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ACVIM Specialty: Ettinger - MS 2023 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What are the 5 cranial nerved involved in oesophageal motility?

A

Trigeminal (V)
Facial (VII)
Glossopharyngeal (IX)
Vagus (X)
Hypoglossal (XII) - motor only, the rest are sensory and motor

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2
Q

Distribution of striated vs. skeletal muscle in oesophagus of cats vs. dogs

A

Dogs have striated muscle all the way down, cats only in the proximal 2/3

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3
Q

Which muscle makes up the upper oesophageal sphincter?

A

Cricopharyngeus muscle

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4
Q

Breed predisposition to the following that may result in dysphagia:
a) Pharyngeal weakness
b) Cricopharyngeal achalasia
c) Muscular dystrophy
d) Inflammatory myopathies
e) Masticarotry muscle disorders

A

a) Golden retrievers
b) Cocker and springer spaniels
c) Bouvier des Flandres, CKCS
d) Boxers, Newfoundlands
e) Large breed dogs

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5
Q

Breeds predisposed to congenital MegaO

A

Megaoesophagus Should Not Get Food Stuck In their Lower oesophagus

Miniature shnuazers, SharPei, Newfoundland, GSD, Great Dane, Fox Terriers, Siamese, Irist setters, Labradors

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6
Q

What percentage of dogs with MG may have pharyngael weakness as their only clinical sign?

A

1%

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7
Q

What is the anatomical cause of cricopharyngeal achalasia

A

Thickening of the cricopharyngeus muscle

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8
Q

What is the most common vascular ring anomaly in dogs? Which breed(s) are predisposed?

A

Persistent right aortic arch - GSD and Irish Setters

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9
Q

Most common oesophageal neoplasias in dogs vs. cats

A

Fibrosarcoma and osteosarcoma (can results from Spirocerca granuloma transformation).

Cats = SCC

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10
Q

Which breed is predisposed to congenital oesophageal fistulas?

A

Cairn terriers

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11
Q

Why are prokinetics unlikely to be useful in the management of oesophageal dysmotility/megaoesophagus disorders?

A

None of the prokinetics affect striated muscle. Can actually make the signs worse.

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12
Q

What percentage of MG patients with megaO will respond to therapy?

A

Approximately 50%

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13
Q

What is the proposed mechanism of action of sildenafil in the treatment of congenital idiopathic megaoesophagus?

A

It decreased LES tone

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14
Q

What are the types of hiatal hernia in dogs and the most common

A

I = sliding of the abdominal oesophagus and stomach throguh the oesophageal hiatus, this is most common
II = paraoesophageal = stomach only moving into the oesophagus
IV = liver, stomach and SI displaced into the thorax.

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15
Q

Breeds predisposed to hiatal hernia

A

Brachys: Pug, EBD, FBD, Boston
NonBrachy: Shar-Pei, Chow Chow

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16
Q

Treatment of hiatal hernia?

A

Treat medically for oesophagitis initially
BOAS surgery
Pexy

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17
Q

What are the main family of bacteria present within the gastric flora?

A

Proteobacteria (99.6%) - this includes helicobacter spp.
Firmicutes (0.3%)

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18
Q

Breeds predisposed to hypertrophic gastropathy

A

Drentse Patrijshond
Basenji
Shih Tzu (pyloric)

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19
Q

Breeds predisposed to atrophic gastritis

A

Lundehunde

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20
Q

Breeds predisposed to gastric neoplasia

A

Belgian Shepherd
Rough collie
SBT
Lundehunde

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21
Q

What acid-base abnormality can develop with a pyloric outflow obstruction?

DDx for this metabolic abnormality

A

Hypochloraeimc metabolic alkalosis with paradoxical renal aciduria- this occurs when Cl loss exceeds HCO3 loss.

Paradoxical aciduria occurs because the kidney will attempt to re-absorb Na in a attempt to concserve water. HCO3 is also reabsorped. Na/H+ exchagne leads to loss of H+ in the urine.

DDx. is parvoviral enteritis and increased gastric acid secretion (e.g. with gastrinoma).

