Gastrointestinal Flashcards
What are the 5 cranial nerved involved in oesophageal motility?
Trigeminal (V)
Facial (VII)
Glossopharyngeal (IX)
Vagus (X)
Hypoglossal (XII) - motor only, the rest are sensory and motor
Distribution of striated vs. skeletal muscle in oesophagus of cats vs. dogs
Dogs have striated muscle all the way down, cats only in the proximal 2/3
Which muscle makes up the upper oesophageal sphincter?
Cricopharyngeus muscle
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) Golden retrievers
b) Cocker and springer spaniels
c) Bouvier des Flandres, CKCS
d) Boxers, Newfoundlands
e) Large breed dogs
Breeds predisposed to congenital MegaO
Megaoesophagus Should Not Get Food Stuck In their Lower oesophagus
Miniature shnuazers, SharPei, Newfoundland, GSD, Great Dane, Fox Terriers, Siamese, Irist setters, Labradors
What percentage of dogs with MG may have pharyngael weakness as their only clinical sign?
0.01
What is the anatomical cause of cricopharyngeal achalasia
Thickening of the cricopharyngeus muscle
What is the most common vascular ring anomaly in dogs? Which breed(s) are predisposed?
Persistent right aortic arch - GSD and Irish Setters
Most common oesophageal neoplasias in dogs vs. cats
Fibrosarcoma and osteosarcoma (can results from Spirocerca granuloma transformation).
Cats = SCC
Which breed is predisposed to congenital oesophageal fistulas?
Cairn terriers
Why are prokinetics unlikely to be useful in the management of oesophageal dysmotility/megaoesophagus disorders?
None of the prokinetics affect striated muscle. Can actually make the signs worse.
What percentage of MG patients with megaO will respond to therapy?
Approximately 50%
What is the proposed mechanism of action of sildenafil in the treatment of congenital idiopathic megaoesophagus?
It decreased LES tone
What are the types of hiatal hernia in dogs and the most common
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.
Breeds predisposed to hiatal hernia
Brachys: Pug, EBD, FBD, Boston
NonBrachy: Shar-Pei, Chow Chow
Treatment of hiatal hernia?
Treat medically for oesophagitis initially
BOAS surgery
Pexy
What are the main family of bacteria present within the gastric flora?
Proteobacteria (99.6%) - this includes helicobacter spp.
Firmicutes (0.3%)
Breeds predisposed to hypertrophic gastropathy
Drentse Patrijshond
Basenji
Shih Tzu (pyloric)
Breeds predisposed to atrophic gastritis
Lundehunde
Breeds predisposed to gastric neoplasia
Belgian Shepherd
Rough collie
SBT
Lundehunde
What acid-base abnormality can develop with a pyloric outflow obstruction?
DDx for this metabolic abnormality
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).
Gastric Secretory Testing:
- Methods
- Interpretation
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
Parasitic causes of (acute) gastritis
Ollanus spp. physaloptera spp.
DDx for GI ulceration
Mortality rates and prognositc indicators for GDV
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
What percentage of dogs with chronic vomiting have chronic gastritis?
0.35
What is the most common histologic feature of chronic gastritis?
Mild to moderate superficial lymphoplasmacytic gastritis with follicular hyperplasia
Most predominant helicobacter species in dogs and cats
H. heilmanni cats
H. bizzozeronii in dogs
What has gastric hypertrophy in Drentse Patrijshonds been associated wi
Stomatocytosis, haemolytic anaemia, icterus and polyneuropathy
What diease are Lundehunds prdisposed to?
Gastric mucosal atrophy and is associated with PLE/gastric adenocarcinoma
Where in the USA is pythiosis more likely to occur?
Mexico
Florida
Alabama
Louisiana
Mississipi
What endoscopic findings would be expected with the following gastric parasites:
a) Ollanus spp
b) Pysaloptera spp.
a) Parasitic nodules
b) Worms
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
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
Characterists of Ollanus spp.
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
Characteristics of Physaloptera spp.
Size: 2 - 6 cm
Transmission: most common is physaloptera rara with reservoir host being coyote
Diagnosis: sugar fltation
Tx: pyrantel pamoate
Gastric parasites that may give a nodular parasitc granule
- Gnathostoma (cats)
Spirocerca (dogs)
Aonchotheca spp. (cats)
What is the main pathologic consequence of pythiosis?
Pyogranulomatous inflammation causing transmural thickening of the pyloric outflow tract
How is pythium diagnosed?
