Gastrointestinal Flashcards

1
Q

define dysphagia

A

difficulty swallowing

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2
Q

define odynophagia

A

painful swallowing

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3
Q

define regurgitation

A

passive return of food

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4
Q

define halitosis

A

bad breath

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5
Q

what are clinical signs of oropharyngeal disease?

A
drooling
ptyalism
pseudoptyalism
halitosis
dysphagia
odynophagia
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6
Q

define ptyalism

A

over production of saliva due to pain or disease in mouth

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7
Q

define pseudoptyalism

A

normal amount of saliva but leaves mouth not swallowed

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8
Q

how is oropharyngeal disease investigated?

A
physical exam
radiographs
minimum database
FNA
biopsy
special tests
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9
Q

what can cause oropharyngeal disease?

A
foreign body
ulcers
burns
inflammatory disease
neoplasia
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10
Q

what are nursing considerations for oropharyngeal disease?

A
diagnose and treat underlying disease
analgesia 
oral feeding of warm soft food
may need tube feeding
barrier nursing if infectious cause
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11
Q

why are anorexic patients prone to oral infections?

A

lack of saliva produced so low immune defence

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12
Q

define vomiting

A

acute forceful reflex ejection of gastric contents following stimulation of neural reflex

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13
Q

when can regurgitation happen after food intake?

A

immediate or delayed

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14
Q

what makes regurgitation different to vomiting?

A

passive

neutral pH as not reached stomach acid

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15
Q

what are secondary problems of regurgitation?

A
malnutrition
dehydration
anorexia
polyphagia
aspiration pneumonia
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16
Q

how is regurgitation investigated?

A
physical exam
chest x-rays
haematology
biochemistry
oesophagoscopy
oesophageal fluoroscopy
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17
Q

what can be causes of regurgitation?

A

megaoesophagus
oesophagitis
oesophageal obstruction

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18
Q

what are the different types of oesophageal obstruction?

A

complete or partial
intraluminal
intramural
extraluminal

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19
Q

what are the types of megaoesophagus?

A

generalised

focal dilation

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20
Q

what causes generalised megaoesophagus?

A

idiopathic

myasthenia gravis

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21
Q

what causes focal dilation of oesophagus?

A

vascular ring abnormality

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22
Q

how is generalised megaoesophagus treated?

A

idiopathic- no cure

myasthenia gravis- pyridostigmine, neostigmine

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23
Q

how is focal dilation oesophagus treated?

A

surgery

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24
Q

what is nursing care for megaoesophagus?

A

postural feeding as no oesophageal contraction to move food

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25
Q

what are complications associated with megaoesophagus?

A

aspiration pneumonia

changes to body weight

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26
Q

what causes oesophagitis?

A

ingesting hot liquids, caustics, hot food, foreign body, irritants
gastro-oesophageal reflux causing inflammation
persistent vomiting

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27
Q

what are signs of oesophagitis?

A
regurgitation 
hypersalivation
anorexia
pain
weightloss
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28
Q

how is oesophagitis managed?

A
oesophageal rest by gastrotomy tube
analgesia
antacid gels or coating agents for food
acid blockers- omeprazole
drugs to reduce reflux
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29
Q

how can oesophageal foreign bodies be removed?

A

endoscopy

surgery

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30
Q

how do oesophageal strictures form?

A

fibrosis after severe ulceration of mucosa

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31
Q

define emetic

A

substance that stimulates vomiting

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32
Q

define -itis

A

inflammation

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33
Q

what questions should be asked in phone triage for patients with acute vomiting and diarrhoea?

A
productive or non-productive vomiting
frequency
foreign materials present
haematemesis
melaena
other conditions
worming history
demeaner
appetite and drinking
systemic signs
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34
Q

define haematemesis

A

vomiting blood

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35
Q

define melaena

A

faecal passage of digested blood

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36
Q

when are consults advised for acute vomiting and diarrhoea?

A
unproductive vomiting
lots of fluid lost
haematemesis
melaena
suspicion of FB ingestion
inappetant
hypodipsic
systemic signs
young animal
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37
Q

define emesis

A

vomiting

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38
Q

what is vomiting?

A

complex coordinated reflex reaction, not involving gastric contraction

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39
Q

list the stages of vomiting

A

prodromal
retching
expulsion
relaxation

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40
Q

what are signs of the prodromal stage of vomiting?

A
nausea 
restlessness
hypersalivation
gulping
lip licking
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41
Q

what happens in the retching stage of vomiting?

A

inhibition of saliva
simultaneous uncoordinated spasmodic contraction of respiratory muscles, duodenal retroperistalsis and mixing of gastric contents

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42
Q

what happens in the expulsion stage of vomiting?

A

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

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43
Q

what happens in the relaxation phase of vomiting?

A

abdominal, diaphragmatic and respiratory muscles, glottis and nasopharynx relax
breathing returns

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44
Q

define diarrhoea

A

high faecal water content

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45
Q

what are characteristics of SI diarrhoea?

A

large volume
watery
normal frequency
normal colour or melaena

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46
Q

what are characteristics of LI diarrhoea?

A
small volume
increased urgency and frequency
tenesmus
dyschezia 
mucus or blood present
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47
Q

define tenesmus

A

straining to pass faeces

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48
Q

define dyschezia

A

difficulty passing faeces

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49
Q

what can cause non-fatal acute vomiting and diarrhoea?

A

diet
parasites
enteric infection
adverse drug event

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50
Q

what can cause severe acute vomiting and diarrhoea?

A
pathogenic enteric infections 
acute haemorrhagic diarrhoea syndrome
acute pancreatitis
surgical disease
intoxications
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51
Q

what are examples of causes of surgical acute vomiting and diarrhoea?

A
intussusception
GDV
incarceration
stricture
obstruction
FB
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52
Q

define intussusception

A

intestine slides inside itself

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53
Q

list consequences of acute vomiting and diarrhoea

A

dehydration
hypovolaemia
acid base imbalance
aspiration

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54
Q

how is acute gastroenteritis diagnosed?

A
history
physical exam
electrolytes
haematology
biochemistry
faecal sample testing
imaging
response to treatment
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55
Q

how is hydration maintained for patients with gastroenteritis?