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22
Q

Gastric Secretory Testing:
- Methods
- Interpretation

A

IV secretin, calcium should increase serum gastrin
pentagastrin or bombesin can also stimualte gastric acid secretion

Interpretation:
- pH <3 with increase gastrin is inappropropriate and may indicate gastrinoma
- pH > 3 and increased gastrin could indicate achlorhydria

n.b. basenji can have increased gastrin in the abscence of a gastrinoma

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23
Q

Parasitic causes of (acute) gastritis

A

Ollanus spp. physaloptera spp.

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24
Q

DDx for GI ulceration

A
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25
Q

Mortality rates and prognositc indicators for GDV

A

10 -15% mortality
Px facrtors:
- Gastric necrosis/need for resection
- Arrythmias at any time
- length of time prior to presentation
- Lck fo decrease in serum lactate within 12h of hospital admission

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26
Q

What percentage of dogs with chronic vomiting have chronic gastritis?

A

35%

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27
Q

What is the most common histologic feature of chronic gastritis?

A

Mild to moderate superficial lymphoplasmacytic gastritis with follicular hyperplasia

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28
Q

Most predominant helicobacter species in dogs and cats

A

H. heilmanni cats
H. bizzozeronii in dogs

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29
Q

What has gastric hypertrophy in Drentse Patrijshonds been associated wi

A

Stomatocytosis, haemolytic anaemia, icterus and polyneuropathy

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30
Q

What diease are Lundehunds prdisposed to?

A

Gastric mucosal atrophy and is associated with PLE/gastric adenocarcinoma

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31
Q

Where in the USA is pythiosis more likely to occur?

A

Mexico
Florida
Alabama
Louisiana
Mississipi

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32
Q

What endoscopic findings would be expected with the following gastric parasites:
a) Ollanus spp
b) Pysaloptera spp.

A

a) Parasitic nodules
b) Worms

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33
Q

What do the following stains indicate on gastrointestinal biopsy samples:
a) H&E
b) Modified Steiner’s stain
c) Gomori’s methanamine silver
d) Massons trichrome
e) Siriuis red
f) Acion blue
g) ICC
h) Mucin

A

What stains can be used to highlight the following on gastrointestinal biopsies?

a) tissue architechture and cellularits
b) Spiral bacterial
c) Fungal organisms
d) Fibrosis
e) eosinophils
f) Mst cells
g) lymphoma
g) Lundehund gastric atrophy: mucus nexk cells and pseudopyloric metaplasia

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34
Q

Characterists of Ollanus spp.

A

Size: 0.7 - 1mm
Transmission: ingestion of vomitus
Pathologic consequency: rugal hyperplasia and/or nodular gastritis
Dx: cytology of gastric juice or vomiting, histopathology (n.b. will not be detected in faeces)
Tx: 10mg/kg fenbendazole for 2 days

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35
Q

Characteristics of Physaloptera spp.

A

Size: 2 - 6 cm
Transmission: most common is physaloptera rara with reservoir host being coyote
Diagnosis: sugar fltation
Tx: pyrantel pamoate

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36
Q

Gastric parasites that may give a nodular parasitc granule

A
  • Gnathostoma (cats)
    Spirocerca (dogs)
    Aonchotheca spp. (cats)
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37
Q

What is the main pathologic consequence of pythiosis?

A

Pyogranulomatous inflammation causing transmural thickening of the pyloric outflow tract

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38
Q

How is pythium diagnosed?

A

Gomori’s methanamine silver staining
Fungal culture
PCR

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39
Q

How is pythium treated?

A

Surgcal recetion followed by itraconazole and terbinafine for 2 -3 months. Monitoring serology can be performed and treatment courses may need to be extended.

N.B <25% will be cured with medical therapy alone

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40
Q

Treatment of helicobacter pylori

A

Amoxicillin + MTZ
Amocicillin + Clarithromycine + MTZ

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41
Q

What breed is atrophic gastritis associated with and what is the pathologic feature?

A

Lundehunds
Reduced number of prietal cells and neuroendocrine cell hyperplasia.
Aso associated withadenocarcinoma formation

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42
Q

What change in gastrin is expected with hypertrophic gastropathy?