Gomori’s methanamine silver staining
Fungal culture
PCR
How is pythium treated?
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
Treatment of helicobacter pylori
Amoxicillin + MTZ
Amocicillin + Clarithromycine + MTZ
What breed is atrophic gastritis associated with and what is the pathologic feature?
Lundehunds
Reduced number of prietal cells and neuroendocrine cell hyperplasia.
Aso associated withadenocarcinoma formation
What change in gastrin is expected with hypertrophic gastropathy?
Increased serum gastrin along wiht exaggerated gastrin stimulation testing. Can also have over-sectretion of pancreatic polypeptides.
If a patient is consistently vomiting 8 - 16h after eating what disorder should one consider?
Gastric motility disorder
What testing can be employed for the evaluation of gastric motility?
Barium contrast
BIPS
Ultrasonography
113Coctanoate and 13Cacetate breath testing
Wireless motility capsules
Scintigraphy
Is there a male/female predisposition to gastric neoplasia?
Males > Females
Predisposed breeds to gastric adenocarcinoma
Belgian Shepherds
Rough Collies
+/-SBT
Bouviour-des-Flandres
Groendael
Lundehund
Collie
Standard Poodle
Norweigan Elkhound
What are the 4 main cell types in the gastric gland and what do they secrete?
Mucus neck cells = mucus
Parietal (Oxyntic) = HCL, IF
Chief/Peptic = Pepsinogen
ECL cells = histamine
Outline the chemical events of gastric acid secretion
Outline the interactions between the ANS, local hormonal factors and cells involved in gastric acid secretion
Hormones that increase and decrease gastric acid secretion
Increase:
- AcH
- gastrin
- Histmine
Decrease:
- SST
- GIP
- VIP
- Secretin
Outline the chemical process of pancreatic bicarbonate secretion
What are the main hormones involved in pancreatic secretion?
Ach (HCO3 and enzymes)
CCK (HCO3 and enzymes)
Secretin (HCO3 mainly)
Gastrin:
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions
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
SST
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions
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
CCK
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions
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
Secretin
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions
a) S cells in the duodenum
b) Fat and acid in the duodenum
c)
d) Pancreatic secretion (HCO3), gallblader secretions, inhibition of gastrin release
GLP-1
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions
a) L-cells in ileum and LI
b) Fatty acids in the duodenum and ileum
c)
d) Insulin secretion, Inhibition of gastric emptying,
GIP
a) Cells that secrete and location
b) Stimulus for secretion
c) Inhibitors of secretion
d) Actions
a) duodenal K cells
b) All duodenal nutrients
c)
d) Insuline secretion, delays gastric emptying, inhibits gastrin release
What is the main energy source for enterocytes?
Glutamine
What is the function of brush border enzymes?
Hydrolysis of carbohydrates
Why are cats likely to be more prone to vitamin B12 deficiency?
They do not have transcobalamin 1 (R protein) therefore lose cobalamin through enterohepatic recycling.
What molecular pattern recognition receptors are particularly important in the GIT
TLRs and NODs
What do the following PRRs recognise?
a) TLR 2
b) TLR 4
c) TLR 5
d) NOD2
a) lipopeptides
b) lipopolysaccharides
c) flagellin
d) LPS
Predominant lymphocyte type in intraepithelial GIT
gamma-delta T cells
Predominant lymphocyte type in lamina propria
alpha-beta T-cells
Predominant gastrointestinal lamina propria cells in cats vs. dogs
Dogs = alpha-beta CD4
Cats = CD8
Outline the important IL and cells that produce them in the SI
What receptor does IgE bind to?
FcER1 receptor - leading to mast cell degranulation and eosinophil recruitment.
What breed-associated B12 syndromes have been reported?
Chinese Shar-Pei - mutation in cubulin
Immerslund-Grasbeck syndrome - Australian Shepherds, Collies, Giant Schnauzers and Beagles
Which parts of the villi are affected by the following pathogens?
Rotavirus
Coronavirus
Parvovirus
Vincristine
Rotavirus - villus tip
Coronavirus - mid-villus
Parvovirus - Crypt
Vincristine - Crypt
What is the mechanism by which LI diarrhoea can results from SI diarrhoea?
Increased VFA and bile salts in faeces increase colonic secretions
DDx for PLE
Breeds that are predisposed to PLE
Basenji
Lundehund
Rottweiler
Soft-Coated Wheten Terrier - get concurrent PLN
Yorkshire Terrier
Shar Pei
What clinicopathologic alterations can occur along with PLE?