A

hartmanns with KCl
water
oral rehydration solutions

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56
Q

what is dietary advice for acute vomiting?

A

rest gut but free access to water
re introduce bland diet in small quantities
transition to normal diet over 2-5 days

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57
Q

state dietary advice for diarrhoea

A

feed through to help repair intestinal cells and reduce sepsis risk

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58
Q

define anti-emetic

A

substance that inhibits vomiting

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59
Q

what is supportive management for gastroenteritis?

A
anti-emetics if no obstruction- metoclopramide, maropitant
antispasmodics- buscopan
barrier nurse until diagnosis of cause
keep patient clean
keep environment clean
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60
Q

how is gastroenteritis treated?

A

anthelmintics for young or unwormed adults
antibiotics if pyrexic or haemorrhagic diarrhoea
pro-biotics may be effective

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61
Q

why are NSAIDs contraindicated in treatment of gastroenteritis?

A

prostaglandins needed for maintenance of GI mucosa and renal blood flow

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62
Q

how are non-obstructive small gastric FB treated?

A

induce emesis
dogs- apomorphine
cats- xylazine

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63
Q

how are non-obstructive intestinal FB treated?

A

monitor passage with radiographs

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64
Q

how are non-obstructive gastric FB treated?

A

endoscopic retrieval

surgery

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65
Q

how are obstructive GI FB treated?

A

surgery

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66
Q

what is the consequence of GDV?

A

impaired venous return
compromised gastric mucosa
shock
death

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67
Q

what are potential causes for GDV?

A
deep chested, older dogs
diet
aerophagia
delayed emptying
exercise timing
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68
Q

how is GDV treated?

A

aggressive IVFT
decompression by stomach tube or needle paracentesis
IV antibiotics
surgical derotation and gastropexy

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69
Q

what is common after GDV?

A

cardiac arrhythmia

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70
Q

what is gastropexy?

A

tying stomach to wall of abdomen to reduce future risk of recurring GDV

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71
Q

what are some parasitic causes of acute vomiting and diarrhoea?

A

round worms
hook worms
whip worms
cestodes

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72
Q

what are some protozoal causes of acute vomiting and diarrhoea?

A

coccidia spp.

giardia spp.

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73
Q

who does tritrichomonas foetus effect and how is it spread?

A

young cats

faeco-orally

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74
Q

what is the effects of tritrichomonas foetus infection?

A

intractable diarrhoea
perianal oedema
faecal incontinence

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75
Q

how is tritrichomonas foetus diagnosed?

A

colonic wash

PCR

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76
Q

how is tritrichomonas foetus treated?

A

maturity provides immune response otherwise poor response to treatment
manage environment to prevent spread

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77
Q

what are causes of acute pancreatitis?

A

idiopathic

predisposing factors

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78
Q

what are predisposing factors for acute pancreatitis?

A
dietary indiscretion
high fat diet
hyperlipidaemia
impaired perfusion
truama
obesity
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79
Q

how does acute pancreatitis effect the body?

A

local release of pancreatic enzymes causing pancreatic autodigestion
severe local inflammation and cell necrosis
can have systemic inflammation and death

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80
Q

what are signs of acute pancreatitis?

A
inappetence
lethargy
abdominal pain
vomiting and diarrhoea
jaundice if bile duct obstruction
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81
Q

how is acute pancreatitis diagnosed?

A
history
physical exam
imaging
haematology
biochemistry
pancreatic lipase immunoreactivity sensitive test
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82
Q

what is treatment for acute pancreatitis?

A
supportive management
IVFT
keep up nutrition
analgesia
antiemetics
gastroprotectants
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83
Q

what is prognosis for acute pancreatitis?

A

guarded

death and recurrence possible

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84
Q

what diet should be given to acute pancreatitis patients?

A

highly digestible
complex carbs
low fat

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85
Q

what causes chronic pancreatitis?

A

repeated acute pancreatitis

low grade chronic pancreatitis

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86
Q

what are signs of chronic pancreatitis?

A

inappetence
lethargy
vomiting
diarrhoea

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87
Q

what is management for chronic pancreatitis?

A

modify diet
manage nausea and appetite
analgesia

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88
Q

define hyporexia

A

reduced appetite

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89
Q

define polyphagia

A

excessive appetite

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90
Q

define pica

A

appetite for non-nutritional substances

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91
Q

define ileus

A

reduced GI motility

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92
Q

define anorexia

A

loss of desire to eat

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93
Q

what are consequences of anorexia?

A
weight loss
impaired immune function
increased risk of sepsis
poor wound healing
slow recovery
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94
Q

list signs of chronic GI disease

A
altered appetite
dehydration
vomiting
BW or condition loss
borborygmi
flatus
abdominal discomfort
ascites or oedema
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95
Q

define borborygmi

A

gurgling

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96
Q

what causes chronic vomiting and diarrhoea?

A
gastric ulceration
dietary sensitivity
neoplasia
liver disease
kidney disease
pancreatitis
endocrine disease
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97
Q

how is chronic vomiting and diarrhoea diagnosed?

A
history
clinical exam
haematology
biochemistry
faecal analysis
absorption tests
imaging
gastroscopy
laparotomy
biopsy
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98
Q

how is chronic vomiting and diarrhoea treated?

A
treat underlying cause
exclude parasites
modify diet
vitamin B12
steroids
anti-emetics
appetite stimulants
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99
Q

what are causes of inappetance?

A
pain
stress
dehydration
hypokalaemia
nausea
delayed gastric emptying
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100
Q

how can you encourage inappetent patients to eat?

A
wet, warm, smelly food
preferred food and method
keep euhydrated and electrolyte balanced
anti-emetics
appetite stimulants
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101
Q

how can you provide nutritional support to inappetant patients?

A

feeding tubes

cobalamin supplements

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102
Q

define chronic enteropathies

A

chronic disease of SI

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103
Q

what is part of IBD complex?

A

food responsive diarrhoea
antibiotic responsive diarrhoea
idiopathic IBD

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104
Q

what is protein losing enteropathy?

A

severe SI disease resulting in severe malabsorption and loss of albumin and globulin
form of chronic enteropathy

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105
Q

what is the consequences of protein losing enteropathy?