A

Increased serum gastrin along wiht exaggerated gastrin stimulation testing. Can also have over-sectretion of pancreatic polypeptides.

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43
Q

If a patient is consistently vomiting 8 - 16h after eating what disorder should one consider?

A

Gastric motility disorder

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44
Q

What testing can be employed for the evaluation of gastric motility?

A

Barium contrast
BIPS
Ultrasonography
113Coctanoate and 13Cacetate breath testing
Wireless motility capsules
Scintigraphy

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45
Q

Is there a male/female predisposition to gastric neoplasia?

A

Males > Females

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46
Q

Predisposed breeds to gastric adenocarcinoma

A

Belgian Shepherds
Rough Collies
+/-SBT
Bouviour-des-Flandres
Groendael
Lundehund
Collie
Standard Poodle
Norweigan Elkhound

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47
Q

What are the 4 main cell types in the gastric gland and what do they secrete?

A

Mucus neck cells = mucus
Parietal (Oxyntic) = HCL, IF
Chief/Peptic = Pepsinogen
ECL cells = histamine

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48
Q

Outline the chemical events of gastric acid secretion

A
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49
Q

Outline the interactions between the ANS, local hormonal factors and cells involved in gastric acid secretion

A
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50
Q

Hormones that increase and decrease gastric acid secretion

A

Increase:
- AcH
- gastrin
- Histmine

Decrease:
- SST
- GIP
- VIP
- Secretin

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51
Q

Outline the chemical process of pancreatic bicarbonate secretion

A
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52
Q

What are the main hormones involved in pancreatic secretion?

A

Ach (HCO3 and enzymes)
CCK (HCO3 and enzymes)
Secretin (HCO3 mainly)

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53
Q

Gastrin:
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions

A

a) G-cells: stomach (pyloric antrum), duodenum and ileum
b) Proteins and fat in the stomach, gastric distension, Ach, GRP
c) SST, GIP, GLP-1
d) Gastric HCl secretion, Gastric hypertrophy, Pepsinogen secretion, pancreatic enzyme secretion, glucagon release

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54
Q

SST
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions

A

a) D-cells: pyloric antrum, duodenum and pancreatic islets
b) Luminal acid, luminal proteins, luminal bile
c)
d) Inhibits gastrin release (therefore reducing gastric acid and pepsinogen release), inhibits histamine release, slows gastric emptying and intestinal motility, inhibits insulin and exocrine pancreatic secretion

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55
Q

CCK
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions

A

a) I cells in the small intestine
b) Proteins, fats and acid in the SI
c)
d) Gallbladder contraction, increased pancreatic enzyme and HCO3 secretion, pancreatic growth, delayes gastric emptying, inhibits appetite

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56
Q

Secretin
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions

A

a) S cells in the duodenum
b) Fat and acid in the duodenum
c)
d) Pancreatic secretion (HCO3), gallblader secretions, inhibition of gastrin release

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57
Q

GLP-1
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions

A

a) L-cells in ileum and LI
b) Fatty acids in the duodenum and ileum
c)
d) Insulin secretion, Inhibition of gastric emptying,

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58
Q

GIP
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions

A

a) duodenal K cells
b) All duodenal nutrients
c)
d) Insuline secretion, delays gastric emptying, inhibits gastrin release

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59
Q

What is the main energy source for enterocytes?

A

Glutamine

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60
Q

What is the function of brush border enzymes?

A

Hydrolysis of carbohydrates

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61
Q

Why are cats likely to be more prone to vitamin B12 deficiency?

A

They do not have transcobalamin 1 (R protein) therefore lose cobalamin through enterohepatic recycling.

