Gastrointestinal Flashcards
Which are the animals’ salivary glands?
Mandibular, zygomatic, parothid, sublingual and molar (only in cats)
Which is the innervation of salivary glands?
- SNp: contorl the rate of the salivary secretion, inducing the formation of large amounts of a low-protein, serous saliva.
- SNs: promotes saliva flow through muscle contraction at salivary ducts.
–> both SNs and SNp result in an increase in salilvary production.
Which is the cause of halitosis in periodontitis?
Anaerobic gram negative bacteria that colonize the oral mucosa produce volatile sulfur compounds, such as hyrogen sulfide, methylmercaptan and dimethyl sulfide.
Which is the most important clinical sign in each type of dysphagia?
- Oral dysphagia: difficulty in prehension, mastication
- Pharyngeal: gagging
- Esophageal: regurgitations
–> ask for each sign if there is a case of dysphagia
Which is the prokinetic mehcanism of action of cisapride and methoclopramide?
- Cisapride: increase Acho concentration and 5HT4 (serotonin) agonism
- Metoclopramide: 5HT4 agonism (it also is a D2 antagonism = antiemetic)
Which type of colonic contractions can be found?
- Haustral contractions: accumulation of colonic contents
- Mass contractions: propulsive contractions
Which cat and dog breeds are predisposed to constipation due to sacral malformation?
- Dogs: English Bulldogs and Boston Terrier
- Cats: Manx
Which are the main causes of fecal incontinence?
- Unconsciousness:
—- Sphincter incompetence due to direct damage
—- Sphincter incompetence of neurogenic origin (low pudendal tone) - Conscious:
—- Reservoir incontinence (reduced capacity or compliance of rectum)
What is found in each area of the protein electrophoresis?
- Alfa1 and alfa2: acute phase proteins
- Beta: IgM
- Gamma: IgG and IgA
Which breed have lower globulins levels?
Greyhound
Which echographic abnormality can be found in dogs with hypoalbuminemia?
Gastric wall thickening (21% of dogs with hypoalbuminemia have gastric wall thickening), specially submucosa <– suggested to be due to wall edema
Comparing peripheric regions (paw, oral mucose, ear margin), which is the most accurate area to monitor glood glucose?
Ear margin
How is calprotectin in Miniature Shanzuers with hyperlipidemia?
And glucose and insulin?
Calprotectin:
It is increased, suggesting a role of inflammation in the development of the disease.
It doesn’t decrease with ultra low fat diet treatment.
Glucose and insulin:
- Glucose: increased
- Insulin: increased
–> indicative of insulin resistance
With treatment, both reduce.
Which is the effect of statins on coagulation?
Hypercoagulable
Which are the most common causes of hypocolesterolemia in cats?
Gastrointestinal (25%) > Hepatobiliar > Hematologic > Urogenital
Neoplasia (specially lymphoma) overrepresentated
**hypochol + hypoalb = worse prognosis
Which lipid marker is associated with worse prognosis in dogs in ICU?
Hypocholesterolemia + hypertrigiceridemia
Which GI markers can be found?
Dogs:
- SA100 (neutrophilic inflammation), Calprotectin (neutrophilic inflammation), Gliadin, OmpC, Methylhistamine (mast cell desgranulation), Iodinated Tyrosine (eosinophilic inflammation), Ki67/CD3 (marker of T lymph cells proliferating), pSTAT3: increased in chronic enteropathy, but cannot distinguish among ethiologies
- GLP2: reduced in chronic enteropathy
- miRNA: could be a marker of lymphoma
Cats:
- Haptoglobin, Ceruloplasmin, fecal S100A: All of them are increased in IBD in comparison with health, but cannot distinguish between IBD/lymphoma
- Alfa1 acid glycoprotein: reduced in chornic enteropathy in comparison with health. IBD < lymphoma –> in a cat with GI signs, a high value could be suggestive of lymphoma
Which is the suggested etiology of feline stomatitis?
It is an inadequate immunomediated response precipitated by bacterial plaque and virus.
What is erithema multiforme?
It is characterized by immunecomplexes deposition in the superficial capillaries of the skin and oral mucosa.
What is toxic epidermal necrolysis?
It is characterized by full thickness necrosis with minimal dermal inflammation
Which is the most recommended second immunosupressive in MMM?
Azathioprine
Which type of epulis can be distinguished?