Reduced cholesterol
Lymphopenia
Reduced magnesium and ionised calcium
Reduced vitamin D
What test may be a more sensitive test for PLE in dogs?
Faecal alpha-1 protease inhibitor - need to measure over 3 stool samples
What stains may identify the following on faecal smear examinations:
a) Starch granules
b) Fat Globules
c) Muscle Fibres
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
How long should an animal have a meat free diet fr prior to faecal occult blood testing?
≥72h
What are the following compounds markers of?
a) Calprotectin
b) 3-Bromotyrosine
c) N-methylhistidine
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
What are the things (5 morphological features) that are looked for on WSAVA guidelines for histologic biopsy samples?
What are the top antibiotic treatment choices for campylobacter?
- Erythromycin
- Clindamycin or tylosin
- Fluroquinolones
Which organism is responsible for seasonal febrile diarrhoea syndrome?
Salmonella typhimurium
What is the treatment for salmonellosis?
Fluroquinolones
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) ETEC = enterotoxigenic
b) EPEC = enteropathogenic
c) EHEC = enterohaemorrhagic
d) AIEC = attacking and invading
How is E.coli enteritis dianosed?
PCR
Salmon poisening:
- Responsible organism
- Disease distribution
- Intermediate host
- Clinical signs
- Diagnosis
- Treatment
- 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
What is the public health implication of roundworms in dogs?
Embryonated L3 larvae, embyronation takes 2 - 7 weeks after passage of faeces so the risk is more from contaminated foodstuffs than dog/cat poop.
Which species of strongyloides are of concern to small animal diarrhoea, what disease are these associated with?
S. tumefaciens = large intestinal diarrhoea
S. stercoralis = haemorrhagic enteritis in puppies
What is the risk of hookworms to people? Which worm is specifically associated with particular lesions in dogs?
Hookworms as they can cause cutaenous larval migrans
Pedal lesions are associated with uncinaria stenocephala
What is the treatment for:
a) Strongyloides spp.
b) Hookworms
a) Fenbendazole and related
b) Pyrantel (ivermectin and milbemycin can be used as preventatives)
How might diplydium caninum be recognised on faecal analysis?
Motile rice grains can be seen
Which eccinococcus spp. causes hydatid disease?
E. granulosus
Which tapeworm species can mimic PLE?
Mesocestoides
Treatments for cytoisospora
- Toltrazuril, diclazuril
- TMPS/Sulfasalazine
When might cyrptosporidium be a concern/should be tested for?
When there s severe haemorrhagic diarrhoea in a young or immunocompromised animal
Treatments for cryptosporidium
Paromonycin (AKI risk)
Tylosin, azithromyxin
Nitazoxanide
Which breed has gluten-sensitive enteropathy been documented in and what is the likely genetic inheritance pattern?
Autosomal recessive in Irish Setters
Which breeds are predisposed to eosinophilic enteritis?
Dobermans and Boxers +/- GSD
What feline breed appears predisposed to FESF?
Ragdolls
Which feline breed is predisposed to lymphoplasmacytic enteritis?
Siamese
Which breeds are predisposed to lymphangiectasia?
Yorkshire terriers, maltese, lundehunds, Rottweilers
What are the causes of secondary lymphangiectasia?
Infiltrative neoplasia, thoracic duct obstruction, R-CHF
Which hepatic disorder has been associated with lymphangiectasia?
Granulomatous hepatopathy
What is the most significant prognostic marker for gastrointestinal adenocarcinoma?
Presence of metastasis
What IHC markers should be used to differentiate leiomyoma from GIST?
C kit, S100, vimentin, desmin and SMA
Predilection sites for leiomyosarcoma/GIST in dogs vs. cats?
Dog = jejunum or caecum
Cat = small intestine
What molecule is responsible for hypoglycaemia in leiomyosarcoma?
Insulin-like growth factor II like peptide
What stain can identify Helicobacter organisms on gastric mucosa?
Warthrin-Starry stain
What toxins should be considered if you suspect clostridial gastrointestinal disease?
C difficile - A and B
C. perfringens = CPE
Is Giardia ELISA sensitive or specific?
Sensitive but poorly specific.
What diagnostic tests are appropriate for Herobilharzia americana?
Sodium chloride sedimentation
PCR for egg DNA
Folate digestion and absorption
Outline cobalamin digestion and absorption
What is faecal alpha-1 proteinase inhibitor?