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62
Q

What molecular pattern recognition receptors are particularly important in the GIT

A

TLRs and NODs

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63
Q

What do the following PRRs recognise?
a) TLR 2
b) TLR 4
c) TLR 5
d) NOD2

A

a) lipopeptides
b) lipopolysaccharides
c) flagellin
d) LPS

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64
Q

Predominant lymphocyte type in intraepithelial GIT

A

gamma-delta T cells

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65
Q

Predominant lymphocyte type in lamina propria

A

alpha-beta T-cells

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66
Q

Predominant gastrointestinal lamina propria cells in cats vs. dogs

A

Dogs = alpha-beta CD4
Cats = CD8

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67
Q

Outline the important IL and cells that produce them in the SI

A
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68
Q

What receptor does IgE bind to?

A

FcER1 receptor - leading to mast cell degranulation and eosinophil recruitment.

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69
Q

What breed-associated B12 syndromes have been reported?

A

Chinese Shar-Pei - mutation in cubulin
Immerslund-Grasbeck syndrome - Australian Shepherds, Collies, Giant Schnauzers and Beagles

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70
Q

Which parts of the villi are affected by the following pathogens?
Rotavirus
Coronavirus
Parvovirus
Vincristine

A

Rotavirus - villus tip
Coronavirus - mid-villus
Parvovirus - Crypt
Vincristine - Crypt

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71
Q

What is the mechanism by which LI diarrhoea can results from SI diarrhoea?

A

Increased VFA and bile salts in faeces increase colonic secretions

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72
Q

DDx for PLE

A
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73
Q

Breeds that are predisposed to PLE

A

Basenji
Lundehund
Rottweiler
Soft-Coated Wheten Terrier - get concurrent PLN
Yorkshire Terrier
Shar Pei

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74
Q

What clinicopathologic alterations can occur along with PLE?

A

Reduced cholesterol
Lymphopenia
Reduced magnesium and ionised calcium
Reduced vitamin D

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75
Q

What test may be a more sensitive test for PLE in dogs?

A

Faecal alpha-1 protease inhibitor - need to measure over 3 stool samples

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76
Q

What stains may identify the following on faecal smear examinations:
a) Starch granules
b) Fat Globules
c) Muscle Fibres

A

a) Lugoli’s iodine
b) Sudan Stain
c) Wrights or Diff quick

n.b. the point of these is that thhey can identify malapsorption although all have a low specificity

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77
Q

How long should an animal have a meat free diet fr prior to faecal occult blood testing?

A

≥72h

78
Q

What are the following compounds markers of?
a) Calprotectin
b) 3-Bromotyrosine
c) N-methylhistidine

A

a) Neutrophil elastase activity - correlated with level of inflamation in IBD
b) Product of eosinophil peroxidase, although can be increased in any IBD disorders (has been shown to be increased in dogs with SRE compared to FRE)
c) Marker of mast cell activation although is not a very good test in small animals

79
Q

What are the things (5 morphological features) that are looked for on WSAVA guidelines for histologic biopsy samples?

A
80
Q

What are the top antibiotic treatment choices for campylobacter?

A
  1. Erythromycin
  2. Clindamycin or tylosin
  3. Fluroquinolones
81
Q

Which organism is responsible for seasonal febrile diarrhoea syndrome?

A

Salmonella typhimurium

82
Q

What is the treatment for salmonellosis?

A

Fluroquinolones

83
Q

E. coli forms that are associated with the following:
a) Secretory SI diarrhoea
b) SI or large intestinal diarrhoea
c) Haemolytic uraemic syndrome
d) Granulomatous colitis

A

a) ETEC = enterotoxigenic
b) EPEC = enteropathogenic
c) EHEC = enterohaemorrhagic
d) AIEC = attacking and invading

84
Q

How is E.coli enteritis dianosed?

A

PCR

85
Q

Salmon poisening:
- Responsible organism
- Disease distribution
- Intermediate host
- Clinical signs
- Diagnosis
- Treatment

A
  • Neorickettsia helminthoeca & elohominica
  • West coast of USA: northern california upwards
  • Metececariae of Nanophytus salmonicola (carried by salmon)
  • pyrexia, HGE, vomiting, nasal discharge and peripheral lymphdenopathy
  • Oxytetracycline for rickettsia, praziquantel for fluke
86
Q

What is the public health implication of roundworms in dogs?

A

Embryonated L3 larvae, embyronation takes 2 - 7 weeks after passage of faeces so the risk is more from contaminated foodstuffs than dog/cat poop.