A

weight loss
oedema
ascites
thromboembolism

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106
Q

what causes protein losing enteropathy?

A

IBD
lymphangiectasia
alimentary lymphoma or lymphosarcoma

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107
Q

how is protein losing enteropathy diagnosed?

A

endoscopy

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108
Q

what are dietary considerations for chronic enteropathies?

A
avoid allergens
highly digestible food
restrict fat
supplement fibre
feed little and often
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109
Q

what is EPI?

A

failure of normal exocrine secretions

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110
Q

what is the effects of EPI?

A

maldigestion

malabsorption

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111
Q

what causes EPI?

A

pancreatic acinar atrophy
common in GSD
recurrent pancreatitis

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112
Q

what are signs of EPI?

A

ravenous appetite
diarrhoea
fatty faeces as limited fat digestion
weight loss

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113
Q

how is EPI diagnosed?

A

trypsin like immunoreactivity serum test

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114
Q

how is EPI treated and what are downsides?

A

oral pancreatic extract

expensive and lifelong

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115
Q

describe diet for EPI

A
2-3 meals
enzyme at every meal
highly digestible
good quality protein
non-complex carbs
cobalamin supplement
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116
Q

define colitis

A

colonic inflammation

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117
Q

how is colitis treated?

A

anti-inflammatory sulfasalazine

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118
Q

what can be a side effect to colitis treatment?

A

keratoconjunctivitis sicca

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119
Q

what are signs of IBS?

A

LI diarrhoea

occasional vomiting

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120
Q

what is signalment for IBS?

A

anxious small breed dogs

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121
Q

how is IBS diagnosed?

A

exclusion of other causes

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122
Q

how is IBS treated?

A

long term diet modification
anti-spasmodics
anti-cholinergics

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123
Q

list causes of GI bleeding

A

coagulopathy

swallowed blood

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124
Q

what is seen from gastric or SI bleeding?

A

haematemesis

melaena

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125
Q

what is seen from LI bleeding?

A

haematochezia

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126
Q

define haematochezia

A

fresh blood in faeces

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127
Q

what are causes of GI ulceration?

A
NSAIDs 
steroids
FB
gastric carcinoma
hypoadrenocorticism
kidney or liver disease
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128
Q

how is GI ulceration treated?

A

treat underlying cause

surgery if perforates

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129
Q

what is constipation?

A

impaction of colon or rectum with faecal matter, usually excessive hard or dry

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130
Q

what is consequence of prolonged constipation?

A

irreversible changes

obstipation

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131
Q

define obstipation

A

excess faeces accumulation that cant be passed

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132
Q

what are signs of constipation?

A
infrequent defecation
dyschezia 
pain with defecation
vomiting
anorexia
lethargy
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133
Q

what causes constipation?

A
ingestion of FB
dehydration
drugs
stress
lack of toileting opportunity
pain preventing posturing
CNS disease
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134
Q

how is constipation and megacolon treated?

A
correct underlying cause
IVFT
correct electrolytes
oral laxatives
enema
surgery if needed
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135
Q

how can you manage and prevent constipation?

A
good water intake
control underlying disease
add fibre to diet
increase exercise
laxatives as needed
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136
Q

what causes megacolon?

A

idiopathic neuromuscular dysfunction

chronic underlying disease

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137
Q

state normal liver function

A

synthesis of proteins, glucose, cholesterol

clearance and detoxification of ammonia, bilirubin, bile acids, drugs

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138
Q

what are signs of hepatic dysfunction?

A
inappetence
lethargy
vomiting
diarrhoea
jaundice
ascites
synthesis failure
persistent drug activity
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139
Q

what causes jaundice?

A

failure of clearance of bilirubin causing yellow discolouration from hyperbilirubinemia and bile pigment deposition in tissues

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140
Q

what are the types of jaundice?

A

pre-hepatic- too much bilirubin to be cleared
hepatic- failure of hepatic uptake, coagulation and transport of bilirubin
post-hepatic- failure of bile excretion

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141
Q

what are causes of ascites?

A

hypoalbuminemia
portal hypertension
sodium and water retention

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142
Q

what causes failure of hepatic detoxification?

A

hepatic dysfunction

abnormal blood supply

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143
Q

what is the effect of failure of conversion of ammonia to urea?

A

hyperammonaemia

hepatic encphalopathy

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144
Q

what is the impact of build up of encephalopathic toxins?

A
fore brain dysfunction
lethargy
pacing
head pressing
seizures
coma
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145
Q

what precipitates hepatic encephalopathy?

A

high protein meal
vomiting
diarrhoea
diuretics

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146
Q

how is hepatic dysfunction diagnosed?

A
liver enzymes
bilirubin
bile acids
blood glucose
blood clotting
imaging
liver cytology
liver biopsy
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147
Q

what can cause acute liver disease?

A

hepatotoxins
infection
medication side effects

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148
Q

what are nursing considerations for acute liver disease?

A
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
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149
Q

how is nutrition managed for acute liver disease patients?

A

restrict animal protein
hepatic prescription diet
restrict copper
antioxidant supplements

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150
Q

what are causes of chronic inflammatory liver disease?

A
chronic hepatitis
lymphocytic cholangitis
infectious cholangitis 
leptospirosis
chronic FIP
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151
Q

how is chronic inflammatory liver disease treated?

A
de-coppering therapy
antibiotics if indicated
modify diet
anti-oxidants
steroids
hepatic encephalopathy therapy
manage ascites
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152
Q

what is gall bladder mucocoeles?

A

gall bladder full of insipidated bile and mucus

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153
Q

what are signs of gall bladder mucocoeles?

A

asymptomatic
obstructed bile flow
rupture

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154
Q

how is gall bladder mucocoeles treated?

A

medication

gall bladder removal

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155
Q

what is feline hepatic lipidosis?

A

hepatocyte triglyceride deposition

when anorexic fat stores mobilise for energy then accumulate in liver

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156
Q

what predisposes to feline hepatic lipidosis?

A

obesity
high fat or carb diet
systemic illness
diabetes mellitus

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157
Q

what are the effects of feline hepatic lipidosis?