- Mixt: peripheric odontogenic fibromas –> no locally invasive neither methastases
—- Fibromatous
—- Ossificant - Epithelial: epithelial odontogenic tumors (no methastases but locally invasive)/ameloblastoma/acantomatoso
Which are the most common oral lesions in cats?
- Inflammatory (63%): specially feline chronic gingivostomatitis
- Neoplasia (37%): specially SCC
Which oral SCC have a better prognosis?
- Oropharyngeal
- Positive p16 (p16 prevents cellular replication)
Which are the two reactions catalyzed by cobalamin?
- Homocysteine –> Methionine (by methionine synthase)
–> leads to hyperHCY and afunctional folate - MethylmalonylCoA –> Succinil CoA
Leads to increase concentrations of methylmalonic acid, which is excreted by urine (aciduria) and block the urea cycle –> increase ammonia
Which are potential causes of increase HCY and MMA?
- HCY: hypocobalaminemia, renal disease, reduce folate and reduce B6 vitamin (causes of false reduced HCY: hypoalbuminemia, because HCV circulates bound to albumin)
- MMA: hypocobalaminemia, renal diseases, dehydration, disbyosis
Which are most common clinical signs associated to hypocobalaminemia?
- Apathy, anorexia, lethargy
- Neurologic signs
- Vhomits, diarrhea
- Blood dyscrasias: anemia, neutropenia and hypersegmented neutrophils
Whcih are the typical characteristics of every breed predisposed to hypocobalaminemia?
- Giant Shnauzer:
—- Mutation on amnionless subunit - Border Collie:
—- Mutation on cubulin subunit
—- Clinical signs less severe and delayed into adulthood
—- Abnormality on receptor + primary methylmalonic aciduria - Beagle:
—- Mutation on cubulin subunit
—- Development of degenerative liver disease
—- Immunosupression - SharPei:
—- Mutation on cubulin subunit
—- Higher MMA levels
—- Clinical signs of diarrhea and vomiting, but not present with blood syncrasis or neuro signs - Komondor:
—- Mutation on cubulin subunit
Which is the cause of increased homocisteine in Greyhound?
Primary defect in the enzymatic pathway of HCY to methionine –> increase HCY + reduced cobalamin/folate/methionine
Which is the prevalence of hypocobalaminemia in dogs with EPI?
82%
Which are the mehcnisms by EPI have hypocobalaminemia?
- Reduced IF production
- No digestive enzymes –> no release of cobalamin
- Disbiosis
- Affected intestinal mucosa
Which are the most common bacteria causing hypocobalaminemia?
Bacteroides (and it is also a folate producing bacteria)
Which is the prevalence of dogs with Myastenia Gravis that present only with pharyngeal weakness?
1%
Which breeds are predisposed to crycopharyngeal dysphagia?
Cocker Spaniel and Springer Spaniel
What are the reasons of esophagic varices?
- Abdominal: portal hypertension
- Thoracic: pulmonary/cava/systemic hypertension
No associated with hemorrhage
Which are the most common esophagic neoplasias in dogs and cats?
- Dogs: fibrosarcoma
- Cats: SCC
Which is the prevalence of megaesophagus secondary to myastenia gravis that respond to treatment?
50%
Which is the most common cause of hiatal hernia in dogs? And cats?
- Dogs: Congenital (brachyceph)(dx <1y) > Acquired
- Cats: most common dx >3y (–> acquired vs congenital but diagnosed delayed in time)(associated with other comorbidities)
Which type of diet is recommended in a patient with GERD?
Low fat diet, because high fat diets reduce low sphicnter tone as well as delay gastric emptying, increasing the risk of reflux.
Which are the benefitial effects of intestinal microbiota?
- Compite against pathogenic bacteria
- Produce trophic effects (short chain fatty acids through non fementable CH fermentation) beneficial for:
—- Epithelial integrity
—- Immune system function
Which are the mechanisms by a intestinal bacterial overgrowth produce diarrhea?
- Competition for nutrients with commensal bacteria
- Bacterial metabolism of nutrients into secretory molecules (hydroxilated FA, deconjugated bile acids)
- Biochemical injury to the intestinal brush border
Which secreting cells are found in the stomach?