87
Q

Which species of strongyloides are of concern to small animal diarrhoea, what disease are these associated with?

A

S. tumefaciens = large intestinal diarrhoea
S. stercoralis = haemorrhagic enteritis in puppies

88
Q

What is the risk of hookworms to people? Which worm is specifically associated with particular lesions in dogs?

A

Hookworms as they can cause cutaenous larval migrans
Pedal lesions are associated with uncinaria stenocephala

89
Q

What is the treatment for:
a) Strongyloides spp.
b) Hookworms

A

a) Fenbendazole and related
b) Pyrantel (ivermectin and milbemycin can be used as preventatives)

90
Q

How might diplydium caninum be recognised on faecal analysis?

A

Motile rice grains can be seen

91
Q

Which eccinococcus spp. causes hydatid disease?

A

E. granulosus

92
Q

Which tapeworm species can mimic PLE?

A

Mesocestoides

93
Q

Treatments for cytoisospora

A
  1. Toltrazuril, diclazuril
  2. TMPS/Sulfasalazine
94
Q

When might cyrptosporidium be a concern/should be tested for?

A

When there s severe haemorrhagic diarrhoea in a young or immunocompromised animal

95
Q

Treatments for cryptosporidium

A

Paromonycin (AKI risk)
Tylosin, azithromyxin
Nitazoxanide

96
Q

Which breed has gluten-sensitive enteropathy been documented in and what is the likely genetic inheritance pattern?

A

Autosomal recessive in Irish Setters

97
Q

Which breeds are predisposed to eosinophilic enteritis?

A

Dobermans and Boxers +/- GSD

98
Q

What feline breed appears predisposed to FESF?

A

Ragdolls

99
Q

Which feline breed is predisposed to lymphoplasmacytic enteritis?

A

Siamese

100
Q

Which breeds are predisposed to lymphangiectasia?

A

Yorkshire terriers, maltese, lundehunds, Rottweilers

101
Q

What are the causes of secondary lymphangiectasia?

A

Infiltrative neoplasia, thoracic duct obstruction, R-CHF

102
Q

Which hepatic disorder has been associated with lymphangiectasia?

A

Granulomatous hepatopathy

103
Q

What is the most significant prognostic marker for gastrointestinal adenocarcinoma?

A

Presence of metastasis

104
Q

What IHC markers should be used to differentiate leiomyoma from GIST?

A

C kit, S100, vimentin, desmin and SMA

105
Q

Predilection sites for leiomyosarcoma/GIST in dogs vs. cats?

A

Dog = jejunum or caecum
Cat = small intestine

106
Q

What molecule is responsible for hypoglycaemia in leiomyosarcoma?

A

Insulin-like growth factor II like peptide

107
Q

What stain can identify Helicobacter organisms on gastric mucosa?

A

Warthrin-Starry stain

108
Q

What toxins should be considered if you suspect clostridial gastrointestinal disease?

A

C difficile - A and B
C. perfringens = CPE

109
Q

Is Giardia ELISA sensitive or specific?

A

Sensitive but poorly specific.

110
Q

What diagnostic tests are appropriate for Herobilharzia americana?

A

Sodium chloride sedimentation
PCR for egg DNA

111
Q

Folate digestion and absorption

A
112
Q

Outline cobalamin digestion and absorption

A
113
Q

What is faecal alpha-1 proteinase inhibitor?

A

It is a proteinase inhibitor normally used by the liver that is slightly smaller than albumin. Therefore may be an early marker of PLE.

114
Q

Which is the type of muscle fibre present in normal muscle that means it is not affected by MMM?

A

Type 2 C fibres

115
Q

Define the following conditions of the salivary glands:
- Sialocoele
- Sialadenitis
- Sialadenosis
- Necrotising sialometaplasia

A
  • Extravasion of the saliva into the submucosal or subcutaneous space
  • Inflammation of the salivary gland
  • Non-inflammatory enlargement of the salivary gland
  • Severe form of sialadenosis where there is squamous metablasia of the gland and ischaemic infarction of the lobules.
116
Q

What is the treatment for craniomandibular osteopathy?