A
intracellular fat accumulation
liver failure
encephalopathy
coagulopathy
death
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158
Q

how is feline hepatic lipidosis treated?

A
treat underlying diseases
nutritional support
enough protein
antioxidants
often 6-8 weeks tube feeding
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159
Q

state the types of portosystemic shunt

A

single

acquired/multiple

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160
Q

list signs of portosystemic shunt

A

dullness
lethargy
inappetance
history of GI signs

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161
Q

how are portosystemic shunts diagnosed?

A
abnormal liver function
low albumin
low cholerterol
high bile acids
high ammonia
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162
Q

what is the effects of portovascular abnormalities?

A

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

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163
Q

how are portosystemic shunts treated?

A
hydrated and normal blood potassium
restrict protein
lactulose to trap ammonia in colon
antibiotics to minimise ammonia produced by gut flora
close surgically
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164
Q

what are signs of hepatic neoplasia?

A

asymptomatic
hepatic or obstructive signs
rupture causing haemoabdomen

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165
Q

what are types of hepatic neoplasia and how are they treated?

A

primary- surgery
infiltrive, lymphomas- chemo
metastatic, carcinomas- none

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166
Q

why are dry food diets reccomended?

A

balanced nutrients
convenient
good for dental hygiene

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167
Q

state the most important nutrient

A

water

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168
Q

how much water is needed a day?

A

50ml/kg/day

affected by factors such as exercise, weather

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169
Q

list fat soluble vitamins

A

A
D
E
K

170
Q

why is it important not to have too many fat soluble vitamins in the diet?

A

they get stored in fat reserves and not excrete

171
Q

state the water soluble vitamins

A

B

C

172
Q

are water soluble vitamins stored in the body?

A

no

173
Q

why is it important to get the right amount of vitamins?

A

energy metabolism
biochemical reactions
deficiency syndromes

174
Q

list macrominerals

A
calcium
phosphorus 
magnesium
sodium
potassium
chloride
sulphur
175
Q

list microminerals

A
iron
copper
zinc
manganese
iodine
selenium
176
Q

which type of minerals are most important?

A

microminerals

177
Q

what is an essential amino acid?

A

amino acid not synthesised by the body

178
Q

why are cats obligate carnivores?

A

need to take in taurine through diet as cant synthesise it

179
Q

how many amino acids are there?

A

23

180
Q

state the function of protein

A

regulate metabolism
cell and muscle fibre structure
tissue growth and repair
energy

181
Q

define biological value

A

amount of protein utilisable

182
Q

how is biological value assessed?

A

acceptable
digestible
utilisable
bioavailability

183
Q

what is the consequence of excess protein?

A

liver and kidney issues

184
Q

list effects of protein deficiency

A
poor growth
muscle loss
weight loss
dull hair
reduced immunity
oedema
death
185
Q

what is the function of fats?

A

energy
absorption of fat soluble vitamins
enhance palatability
source of EFA

186
Q

what is the effect of lack of fat in diet?

A

energy deficiency
impaired reproduction
impaired wound healing
dry coat and skin

187
Q

what are the types of carbohydrates and examples of each?

A

monosaccharide- glucose, fructose
disaccharides- maltose, lactose, sucrose
polysaccharides- starch, glycogen, fibre

188
Q

what is the function of carbohydrates?

A

energy
fat stores
precursor for AA and glycerol

189
Q

what is dietary fibre and examples?

A

indigestible polysaccharides

cellulose, lignin, pectin

190
Q

what is the function of fibre?

A

bulk faeces
prevent constipation and diarrhoea
keep full for longer
blood glucose regulation in diabetes

191
Q

what is meant by metabolizable energy?

A

kcal/100g food

192
Q

what is gross energy of food?

A

all energy of the food by not all available to the animal

193
Q

define BER

A

amount exerted in sleep 12-18 hours after feeding in thermoneutral environment

194
Q

define RER

A

includes energy for recovery from activity and feeding

195
Q

define MER

A

energy required by moderately active animal not including growth, lactation, work

196
Q

what needs considering when calculating MER?

A

life stage factors

197
Q

state the calculation of RER

A

70 x BW^0.75 if less than 2kg or over 45kg

otherwise (30 x BW) + 70

198
Q

how do you calculate how much to feed an animal?

A

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

199
Q

which energy requirements are used for sick and healthy animals?

A

sick- RER

healthy- MER

200
Q

how is MER calculated?

A

RER x appropriate life stage factor

201
Q

define obesity

A

excess accumulation of body fat

202
Q

what predisposes to obesity?

A

neutering
overfeeding
poor owner knowledge

203
Q

list consequences of obesity

A
hepatic lipidosis
joint disease
exercise intolerance
diabetes mellitus 
skin disease
cardiorespiratory disease
risk in surgery
FLUTD
204
Q

what is ideal amount of weight to lose a week?

A

1-2% BW

205
Q

describe how to implement weight loss for patients

A

change diet
gradually build up exercise
base MER of ideal weight
individually tailored

206
Q

what is the effect of starvation when trying to lose weight?

A

excess loss of muscle mass
body function problems
hepatic lipidosis

207
Q

what are features of obesity diet?

A

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

208
Q

what problems GI diets be used to treat?

A
diarrhoea
gastritis
enteritis
IBD
maldigestion
EPI
209
Q

what are features of GI diets?

A

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

210
Q

what are hypoallergenic diets used for?

A

manage food allergy
food elimination trials
EPI
IBD

211
Q

what are features of hypoallergenic diets?

A

hypoallergenic and highly digestible hydrolysed or novel proteins
nutrients support skin, GI mucosa and healthy intestinal environment

212
Q

what are the effects of pancreatitis if not treated?

A
renal failure
acute lung injury
chronic pancreatitis
EPI
death
213
Q

what is the feature of convalescent diets?

A

protein provides 30-50% total energy source

214
Q

state consideration for use of convalescent diets

A

due to high protein care with renal failure or hepatic encephalopathy as reduced ability to deal with protein

215
Q

why do critical care patients have high risk of malnutrition?

A

catabolism and rapid breakdown of protein and energy stores

216
Q

what nutrition should be given to critical care nutrition?

