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