BODY:
- Mucous neck cells: pepsinogen, gastric lipase, mucous
- Parietall cells: pepsinogen, IF
- Chief cells: pepsinogen
FUNDUS:
- Enterochromoaffin cells: histamine
- Somatostatin producing cells: somatostatin
ANTRUM:
- Gastrin cells: gastrin
- Somatostatin producing cells: somatostatin
Which is the microbiota found in stomach?
Helicobacter, Lactobacillus, Proteus, Streptococcus
Which is the prevalence of erosion/ulceration in dogs with hepatic disease?
Global erosion/ulceration 20%
Ulceration 10%
Which is the characteristics of gastrointestinal ulcers in cats?
- Less frequent than in dogs
- Most common location: antrum
- 50% benign etiology, 50% malign etiology (main lymphoma)
Which is the objective in an antiacid treatment?
- ph > 3, 75% of the day
- ph > 4, 65% of the day
Reach by:
- Intravenous: omeprazol, esomeprazol, CRI famotidine (but produce tolerance –> not recommended to prolong tt with famotidine due to loss of power)
- Oral: omeprazol, esomeprazol
Which antiacids can be administered as a preventive way?
Misoprostol in NSAIDs treatmemt
Antihistamines in MCT
Omeprazol as preventive treatment in NSAIDs tt produce an increase in disbiosi index + increase calprotectin
Which are the most common gastric parasites in dogs and cats?
- Ollalunus tricuspis (cat)
- Physaloptera (dogs and cat)
Which are the breed specific gastropathies?
- Atrophic gastritis: Lundehund
—- Panhipoproteinemia
—- Achloridria
—- Predisposition to gastric adenocarcinoma - Hypertrophic gastritis:
—- ShiTzu/Lhasa Apso: pylori
—- Basenji: fundus
—- Patrijshond: fundus
——– Associated with stomatocitosis, hemolytic anemia, icterus and polyneuropathy
Which is the most common location of GI angiodisplasias?
Colonic mucose
In which prevalence of perineal hernia the urinary bladder/prsotate is herniated?
25%
Which are the most common locations of AGASACA methastases?
- Early: regional LN
- Delayed: lungs and bone
Which prevalence of dogs with AGASACA present with hypercalcemia?
25%
In which situations can loperamide be used?
In fecal incontinence.
It is an opioid that slows colonic transit and increase anal sphincter tone.
Which molecules are responsible of a secretory diarrhea?
- Endotoxins and enterotoxins
- Hydroxilated fatty acids
- Unconjugated bile acids
- Giardia infection
- Laxatives
- Cardiac glycosides
Which breed have aminopeptidase deficiency?
Beagle
In which cases of protein losing enteropathy can globulins be increased?
- Basenji enteropathy
- Hitoplasmosis/Phtiosis
- Lymphoma
- Severe IBD
Which aspects are most relevant in an endoscopic evaluation of the intestine?
- Friability
- Granularity
- Erosions/ulcers
- Lymphatic dilation
Which parameters are evaluated in intestinal biopsies?
- Villus atrophy
- Epithelial damage
- Fibrosis
- Lacteal dilation
- Crypt distension
- Inflammation
Which platelet markers are associated with a higher clinical score?
- More platelet numbers
- Less platelet mass
Which is the calcium metabolism in chronic enteropathy?
CE:
Low magnesium –> low vitamin D –> low calcium –> high PTH
When Mg levels are very reduced, PTH is also low.
Which are the supposed effects on microbiota of GEH?
- Increased Clostridium perfringens
- Increased Proteobacteria
- Increased Providencia
- Reduced Firmicutes
Which types of hypersensibility are detected in a food allergy?
Type I, type III and type IV
How many weeks is reccommended to wait in food exclusion?
3w, and 6w if partial response
Which are the hypothesis of antibiotic reponsive diarrhea in GSD?
- Deffect in TLR5
- Deffect in IgA:
—- Deffect in IgA production
—- Deffect in IgA translocation
—- Excess in IgA proteolysis
Which is the most common entity associated with secondary SIBO?
EPI
How is the best diet in ARD cases?
Highly digestible diet, low fiber.
FOS can be added.
Which is the graduation of CIBDAI/CCECAI?
- Normal: <=3
- Mild: 4-5
- Moderate: 6-8
- Severe: >=9
Which aa can be affected in IBD?
Methionine, Proline, Tryptophan and Serine can be reduced.
Specially serine, it is inversely associated with CCECAI.
Which is the relevance of CRP in IBD?