A

oral nutrition as early as possible
enough energy sources
EFAs
micronutrients

217
Q

how do dental diets help dental health?

A

mechanically remove plaque if hard food
phosphate salts reduce mineralisation of plaque
chews reduce plaque

218
Q

what nutrients are needed for skeletal development and maintenance?

A

calcium
phosphorus
vitamin D

219
Q

what are examples of conditions that can be helped by orthopaedic diets?

A

osteoarthritis
joint dysplasia
CCLR
luxating patella

220
Q

how do orthopaedic diets help?

A

manage weight
omega 3s to manage inflammation
help cartilage repair or slow degeneration

221
Q

how can diets help diabetes mellitus?

A

achieve and maintain normal serum glucose levels
decrease peaks of glucose post feeding
help normal metabolism
normalise body weight

222
Q

what are features of diabetes diets?

A

high protein
low fat
low soluble carbs
fibre

223
Q

describe diet for hyperthyroidism

A

0.2ppm iodine dry matter base
hills y/d
exclusive feeding

224
Q

what are feeding considerations for cardiac diets?

A

mild sodium restriction
maintain ideal BCS
monitor for cachexia

225
Q

define cachexia

A

muscle loss in presence of disease

226
Q

what are features of cardiac diets?

A

taurine as deficiency linked to DCM
L-carnitine for myocardial energy requirement
arginine for vascular tone
omega 3s

227
Q

define -otomy

A

cutting open tissue which is then repaired to allow normal healing

228
Q

define -ostomy

A

creation of opening to outside of skin

if device removed keeping open wound either heals closed or as permanent stoma

229
Q

define -oscopy

A

device to visualise inside cavity

230
Q

define -ectomy

A

removal of part or all of structure

231
Q

list roles of vet nurse in GI surgery

A
pre op care of animal
surgical prep of animal 
equipment prep
assistance in surgery
anaesthetic monitoring
post op care
232
Q

what are pre op considerations for GI surgery?

A

usually emergency and unwell

stabilise fluids and electrolytes before anaesthesia

233
Q

how are GI patients prepared for surgery?

A

starve for 12 hours ideally but not always possible if emergency
specific condition management
flush mouth with sterile saline if oral surgery

234
Q

what are other considerations for GI surgery?

A

antibiotics during and post op
keep warm as lose lots of heat from abdomen
seal ETT as high risk of regurgitation

235
Q

list equipment used in GI surgery

A
laparotomy swabs
suction
histopathology swabs
retractors
bowel clamps
2 surgical kits to prevent contamination
pre-warmed saline
stomach tube
endoscope
236
Q

state role of vet nurses in GI surgery

A

clamp bowels
keep GI contents moist with saline
separate contaminated instruments
suction

237
Q

what type of suture materials are used for GI surgery and why?

A

short duration absorbable as quick healing

synthetic monofilament to prevent wicking in infection

238
Q

what needles are used for GI surgery suturing and why?

A

round body

least traumatic

239
Q

why are antibiotics used in GI surgery?

A

considered clean contaminated procedure

contaminated if questionable tissue viability or contamination occurs

240
Q

what is oral surgery used for?

A
oral tumours
oronasal fistula
cleft palette
foreign body
penetrating injuries
241
Q

what are pre-op considerations for oral surgery?

A

saline flush to remove debris
positioning
anaesthesia

242
Q

what are post op considerations for oral surgery?

A

ensure can eat and drink
soft food
feeding tube as needed

243
Q

what conditions is oesophageal surgery used for?

A

FB by endoscope or surgical removal from stomach

stricture

244
Q

what are pre-op considerations for oesophageal surgery?

A

manage dehydration and hypovolaemia

IVFT

245
Q

state post op considerations for oesophageal surgery

A

feeding tubes to allow oesophagus to heal

liquid diet

246
Q

what are reasons for gastric surgery?

A
FB
pyloric obstruction
neoplasia
GDV
tube gastrotomy
247
Q

what are pre-op and intra-op considerations for gastric surgery?

A

IVFT for dehydration and hypovolaemia
prepare surgical site
monitor heat loss

248
Q

what are post op considerations for gastric surgery?

A

low fat bland diet
liquid diet if obstruction
IVFT
monitor for arrhythmia if GDV

249
Q

describe treatment plan for GDV

A
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
250
Q

what are types of SI surgery?

A

biopsy
enterotomy for FB removal
enterectomy to removed section
intussusception repair or resection

251
Q

what are pre- and intra-op considerations for SI surgery?

A
IVFT
keep abdomen moist during surgery
prepare wide surgical site
monitor temperature
surgical assistant
252
Q

what are post-op considerations for LI surgery?

A

manage biopsy samples
encourage eating low fat diet
encourage drinking

253
Q

why does LI surgery have more risk than SI surgery?

A

increased bacterial load

slower healing

254
Q

what are examples of LI surgery?

A

biopsy

colectomy

255
Q

list intra-op considerations for LI surgery

A

avoid enemas as slurry more likely to spill

antibiotics

256
Q

what are post op considerations for LI surgery?

A

manage biopsy samples

nutrition to support healing

257
Q

when is anal and rectal surgery performed?

A
polyps or tumours
prolapse
imperforate anus
anal sac removal
anal furcunculosis
258
Q

what is imperforate anus?

A

congential condition where anus doesnt join rectum

259
Q

why is anal sac removal performed?

A

chronic sacculitis, impaction and abscessation

260
Q

what are signs of rectal polyps or tumours?

A

tenesmus
bleeding
discomfort

261
Q

what is anal furcunculosis?

A

inflammatory disease almost exclusively in GSD

262
Q

what are pre-op considerations for anal surgery?

A

positioning
keep prolapses moist and lubricated
purse string placement

263
Q

state post op considerations for anal surgery

A

nutritional support to aid healing

264
Q

how does peritonitis happen?

A

irritation or contamination to peritoneum causing inflammatory response

265
Q

why is peritonitis life threatening?

A

infection develops and rapidly causes severe illness, sepsis, shock, CV collapse

266
Q

list signs of peritonitis

A
pyrexia
anorexia
depression
tachycardia
vomiting
ascites
abdominal pain
267
Q

how is peritonitis treated?

