesis
how are horses with LI obstruction treated?
IVFT
cathartics to move water to gut
analgesia
surgery
why does Li displacement happen in horses?
lots of space for intestines to move around
state types of LI displacement in horses
right dorsal
left dorsal
nephrosplenic entrapment
how are LI displacements managed and treated?
may resolve medication starve to empty and deflate gut so returns to normal IVFT analgesia surgery
how are LI displacements diagnosed in horses?
rectal exam
ultrasound
abdominoparacentesis
surgery
when do LI torsions tend to happen in horses?
spontaneously
following displacement
list signs of LI torsion in horses
extreme pain
abdomen distension
respiratory compromise
how is LI torsion in horses diagnosed?
rectal exam
how is LI torsion in horses treated?
surgery
may need resection
what is prognosis for LI torsion in horses?
depends on damage to LI
can recur
what are causes of acute diarrhoea in horses?
salmonella colitis neoplasia food hypersensitivity toxicity
what causes chronic diarrhoea in horses?
dental disease dietary sensitivity parasites IBD neoplasia
how is diarrhoea diagnosed in horses?
CV parameters rectal exam ultrasound abdominoparacentesis rectal biopsy FEC and culture
how is diarrhoea in horses treated?
hydration electrolytes laminitis prevention treat underlying cause give antibiotics keep feeding nursing care
what are causes of small colon impaction in horses?
foreign bodies
salmonella
what are signs of small colon impaction in horses?
intermittent diarrhoea
colic
how is small colon impaction in horses treated?
medication
surgery
what are signs of peritonitis in horses?
mild colic
pyrexia
how is peritonitis in horses diagnosed?
abdominoparacentesis showing high WBCs
how is peritonitis in horses treated?
antibiotics
laparoscopy
laparotomy
what can be causes of secondary peritonitis in horses?
colic surgery
what are reasons for equine GI surgery?
normally colic related
occasionally due to laparotomy or laparoscopy
what tests influence the decision to perform emergency colic surgery decided?
pain clinical exam rectal exam peritoneal fluid analysis bloods ultrasound findings
what are colic finding indicating possible surgery?
signs of colic despite analgesia lack of faeces HR over 60bpm poor MM colour reduced gut sounds distention or displacement of intestines high PCV, lactate, protein reflux with NG tubing over 5L discoloured peritoneal fluid
what practicalities need considering for colic surgery?
expensive, unsuccessful cases often most
transport to hospital
prognosis
complications
list preparations for colic surgery
jugular IV placement NG tube to decompress stomach analgesia antibiotics IVFT clip abdomen remove shoes and tape feet wash out mouth
describe how NG stomach tubes are placed for stomach decompression in horses
tube passed through ventral meatus with head flexed to encourage passage to oesophagus
confirm placement by observing left side of neck
what preparations are needed for horses laparotomy?
dorsal recumbency for dorsal midline incision urinary catheter clip and prep abdomen cover legs and feet drape
what are principles of colic surgery?
exploration of abdomen and intestines identifying lesions correct displacements decompression of distended viscera resection of devitalised tissue
what is functional intestinal obstruction?
peristalsis fails to propel ingesta causing distention
what are the consequences of strangulation of intestines in horses?
death of section of intestine oedematous thickening of gut wall endotoxin release shock laminitis
how does strangulated small intestines in horses cause issues?
strangulated section dies
mucosa becomes permeable to endotoxins which leak into peritoneal cavity and circulation
how are SI resections done in horses?
isolate segment with bowel clamps
ligate blood vessels supplying segment
resect segment
how are simple or functional SI obstructions treated in horses?
decompression
removal of obstruction by enterotomy
what is prognosis for intestinal obstructions in horses?
simples- good when resolved
strangulating is worse
what are risks for strangulation resection in horses?
contamination peritonitis endotoxic shock ileus adhesions
how are LI displacements in horses treated?
decompression of bowel
evacuation of colon via pelvic flexure enterotomy
correct displacement
coloplexy to prevent recurrence
what are causes of large colon volvulus in horses?
unknown but usually larger horses or brood mares 90 days post foaling
what are signs of equine large colon volvulus?
sudden onset abdominal pain enlarged colon on rectal exam abdominal distension endotoxemia high HR poor peripheral perfusion
how is large colon volvulus treated in horses?
surgery to correct
removal of ischemic colon
what effects the prognosis for large colon volvulus in horses?
time from onset of condition to surgery
what are post op care for horses after GI surgery?
exam every 2-4 hours analgesia antibiotics IVFT monitoring for complications bloods NG tubing as needed
list possible complications following GI surgery in horses
endotoxemia ileus jugular thrombophlebitis obstruction anastomosis leakage peritonitis adhesions laminitis colitis infection
what needs monitoring in horses following GI surgery?
pain pyrexia faecal output gut sounds reflux through NG tube incision catheter feet respiratory system
describe how horses are fed after GI surgery
nil by mouth if significant reflux through NG tube
when no reflux small amounts of water
start with grass then gradually introduce hay
normal volume return over 3 days
what are exercise requirements post GI surgery in horses?
6 weeks box rest
small walks to allow grazing and promote gut motility
turn out after 6 weeks to small paddock
ridden exercise after 3 months if no incisional issues
how is endotoxemia in horses treated?
IVFT
flunixin
polymyxin
hyperimmune plasma
what are signs of endotoxemia in horses?
pyrexia tachycardia tachypnoea hyperaemic MM colic
how is ileus treated in horses?
IVFT
stomach tube decompression
prokinetics