And of HMGB1?
- CRP: Directly associated with CIBDAI and reduces with improvement of clinical signs –> can be used as a marker or clinical severity and response to tt
- HMGB1: is a non-histone cromosomic protein produced by inflammed cells. It is a marker of histopathological severity.
In which cases are there evidence about probiotics/prebiotics utility?
And FMT?
- Probiotics:
—- Acute:
——– Parvovirus
——– GEH
——– Tritrichomonas
—- Chronic:
——– Few information in FRD and ARD
——– IBD - FMT:
—- Parvovirus
—- Clostridium
—- IBD
Which layer is enlarged in feline alimentary lymphoma?
Muscularies
Which are the different markers that can help in the GIST/smooth muscle tumours differentiation?
- CD34 and CD117 (cKIT)
- Smooth muscle markers: vimentine, desmine, actine
- Neurogenic markers: S100
GIST: cKIT positive
Smooth muscle: cKIT negative, muscle markers positive
GIST like: cKIT negative, S100 positive
Which are the most common locations of tumors in intestine?
Adenocarcinoma is the most common tumor in all GI locations in dog, whereas lymphoma is the most common in cats, except in large intestine where adenocarcinoma is more common than lymphoma.
Locations:
- Adenocarcinoma:
—- DOG: LI (colo-rectal) > SI (duodenum)
—- CAT: SI (jejunum, ileum) > LI (descending colon and ilecolic valve)
- Smooth muscle tumor:
—- DOG: SI (jejunum) > LI (cecum)
—- CAT: exclusively in SI
Which is the most common microflora of stomach, SI and LI?
Stomach:
- Helicobacter
- Lactobacillus
- Streptococcus
- Proteus
Small intestine:
- Firmicutes (Clostridia)
- Proteobacteria
- Bacteroidetes
- Fusobacteria
- Actinobacter
Large intestine:
- Fusobacteria
- Bacteroidetes
- Firmicutes (Clostridia)
What is pneumatosis coli?
The presence of free gas in the colon wall.
Etiology: idiopathic vs neoplasia vs colitis
Which molecules seems to have a role in the polyp ethiology?
Increase MMP2 and 9 concentrations
Which breeds are predisposed to polyps?
Daschund, WHWT, Cocker and Shetland.
WHWT are predisposed to bigger polyps and have a higher risk of relapse.
Which colonic prokinetics can be useds?
- Prucalopride: 5HT4 agonism
- Acotiamide: facilitates muscarinic activity
Which is the energy requirement of puppy/kittens?
RER = 70 x (BW)^0.75
Puppies: 2-3xRER
Kittens: 2.5xRER
Which are RER and MER formulas in dogs?
RER = 70 x (BW)^0.75
MER = 81.5 x (BW)^0.93
Which is the evolution of energy and protein requeriments with age in dogs and cats?
Dogs:
- Reduce energy requirements
- Increase protein requirements
Cats:
- Increase energy and protein requeriments
Which are the characteristics of different types of fiber?
Fermentable/soluble:
- Fermentable –> microbiota ferment it and produce short chain fatty acids favorable for colonic health
- Produce less bulk of feces but hidrated
- Delayed gastric emptying and motility
Non fermentable/insoluble:
- Non fermentable
- Produce more bulk of feces but less hidrated
- Increase gastric emptying and intestinal motility
Which is the desired level of TG and cholesterol?
TG < 400
Chol < 700
Which are the proteins most affected by PLE?
Those of long half life –> immunoglobulins, albumin and ceruloplasmin
Which are negative prognosis factors for PLE?
- Medium body weight
- Altered urea
- Low albumin
Which are the characteristics of granulomatous lymphangitis?
- Rare disease causing PLE
- Clinical presentation typical for PLE but can also include fever and abdominal pain
- Neutrophils, macrophags and LP infiltrates surrounding lymphatics
- Unknow etiology: infectious vs immunemediated?
Which are the characteristics of crypt disease?
- Cause of PLE
- YSHT
- Cystic and dilated crypts filled by proteinaceus and cellular debris –> if ruptured: PLE
- Unknown etiology
- Poor response to tt
Which is the follow up of a PLE dog that has started low fat diet?
Rechek albumin 3d later. If serum albumin has not begun to increase, the protein proportion should be increased a 5-10%.
If one week later there is no increase in albumin, swich to another protein source.