A
exploration to find source of contamination
lavage abdomen
provide open peritoneal drainage
IVFT
monitor blood albumin and electrolytes
268
Q

what are common complications following GI surgery?

A
hypothermia
hypovolaemia
hypotension
hypoglycaemia
nausea
dehydration
269
Q

what is post op care for GI surgery?

A

wound care
analgesia
monitor for dysphoria

270
Q

list some immediate post op complications following GI surgery

A
physiological abnormalities worsening
pain
haemorrhage
drug reaction
vomiting and regurgitation
wound breakdown
271
Q

what are longer term post op complications for GI surgery?

A
pain
haemorrhage
aspiration pneumonia
ileus
infection
272
Q

what are features of GI post op care plans?

A

tailored to individual
3-5 careful observation in or out of hospital
monitor for abnormalities
manage hydration with IVFT until eating and drinking normlly

273
Q

describe nutrition plans for post GI surgery

A

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

274
Q

what are signs of nausea?

A

salivation
swallowing
lip-licking

275
Q

what drugs can help prevent nausea?

A

maropitant
metoclopramide
ranitidine
omeprazole

276
Q

what types of medications can be used post GI surgery?

A
prokinetics
probiotics
appetite stimulants
analgesia
anti-emetics
277
Q

why are NSAIDs not recommended post GI surgery?

A

cause GI ulceration and upset

278
Q

define dehiscence

A

disruption of wound edges

279
Q

when is dehiscence mostly seen?

A

3-5 days post op

280
Q

list most common areas affected by dehiscence

A

skin
abdominal wall
intestines

281
Q

what are clinical signs of dehiscence?

A

serosanguinous or purulent discharge from suture line
swelling
necrosis of edges

282
Q

what is the effect of abdominal wall dehiscence?

A

hernia

283
Q

what are clinical signs of abdominal wall dehiscence?

A

oedema
inflammation
serosanguinous drainage
painless swelling

284
Q

what is the effect of intestinal dehiscence?

A

septic peritonitis

285
Q

list clinical signs of intestinal wall dehiscence?

A
depression
anorexia
vomiting
abdominal pain
acute collapse
286
Q

list risk factors for dehiscence

A
wound tension
suture choice
self trauma
underlying neoplasia
closing non-viable skin
endocrine disease
obesity
immunocompromise
hypovolemia
287
Q

how can dehiscence be prevented?

A

bandaging to immobilise
collar to prevent trauma
confined and exercise restricted

288
Q

what is primary cause of peritonitis?

A

cats with FIP

289
Q

what are secondary types of peritonitis?

A

aseptic

septic

290
Q

what are causes of peritonitis?

A

dehiscence
ischaemic necrosis
infection

291
Q

list complications associated with oesophageal surgery

A

regurgitation
oesophagitis
strictures
swallowing affecting healing

292
Q

list complications associated with gastric surgery

A
vomiting
anorexia
ulceration
gastric obstruction
pancreatitis
293
Q

list common gastric surgery performed in first opinion

A

gastrotomy for FB

gastropexy

294
Q

list complications associated with SI surgery

A
adhesions from excess handling
ileus
perforation
stenosis
intestinal strictures
diarrhoea
anorexia
295
Q

define stenosis

A

constriction of lumen

296
Q

what are common SI surgery performed in first opinion?

A

enterotomy for FB

enterectomy for intussucception

297
Q

list complications associated with LI surgery

A
haemorrhage
faecal contamination
leakage
stricture
stenosis
incontinence
298
Q

list complications associated with perineum, rectal and anal surgery

A
tenesmus
rectal prolapse
incontinence
anal stricture
urethral obstruction
stenosis
299
Q

define colic

A

abdominal pain of any origin

300
Q

what is significant about colic?

A

clinical signs of many GI conditions

most die of colic

301
Q

list signs of colic

A

rolling
pawing
flank watching
lip curling

302
Q

what is the purpose of clinical exam for colic patients?

A

determine if needs emergency surgery

303
Q

list what is assessed in clinical exam for colic

A
CV status
HR
RR
temperature
haematocrit
TP
lactate
abdominal exam
rectal exam
ultrasound
abdominoparacentesis
oral exam
gastroscopy
radiography
304
Q

why is assessment of CV status important in colic patients?

A

acute GI conditions can lead to endotoxemia, dehydration, shock, coagulation disorders

305
Q

describe how abdominal exam in horses is done

A

auscultate 4 quadrants

observe for distension

306
Q

what can be identified from rectal exam of horses?

A

distension
impaction
displacement
limited one part of abdomen

307
Q

why are stomach tubes lifesaving in horses?

A

they cant vomit so prevents stomach rupture if outflow is obstructed

308
Q

what is a risk of stomach tubing in horses?

A

nose bleed

309
Q

what is the disadvantage of ultrasounding horses abdomens?

A

can only see 15cm deep so doesnt prove no issues

310
Q

what is an abdominoparacentesis?

A

belly tap of peritoneal fluid

311
Q

what can abdominoparacentesis in horses show?

A
intestinal damage
hamoperitoneum
rupture
inflammatory cells
neoplasia
312
Q

what are gastroscopy in horses used for?

A

look for ulceration
look for outflow obstruction and impactions
biopsies

313
Q

list tests that are done on horses with colic

A
bloods
peritoneal fluid cytology and appearance
FEC
faecal culture
glucose absorption test
laparoscopy
314
Q

why do horse teeth need rasping once a year?

A

less grinding than wild horses so can form sharp edges

if not corrected can cause dysphagia and impaction

315
Q

list examples of dental disease in horses

A
eruption disorders
dental decay
peritoneal disease
fractured tooth
diastema
316
Q

how are equine dental diseases examined?

A

watch eating
palpate
sedate and wash out mouth to examine

317
Q

list some treatment options for dental disease in horses

A

filling or widening to prevent things getting stuck

removal of teeth

318
Q

what are downsides of tooth extraction in horses?