A

This is a non-inflammatory, non-neoplastic disease. The treatment is jsut supportive (i.e. analgesia)

117
Q

What feature(s) differ between craniomandibular osteopathy and calvarial hyperosteosis?

A

Main poins: CMO = small breed dogs and manbible is affected
CHO = BULLMASTIFFS and other breeds (less commonly), mandible is not affected.

Additional point is that CMO affects woven bone whereas CHO is a progressive thickening of the cortical bone

118
Q

Most common oral tumours in dogs

A

Malignant melanoma, SCC, fibrosarcoma

119
Q

Most common oral tumors in cats

A

SCC, fibrosarcoma,

120
Q

Behaviour of oral SCC in tonsillar and lingual vs. gingival sites?

A

Tonsillar and inguinal are highly metastatic wiht lingual and gingival less so

121
Q

Which nerves are responsible for innervation of the proximal and distal colon?

A

Proximal = vagus nerve
Distal = pelvic nerves

122
Q

which hormone is responsible for growth of the colonic mucsa?

A

Growth hormone

123
Q

What is the predominant immune cell of the large intestine?

A

CD8+

124
Q

What is Hirschprung disease?

A

A congenital lack of enteric ganglia

125
Q

What is the main energy source for clonocytes?

A

Short chain fatty acids where are produced by fermentation of fibre by enteric bacteria

126
Q

Explain how colonoscopic allergen provocation can be performed, what are the positive and negative controls. What indicated a positive reaction?

A

A clockface of antigen solutions, positive and negative controlls are instilled around the ICJ. The positive control is histamine, the negative control saline. A positive response is a demarcated oedematous region around the injection sites 1 - 2 minutes after instillation.

127
Q

What are some examples of fermentable soluble fibre?

A

Psyllium, beet-pulp, FOS, insulin, MOS

128
Q

Sulfasalazine:
- MoA/Pharmacology - i.e. how does it become what it needs to become
- Side effects
- alternatives and advantage

A
  • Sulfasalzaine is broken down by distal SI bacteria into 5-amino salicylic acid which is an NSAID. Therefore, this acts as a local anti-inflammatory.
  • Main side effect is KCS, as well as acute pancreatitis and vomiting
  • Olsalazine produces 2 5ASA molecules and has a reduced frequency of KCS in dogs
129
Q

What is the histopathologic characteristic of granulomatous colitis?

A

PAS staining within macropahges under an ulcerated colonic mucosa

130
Q

What is the causative organism of E. coli?

A

Attaching and invading (AIEC)

131
Q

What is the gram positivity of the following large intestinal pathogens?
- Anaerobiospirillum
- Brachyspira pilosicoli
- Campylobacter
- Clostridium spp.
- E. coli

A

Clostridium are the only gram positivies otherwise they are all gram negative

132
Q

What does this picture show?

A

Prototheca

spp. prototheca zopfii is associated with gastrointestinal and then disseminated disease in dogs and cats

133
Q

What is the treatment for prototheciosis?

A

Amphotericin B in combination wiht itraconazole although generally the disease is fata

134
Q

When collecting a faecal sample for Tritrichomonas testing, what contaminant should be avoided?

A

Cat litter - this can inhibit PCR reactions

135
Q

Ronidazole
- MoA
- Side effect

A
  • Similar to metronidazole it is converted into an autotoxic anion within tritrichomonas which results in free radical damage to the organism
  • Side effect is reversible neurotoxicity similar to MTZ, can consider use of benzodiazapines to reverse this
136
Q

Life cycle of heterobilharzia americanum

A

Racoons and other rodents are the reservoir hosts

Intermediate host = snail

Cercaria exit the snal and penetrate dogs skin and migrate through the lung and liver and then through the bowel wall causing a granulomatous inflammatory response.

137
Q

What is the location of heterobilharzia americanum?

A

Southeastern and gulf coast areas

138
Q

What diagnostic test can be used for heterobilharzia (which is in contrast to other flukes)

A

Faecal flotation

139
Q

What is the colonic finding that may be seen with Strongyloides tumefaciens?