It is a proteinase inhibitor normally used by the liver that is slightly smaller than albumin. Therefore may be an early marker of PLE.
Which is the type of muscle fibre present in normal muscle that means it is not affected by MMM?
Type 2 C fibres
Define the following conditions of the salivary glands:
- Sialocoele
- Sialadenitis
- Sialadenosis
- Necrotising sialometaplasia
- 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.
What is the treatment for craniomandibular osteopathy?
This is a non-inflammatory, non-neoplastic disease. The treatment is jsut supportive (i.e. analgesia)
What feature(s) differ between craniomandibular osteopathy and calvarial hyperosteosis?
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
Most common oral tumours in dogs
Malignant melanoma, SCC, fibrosarcoma
Most common oral tumors in cats
SCC, fibrosarcoma,
Behaviour of oral SCC in tonsillar and lingual vs. gingival sites?
Tonsillar and inguinal are highly metastatic wiht lingual and gingival less so
Which nerves are responsible for innervation of the proximal and distal colon?
Proximal = vagus nerve
Distal = pelvic nerves
which hormone is responsible for growth of the colonic mucsa?
Growth hormone
What is the predominant immune cell of the large intestine?
CD8+
What is Hirschprung disease?
A congenital lack of enteric ganglia
What is the main energy source for clonocytes?
Short chain fatty acids where are produced by fermentation of fibre by enteric bacteria
Explain how colonoscopic allergen provocation can be performed, what are the positive and negative controls. What indicated a positive reaction?
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.
What are some examples of fermentable soluble fibre?
Psyllium, beet-pulp, FOS, insulin, MOS
Sulfasalazine:
- MoA/Pharmacology - i.e. how does it become what it needs to become
- Side effects
- alternatives and advantage
- 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
What is the histopathologic characteristic of granulomatous colitis?
PAS staining within macropahges under an ulcerated colonic mucosa
What is the causative organism of E. coli?
Attaching and invading (AIEC)
What is the gram positivity of the following large intestinal pathogens?
- Anaerobiospirillum
- Brachyspira pilosicoli
- Campylobacter
- Clostridium spp.
- E. coli
Clostridium are the only gram positivies otherwise they are all gram negative
What does this picture show?
Prototheca
spp. prototheca zopfii is associated with gastrointestinal and then disseminated disease in dogs and cats
What is the treatment for prototheciosis?
Amphotericin B in combination wiht itraconazole although generally the disease is fata
When collecting a faecal sample for Tritrichomonas testing, what contaminant should be avoided?
Cat litter - this can inhibit PCR reactions
Ronidazole
- MoA
- Side effect
- 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
Life cycle of heterobilharzia americanum
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.
What is the location of heterobilharzia americanum?
Southeastern and gulf coast areas
What diagnostic test can be used for heterobilharzia (which is in contrast to other flukes)
Faecal flotation
What is the colonic finding that may be seen with Strongyloides tumefaciens?
1 - 3 mm nodules in the colonic mucosa
What is the lifecycle of strongyloides tumefaciens?
Skin penetracion, migration and coughing up of eggs from the lungs, adult parasites burrow into the colonic mucosa
What is the life cycle of trichuris vulpis?
Direct via oro-faecal route
How does the natural behaviour of large intesinal neoplasia differ between cats and dogs?
cats have a high rate of local metastatis of adenocarcinoma and the predilection site is the ileum.
What is the predilection site for leiomyosarcoma in the large intestine of dogs?
Caecum
How are rectal prolapse and rectal intussuception differentiated?
If a blunt instrument cannot pass between the protruding segment and the anal sphincter then this indcates a rectal prolapse
Outline nervous control of the rectoanal region
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
What are the two types of faceal incontinance?
Reservoir incontinance - no nervous problem, is usually accompanied by tenesmus
Sphincter incontinance - this tends to suggest spinal chord dysfunction
What abdominal organs can herniate through a perineal hernia?
Prostate and bladder (this can occur in 18 - 25% patients!)
What is the risk of recurrance of perineal hernia in castrated male dogs compared to those that are not castrated?
Non-castration associated with a 2.7x risk of recurrance
What is the surgical treatment of choice for severe perineal hernias? What treatment can be given to manage these medically?
Internal obturator transposition has the best success rate
Medical management considts of stool softening and periodic enemas
What is the hormonal basis for perineal hernia development?
Possibly:
- Reduced adnrogen receptors in the levator ani and coccygeus muscles
- Relaxin (is secreted by the prostate) can softe connective tissue
Classification of atresia ani
What is the most common additional malformation associated with atresia ani?