A

opposite tooth wont be ground down

hard to remove

319
Q

define oesphageal choke

A

obstruction

320
Q

list causes of oesophageal choke in horses

A
eating to fast
dry concentrate
poor dentition
oesophageal damage from previous choke
mass
321
Q

state clinical signs of oesophageal choke in horses

A
neck extended
food coming from food
gag
cough
dehydration
weight loss
acid base imbalance
aspiration pneumonia
322
Q

what are problems associated with oesophageal choke in horses?

A

damaged oesophagus
acute oesophageal rupture
strictures

323
Q

how is oesophageal choke diagnosed in horses?

A
auscultation
CV parameters
bloods
gastroscopy
imaging
stomach tube to determine site of blockage
324
Q

how is oesophageal choke treated in horses?

A

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

325
Q

what are stages of gastroduodenal ulceration in horses?

A

inflammation
erosion
ulceration
perforation

326
Q

how are gastroduodenal ulcers graded in horses?

A

0-4

none to bleeding

327
Q

what causes gastroduodenal ulcers in horses?

A

imbalance between inciting and protective factors

328
Q

list inciting factors in equine stomach

A

HCl
bile acids
pepsin

329
Q

list protective factors in equine stomach

A
mucus-bicarbonate layer
mucosal blood flow
mucosal prostaglandin E
epidermal growth factor production
gastroduodenal motility
330
Q

state risk factors for gastroduodenal ulcers in horses

A
empty stomach
exercise
diet
stress
NSAIDs
hospitalisation
331
Q

list clinical signs of gastroduodenal ulcers in horses

A
poor appetite
colic
tooth grinding
diarrhoea
poor performance
332
Q

how is gastroduodenal ulcers diagnosed in horses?

A

gastroscopy

interpretation as presence doesn’t mean significance

333
Q

how are gastroduodenal ulcers in horses treated?

A

dependent on cause
general management
omeprazole for adults
sucralfate for foals

334
Q

list causes of primary gastric dilation and rupture in horses

A
gastric impaction
grain engorgement
colic
unknown cause
idiopathic
335
Q

list secondary causes of gastric dilation and rupture in horses

A

SI or LI obstruction
ileus
functional obstruction

336
Q

list clinical signs of gastric dilation and rupture in horses

A
over filling of stomach
acute colic
tachycardia
fluid from nose just before rupture
dehydration
337
Q

how is gastric dilation and rupture in horses diagnosed?

A

clinical signs
reflux
colic work up
gastroscopy

338
Q

how do you treat gastric over filling and rupture in horses?

A

stomach tubing
treat underlying cause
IVFT
IV nutrition if needed

339
Q

what is anterior enteritis in horses?

A

inflammatory condition affecting proximal SI

340
Q

what is a risk factor for anterior enteritis in horses?

A

diet change to high concentrate

341
Q

list clinical signs of anterior enteritis in horses

A

hypersecretion
functional ileus secondary to inflammation
distended SI and stomach
pyrexia

342
Q

how is anterior enteritis diagnosed in horses?

A

colic investigation
peritoneal fluid with raised protein
culture reflux
ex-lap

343
Q

how is anterior enteritis treated in horses?

A
repeated stomach tubing
antibiotics
IVFT
no feeding by mouth
analgesia 
ex-lap
SI decompression
344
Q

what is prognosis for anterior enteritis in horses?

A

varies survival as treatment expensive and long but those that do have it is good prognosis

345
Q

what can cause malabsorption and maldigestion in horses?

A

inflammatory type diseases

lymphosarcoma

346
Q

what is the clinical sign of malabsorption and maldigestion in horses?

A

weight loss

347
Q

how is malabsorption and maldigestion in horses diagnosed?

A

abdominoparacentesis
ultrasound
oral glucose tolerance test
laparoscopic biposy

348
Q

how is malabsorption and maldigestion in horses treated?

A

depends on diagnosis
resection
corticosteroids
no treatment

349
Q

what is a simple obstruction in horses?

A

obstruction of intestinal lumen without obstruction to blood flow

350
Q

what can cause simple SI obstructions in horses?

A

food
ileal hypertrophy
adhesions

351
Q

what is strangulation of intestines in horses?

A

occlusion of lumen and blood supply so intestine dies

352
Q

what are causes of strangulation in horses?

A
lipoma
SI volvulus
mesenteric rent
inguinal diaphragmatic hernia
intussucception
353
Q

list effects of SI obstruction in horses

A
gastric overfilling 
deterioration of intestinal mucosa
intestinal death
sepsis
endotoxemia
354
Q

what are signs of SI obstruction in horses?

A
colic, eases when gut dead
reflux
tachycardia
hypovolaemia
distended SI
serosanguinous, protein and lactate in peritoneal fluid
355
Q

how are SI obstructions in horses treated?

A

surgery with 3-4 months rest

euthanasia

356
Q

what is prognosis for SI obstructions in horses?

A

80% short term survival

60-70% long term survival depending on severity of presentation

357
Q

what are causes of caecal impaction in horses?

A

underlying motility disorder

after ortho procedures in young horses

358
Q

list clinical signs of caecal impaction in horses

A

colic
rupture
severe shock
death

359
Q

how is caecal impaction in horses diagnosed?

A

clinical signs
history
rectal exam
abdominoparacentesis

360
Q

how are ceacal impactions in horses treated?

A

medical
surgery
IVFT

361
Q

what is prognosis for caecal impactions in horses?

A

90% success as most caught early

362
Q

what are the types of caecal intussusception in horses?

A

ileo-caecal

caeco-ceacal

363
Q

what is signalment for caecal intusucception in horses?

A

young horses
tapeworms causing inflammation
reduced motility

364
Q

list clinical signs of caecal intussusception in horses

A

varies
colic
can be chronic

365
Q

how is caecal intussusception diagnosed in horses?

A

rectal exam

ultrasound

366
Q

how is caecal intussusception in horses treated?

A

surgery

treat tapeworms

367
Q

what are causes of simple LI obstructions in horses?

A

impaction

displacement

368
Q

what are causes of LI strangulation in horses?

A

torsion

369
Q

where are LI obstructions in horses normally?

A

pelvic flexure

370
Q

what are causes of LI obstruction in horses?

A

poor teeth
ingesting long fibre
motility disorder
box rest

371
Q

list clinical signs of LI obstruction in horses

A

mild colic

reduced faecal output

372
Q

how are LI obstructions in horses diagnosed?

