Gastrointestinal Flashcards
What are functional abnormalities that can occur with the GIT?
Dysautonomia, cricopharyngeal achalasia, esophageal motility disorders
What are some specifics of GIT signs like vomiting regurgitation and diarrhea what you want to gather to make a better diagnosis?
Onset and duration
Frequency, progression, severity
Appearance
Diet
What are some characteristics of vomiting that regurgitation does not have?
Abdominal contractions, open/relaxed sphincters, reverse peristalsis, digested food, nausea and retching
What are some differences between small bowel and bowel diarrhea?
Large bowel is higher in frequency with normal fecal volumes, with more often urgency, tenesmus, mucous, and blood.
Small bowel can possibly have melena as well as steatorrhea with increased volume
List some key diseases of the oral cavity
Periodontal Viral papillomatosis Odontogenic Neoplasia Malignant oral masses Eosinophilic granuloma complex Gingivostomatitis Foreign body
What disease has benign cauliflower-like lesions in and around the oral caivity?
Canine oral papillomavirus
T/F: Papillomatosis usually afffects younger dogs and will regress on its own as the dog’s immune system matures
True
T/F: Epulides - ondotogenic neoplasms are benign
True
What is the curative form of treatment for peripheral odontogenic fibromas?
Surgery
T/F: Peripheral odontogenic fibromas are invasive, ulcerated lesions in the mouth
False. non-invasive, non-ulcerative
What is the #1 malignant oral mass in the dog?
Malignant melanoma
How would you treat oral malignant cancer?
Surgery, chemo, radiation
What species is affected by eosinophilic granuloma complex?
Cats
What will you see on a FNA/cytology for EGC?
mixed eosinophilic and granulomatous reaction
T/F: prognosis for EGC is good, but recurrence is common
True
How do you treat EGC?
change food, steroids, flea control, pain management
What do you see with gingivostomatitis?
Severe chronic inflammation with ulcers and proliferative lesions
How do you treat gingivostomatitis?
medically for good oral hygiene, full mouth extractions, antibiotics
What are some signs you will see with pharyngeal diseases?
Dysphagia, retching, gagging, coughing, dyspnea, voice change*
What are some diseases that can occur with the pharynx?
Foreign body, inflammation/infection, obstruction, masses, neuromuscular dysfunction
What agents are typically the cause of tonsilar infections?
Viruses
What signs will you see with nasopharyngeal polyps?
Difficulty swallowing, nasal discharge, stertor
Where do nasopharyngeal polyps originate?
Middle ear
How do you treat a nasopharyngeal polyp?
Gentle traction to remove it
What is the #1 salivary gland disorder in dogs?
Sialocele
What is the disease in the salivary gland that responds to phenobarbitol called?
Sialadenosis
T/F: Sialoceles common cause acute pain and inflammation in the early course of disease
True
T/F: Sialoceles are hard and firm
False. Mobile, soft, flocculent
How do you treat sialoceles?
Surgical removal WITH BIOPSY*
How do you treat sialadenitis?
Treat primary disease, antibiotics, pain meds
What may you see with traumatic pharyngeal lesions (from a stick)?
Secondary infections, bloody saliva, pain, anorexia
What neurologic tests would want you want when dealing with an animal with dysphagia?
GAG reflex (CN IX and X)
What are some tests to run to evaluate and diagnose a dysphagic animal?
Radiographs, fluoroscopy, AcH antibody titer, endoscopy, MRI
How can you treat an animal with dysphagia?
elevation of food and water, treat specific disease, “thick-it”, feeding tubes
T/F: Cricopharyngal achalasia is a common disorder seen in male dogs.
False. Rare disease with breed predisposition - Cockers and Spaniels
What action is affected by cricopharyngeal achalasia?
Swallowing
What test can you run to evaluate cricopharyngeal achalasia?
Fluoroscopy with contrast
What treatment is there for cricopharyngeal achalasia?
Cricopharyngeal myotomy/myectomy, botox,
Also treat aspiration pneumonia
T/F: a sedated oral exam is a common part of oral and pharyngeal disease
True
T/F: Animals with esophageal disease are hungry but can’t eat!