Type II atresia ani is most often associated with rectovaginal fistulas.
Most common cause of faecal sphincter incompetance?
DLSS and cauda equina syndrome
What is the hormonal basis of perianal adenomas?
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.
Most common cause of septic peritonitis in dogs?
Wound dehiscence and perforating GI foreign body
What is the most common bacteria identified in septic peritonitis?
E. coli
Ancillary fluid testing for diagnosis of septic peritonitis in dogs?
- TNCC
- Lactate
- Glucose
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
Bilirubin concentration of abdominal effusion that is suggestive of bile peritonitis?
> 2x peripheral blood
Creatinine and potassium concentration of fluid comapred to blood that are diagnostic for uroabdomen
Creatinine > 2x peripheral blood
Potassium >1.4x blood dogs, > 1.9x blood in cats
What biochemical abnomalities can be noted with uroabdomen?
Increased potassium (through re-absorption)
Decreased Na:K ratio (possibly due to loss of sodium into the abdominal cavity and activation of RAAS)
What are the targets for MAP, UOP and lactate in septic peritonitis
Within the first 6 hours aim for
- MAP > 65mmHg
- UOP > 0.5ml/kg/h
- Lactate <2mmHg
What is the most common type of pancreatitis in cats?
Chronic - in an estimated 50.4% cases based on necropsy studies
What is the potential prevalence of pancreatitis in clinically normal cats?
0.45
What percentage of clinical pancreatitis cases in cats have an underlying cause?
5% - 95% are considered idiopathic
What is the main inciting event in acute pancreatitis?
Trypsinogen activation
Three most common clinical signs of pancreatitis in cats
Lethargy
Anorexia
Vomiting
Which lobe of the pancreas can sometimes be identified using abdominal radiography in acute pancreatitis?
Left lobe on a VD view
Compare and contrast the AUS findings of normal, acute and chronic pancreatitis?
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
What is the diagnostic rate of pancreatic FNA?
0.67
Four most common electrolyte abnormalities in feline acute pancreatitis
Hypokalaemia
Hypocalcaemia
Hypochloraemia
Hyponatraemia
PPV/NPV of fPLI in diagnosis of feline pancreatitis
PPV 90%
NPV 76%
What combination of imaging findings has the best agreement with results of lipase testing in feline pancreatitis?
Hypoechoic or mixed echogenicity pancreas
What specific reccomendations are their for the size and fixation of feline pancreatic biopsy speciments
<1cm3 piece in 10% formalin in a 10:1 ratio
When should a feeding tube be placed in a cat with acute pancreatitis?
If 48h inappetence or prolonged inappetance prior to presentation
What vasopressor is discussed in the feline pancreatitis consensus statement as potentially being first line, what specific scenario do they reccomend it in?
Dopamine, particularly in cats undergoing a GA
When can FFP be used in feline pancreatitis?
If they have a coagulopathy
% of cats with bacteria in pancreas detected using FISH
0.35
What are the negative prognostic indicators for cats with acute pancreatitis?
Low ionised calcium
Hypoglycaemia
Azotaemia
What is the mechanism of action of antacids?
Decrease in pepsin activity
Binding of gastric bile salts
Stimulation of local PGE2 release
What are the potential side effects of antacids?
Aluminium toxicity - more of a concern in renal failure
Constipation
What drugs can antacids chelate?
Fluroquinolones, tetracyclines and digoxin
How often do antacids need to be administered for clinical effect?
Every 30 - 60 minutes
What is the possible mechanism of tachyphylaxis to H2 antagonists?
Increase in gastrin secretion and upregulation of ECL histamine synthesis
Why are PPI drugs less effective when given with an H2 antagonist?
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.
How long does it take for PPis to become effective? Why?
2 - 4 days. This is because when used, dormant parietal cells will become active for the first few days of administration.
When should PPIs be tapered?
If given for > 3 - 4 weeks
What drug absorption/action may PPIs potentially interfere with?
Anti-fungal drugs
Iron
Mycophenolate
Clopidogrel
Why might PPIs lead to worse NSAID associated ulceration?
It is thought that this occurs because there is an increase in gram negative bacterial growth secondary to PPI administration.
What is the target of misoprostal?
PGE1 on parietal cells
Which drug has misoprostal proven efficacy for preventing GI associated ulceration in?
Aspirin - this is the only one that the consensus statement reccomends its use in.