A

rectal exam

abdominoparacentesis

373
Q

how are horses with LI obstruction treated?

A

IVFT
cathartics to move water to gut
analgesia
surgery

374
Q

why does Li displacement happen in horses?

A

lots of space for intestines to move around

375
Q

state types of LI displacement in horses

A

right dorsal
left dorsal
nephrosplenic entrapment

376
Q

how are LI displacements managed and treated?

A
may resolve
medication
starve to empty and deflate gut so returns to normal
IVFT
analgesia
surgery
377
Q

how are LI displacements diagnosed in horses?

A

rectal exam
ultrasound
abdominoparacentesis
surgery

378
Q

when do LI torsions tend to happen in horses?

A

spontaneously

following displacement

379
Q

list signs of LI torsion in horses

A

extreme pain
abdomen distension
respiratory compromise

380
Q

how is LI torsion in horses diagnosed?

A

rectal exam

381
Q

how is LI torsion in horses treated?

A

surgery

may need resection

382
Q

what is prognosis for LI torsion in horses?

A

depends on damage to LI

can recur

383
Q

what are causes of acute diarrhoea in horses?

A
salmonella
colitis
neoplasia
food hypersensitivity
toxicity
384
Q

what causes chronic diarrhoea in horses?

A
dental disease
dietary sensitivity
parasites
IBD
neoplasia
385
Q

how is diarrhoea diagnosed in horses?

A
CV parameters
rectal exam
ultrasound
abdominoparacentesis
rectal biopsy
FEC and culture
386
Q

how is diarrhoea in horses treated?

A
hydration
electrolytes
laminitis prevention
treat underlying cause
give antibiotics
keep feeding
nursing care
387
Q

what are causes of small colon impaction in horses?

A

foreign bodies

salmonella

388
Q

what are signs of small colon impaction in horses?

A

intermittent diarrhoea

colic

389
Q

how is small colon impaction in horses treated?

A

medication

surgery

390
Q

what are signs of peritonitis in horses?

A

mild colic

pyrexia

391
Q

how is peritonitis in horses diagnosed?

A

abdominoparacentesis showing high WBCs

392
Q

how is peritonitis in horses treated?

A

antibiotics
laparoscopy
laparotomy

393
Q

what can be causes of secondary peritonitis in horses?

A

colic surgery

394
Q

what are reasons for equine GI surgery?

A

normally colic related

occasionally due to laparotomy or laparoscopy

395
Q

what tests influence the decision to perform emergency colic surgery decided?

A
pain
clinical exam
rectal exam
peritoneal fluid analysis
bloods
ultrasound findings
396
Q

what are colic finding indicating possible surgery?

A
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
397
Q

what practicalities need considering for colic surgery?

A

expensive, unsuccessful cases often most
transport to hospital
prognosis
complications

398
Q

list preparations for colic surgery

A
jugular IV placement
NG tube to decompress stomach
analgesia
antibiotics
IVFT
clip abdomen
remove shoes and tape feet
wash out mouth
399
Q

describe how NG stomach tubes are placed for stomach decompression in horses

A

tube passed through ventral meatus with head flexed to encourage passage to oesophagus
confirm placement by observing left side of neck

400
Q

what preparations are needed for horses laparotomy?

A
dorsal recumbency for dorsal midline incision
urinary catheter
clip and prep abdomen
cover legs and feet
drape
401
Q

what are principles of colic surgery?

A
exploration of abdomen and intestines
identifying lesions
correct displacements
decompression of distended viscera
resection of devitalised tissue
402
Q

what is functional intestinal obstruction?

A

peristalsis fails to propel ingesta causing distention

403
Q

what are the consequences of strangulation of intestines in horses?

A
death of section of intestine
oedematous thickening of gut wall
endotoxin release
shock
laminitis
404
Q

how does strangulated small intestines in horses cause issues?

A

strangulated section dies

mucosa becomes permeable to endotoxins which leak into peritoneal cavity and circulation

405
Q

how are SI resections done in horses?

A

isolate segment with bowel clamps
ligate blood vessels supplying segment
resect segment

406
Q

how are simple or functional SI obstructions treated in horses?

A

decompression

removal of obstruction by enterotomy

407
Q

what is prognosis for intestinal obstructions in horses?

A

simples- good when resolved

strangulating is worse

408
Q

what are risks for strangulation resection in horses?

A
contamination
peritonitis
endotoxic shock
ileus
adhesions
409
Q

how are LI displacements in horses treated?

A

decompression of bowel
evacuation of colon via pelvic flexure enterotomy
correct displacement
coloplexy to prevent recurrence

410
Q

what are causes of large colon volvulus in horses?

A

unknown but usually larger horses or brood mares 90 days post foaling

411
Q

what are signs of equine large colon volvulus?

A
sudden onset abdominal pain
enlarged colon on rectal exam
abdominal distension
endotoxemia
high HR
poor peripheral perfusion
412
Q

how is large colon volvulus treated in horses?

A

surgery to correct

removal of ischemic colon

413
Q

what effects the prognosis for large colon volvulus in horses?

A

time from onset of condition to surgery

414
Q

what are post op care for horses after GI surgery?

A
exam every 2-4 hours
analgesia
antibiotics
IVFT
monitoring for complications
bloods
NG tubing as needed
415
Q

list possible complications following GI surgery in horses

A
endotoxemia
ileus
jugular thrombophlebitis
obstruction
anastomosis leakage
peritonitis
adhesions 
laminitis
colitis
infection
416
Q

what needs monitoring in horses following GI surgery?

A
pain
pyrexia
faecal output
gut sounds
reflux through NG tube
incision
catheter
feet
respiratory system
417
Q

describe how horses are fed after GI surgery

A

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

418
Q

what are exercise requirements post GI surgery in horses?

A

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

419
Q

how is endotoxemia in horses treated?

A

IVFT
flunixin
polymyxin
hyperimmune plasma

420
Q

what are signs of endotoxemia in horses?

A
pyrexia
tachycardia
tachypnoea
hyperaemic MM
colic
421
Q

how is ileus treated in horses?

A

IVFT
stomach tube decompression
prokinetics