A

1 - 3 mm nodules in the colonic mucosa

140
Q

What is the lifecycle of strongyloides tumefaciens?

A

Skin penetracion, migration and coughing up of eggs from the lungs, adult parasites burrow into the colonic mucosa

141
Q

What is the life cycle of trichuris vulpis?

A

Direct via oro-faecal route

142
Q

How does the natural behaviour of large intesinal neoplasia differ between cats and dogs?

A

cats have a high rate of local metastatis of adenocarcinoma and the predilection site is the ileum.

143
Q

What is the predilection site for leiomyosarcoma in the large intestine of dogs?

A

Caecum

144
Q

How are rectal prolapse and rectal intussuception differentiated?

A

If a blunt instrument cannot pass between the protruding segment and the anal sphincter then this indcates a rectal prolapse

145
Q

Outline nervous control of the rectoanal region

A

SNS: hypogastric nerve which originated from L1 - L5 = contraction of the inernal anal sphincter
PNS = pelvic nerve
Pudendal nerve provides somatic input to the ecternal anal sphincter

146
Q

What are the two types of faceal incontinance?

A

Reservoir incontinance - no nervous problem, is usually accompanied by tenesmus
Sphincter incontinance - this tends to suggest spinal chord dysfunction

147
Q

What abdominal organs can herniate through a perineal hernia?

A

Prostate and bladder (this can occur in 18 - 25% patients!)

148
Q

What is the risk of recurrance of perineal hernia in castrated male dogs compared to those that are not castrated?

A

Non-castration associated with a 2.7x risk of recurrance

149
Q

What is the surgical treatment of choice for severe perineal hernias? What treatment can be given to manage these medically?

A

Internal obturator transposition has the best success rate
Medical management considts of stool softening and periodic enemas

150
Q

What is the hormonal basis for perineal hernia development?

A

Possibly:
- Reduced adnrogen receptors in the levator ani and coccygeus muscles
- Relaxin (is secreted by the prostate) can softe connective tissue

151
Q

Classification of atresia ani

A
152
Q

What is the most common additional malformation associated with atresia ani?

A

Type II atresia ani is most often associated with rectovaginal fistulas.

153
Q

Most common cause of faecal sphincter incompetance?

A

DLSS and cauda equina syndrome

154
Q

What is the hormonal basis of perianal adenomas?

A

They often are drive by testosterone and suppressed by oestrogen. Therefore it is most common to find these in intact males or neutered female dogs.

155
Q

Most common cause of septic peritonitis in dogs?

A

Wound dehiscence and perforating GI foreign body

156
Q

What is the most common bacteria identified in septic peritonitis?

A

E. coli

157
Q

Ancillary fluid testing for diagnosis of septic peritonitis in dogs?
- TNCC
- Lactate
- Glucose

A

TNCC > 13x10e9/L is 86% sensitive and 100% specific in dogs and 100% for both in cats
Lactate difference < 2mmol/L between blood and peritoneal fluid is 100% specific but poorly sensitive in DOGS ONLY
Glucose difference >1.1mmol/L between fluid and blood is 100% sensitive and 100% specific in dogs, 100% sensitive and 86% specific in cats

158
Q

Bilirubin concentration of abdominal effusion that is suggestive of bile peritonitis?

A

> 2x peripheral blood

159
Q

Creatinine and potassium concentration of fluid comapred to blood that are diagnostic for uroabdomen

A

Creatinine > 2x peripheral blood
Potassium >1.4x blood dogs, > 1.9x blood in cats

160
Q

What biochemical abnomalities can be noted with uroabdomen?

A

Increased potassium (through re-absorption)
Decreased Na:K ratio (possibly due to loss of sodium into the abdominal cavity and activation of RAAS)

161
Q

What are the targets for MAP, UOP and lactate in septic peritonitis

A

Within the first 6 hours aim for
- MAP > 65mmHg
- UOP > 0.5ml/kg/h
- Lactate <2mmHg

162
Q

What is the most common type of pancreatitis in cats?

A

Chronic - in an estimated 50.4% cases based on necropsy studies

163
Q

What is the potential prevalence of pancreatitis in clinically normal cats?

A

45%

164
Q

What percentage of clinical pancreatitis cases in cats have an underlying cause?

A

5% - 95% are considered idiopathic

165
Q

What is the main inciting event in acute pancreatitis?

A

Trypsinogen activation

166
Q

Three most common clinical signs of pancreatitis in cats

A

Lethargy
Anorexia
Vomiting

167
Q

Which lobe of the pancreas can sometimes be identified using abdominal radiography in acute pancreatitis?

A

Left lobe on a VD view

168
Q

Compare and contrast the AUS findings of normal, acute and chronic pancreatitis?

A

Normal: isoechoic or hypoechoic to the mesentry
Acute:
- Pancreatic enlargement
- Hyperechoic mesentry
- Focal abdominal effusion

Chronic:
- Hyperechoic or mixed echogenicity
- Dilated CBD
- Pancreatic enlargement
- Irregular margins

169
Q

What is the diagnostic rate of pancreatic FNA?

A

67%

170
Q

Four most common electrolyte abnormalities in feline acute pancreatitis

A

Hypokalaemia
Hypocalcaemia
Hypochloraemia
Hyponatraemia

171
Q

PPV/NPV of fPLI in diagnosis of feline pancreatitis

A

PPV 90%
NPV 76%

172
Q

What combination of imaging findings has the best agreement with results of lipase testing in feline pancreatitis?

A

Hypoechoic or mixed echogenicity pancreas

173
Q

What specific reccomendations are their for the size and fixation of feline pancreatic biopsy speciments

A

<1cm3 piece in 10% formalin in a 10:1 ratio

174
Q

When should a feeding tube be placed in a cat with acute pancreatitis?

A

If 48h inappetence or prolonged inappetance prior to presentation

175
Q

What vasopressor is discussed in the feline pancreatitis consensus statement as potentially being first line, what specific scenario do they reccomend it in?

A

Dopamine, particularly in cats undergoing a GA

176
Q

When can FFP be used in feline pancreatitis?

A

If they have a coagulopathy

177
Q

% of cats with bacteria in pancreas detected using FISH

A

35%

178
Q

What are the negative prognostic indicators for cats with acute pancreatitis?

A

Low ionised calcium
Hypoglycaemia
Azotaemia

179
Q

What is the mechanism of action of antacids?

A

Decrease in pepsin activity
Binding of gastric bile salts
Stimulation of local PGE2 release

180
Q

What are the potential side effects of antacids?

A

Aluminium toxicity - more of a concern in renal failure
Constipation

181
Q

What drugs can antacids chelate?

A

Fluroquinolones, tetracyclines and digoxin

182
Q

How often do antacids need to be administered for clinical effect?

A

Every 30 - 60 minutes

183
Q

What is the possible mechanism of tachyphylaxis to H2 antagonists?

A

Increase in gastrin secretion and upregulation of ECL histamine synthesis

184
Q

Why are PPI drugs less effective when given with an H2 antagonist?

A

As PPIs are weak bases they concentrate most in the cell in a higher acid environment. Therefore, giving an H2 antagonist decreases acid production in parietal cells and diminishes this effect.

185
Q

How long does it take for PPis to become effective? Why?

A

2 - 4 days. This is because when used, dormant parietal cells will become active for the first few days of administration.

186
Q

When should PPIs be tapered?

A

If given for > 3 - 4 weeks

187
Q

What drug absorption/action may PPIs potentially interfere with?

A

Anti-fungal drugs
Iron
Mycophenolate
Clopidogrel

188
Q

Why might PPIs lead to worse NSAID associated ulceration?

A

It is thought that this occurs because there is an increase in gram negative bacterial growth secondary to PPI administration.

189
Q

What is the target of misoprostal?

A

PGE1 on parietal cells

190
Q

Which drug has misoprostal proven efficacy for preventing GI associated ulceration in?

A

Aspirin - this is the only one that the consensus statement reccomends its use in.

ACVIM Specialty: Ettinger - MS 2023 (12 decks)

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