True!
T/F: You will see vomiting often with esophageal disease.
FALSE. REGURGITATION!
Where would you perform radiographs with animals with esophageal disease?
Neck and Thorax
How would you act if your patient aspirated barium?
Give antibiotics and monitor. Most will be okay
What medication can cause esophagitis? (Hint: it’s an antibiotic)
Doxycycline
What will you most likely see on radiographs with esophagitis?
Not much significant value
What animal, dog or cat, gets a foreign body stuck in its esophagus more often?
Dog > cat
What are some risks when removing the foreign body in the esophagus from an animal?
Perforation. This can lead to effusion, pyothorax
What is esophageal stricture typically caused by?
Trauma, neoplasia, post-foreign body, post-anesthesia**
How can you treat esophageal stricture?
Balloon dilatation
What is the best method of diagnosing esophageal dysmotility?
Fluoroscopy
What may be a ddx for esophageal dilation in a cat?
Nasopharyngeal polyp
What can be a secondary symptom in a cat with nasopharyngeal polyp?
Megaesophagus
T/F: Megaesophagus is a severe, diffuse generalized dilation of the esophagus
True
T/F: Congenital megaesophagus patients will have abnormal neuromuscular innervation
True
What are the main causes of acquired megaesophagus?
Idiopathic, primary CNS, endocrine, lead toxitiy
What blood tests would you perform with megaesophagus?
CBC, Chem, UA, T4, cortisol
How do you treat megaesophagus?
Treat the underlying disease, nutritional support
How can you improve a dog’s eating habits if they have megaesophagus?
Thicken the food, feeding tube, elevate the food dishes (bailey 4 chairs)
What determines the prognosis in a patient with megaesophagus?
patient’s ability to tolerate the change in eating habits, severity of disease
What is the #1 cause of vascular ring anomaly?
Persistent right aortic arch
What CxS will you see with vascular ring anomaly?
Regurgitation, poor hair coat
What is the best treatment for vascular ring anomaly?
Surgery. sooner the better
What parasite is associated with the esophagus?
Spirocerca lupi
What must form in the esophagus in order to detect spirocerca lupi in the fecal test?
Fistula
T/F: Spirocerca lupi can cause sarcoma
True
T/F: Often spirocerca lupi disease, by the time it is diagnosed, is too advanced to treat
True
What are the two types of hiatal hernia?
Type 1 - sliding, intermittent displacement of LES and fundus into thorax
Type 2 - fundus only displaced
How would you diagnose and treat hiatal hernias?
Diagnose with DI and contrast
Treat with surgery or similar meds to esophagitis
T/F: Neoplasia is common in the esophagus, but has a good prognosis
False. Rare, with poor prognosis
T/F: Vomiting is a reflex
True
What are the phases of vomiting?
Nausea, retching, expulsion
T/F: The stomach, esophagus and sphincters are relaxed during vomiting
True
What systems are stimulated in regards to vomiting?
Cerebral cortex and limbic system, vestibular system -> chemoreceptor trigger zone
Where is the emetic center located in the brain?
Medulla oblongata
What types of stimuli affect the chemoreceptor trigger zone?
Motion (sickness)
Endogenous drug toxins
Pharynx, stomach stimuli
How does motion sickness (kinetosis) lead to vomiting?
Inner ear stimulation -> CRTZ activation -> dopamine and serotonin -> Ach from emetic center
What are some causes of CRTZ activation?
Opioids, toxins, uremia, motion
What are some DDx for acute vomiting? (<1 week)
Toxin, meds, diet, foreign body, pancreatitis, addison’s crisis
What are some DDx for chornic vomiting? (>1 week)
Intermittent foreign body, organ failure, pancreatitis, primary GIT disease
If the pet is vomiting and not systemically ill, how would you treat it?
Symptomatic therapy with diet and meds
If the pet is vomiting and is systemically ill, how would you treat it?
Treat symptoms, but also lab tests and image.
What are the ‘big 4’ tests to run with a pet that is vomiting?
PCV, TS, BG, AZO stick
Why would you run a CBC, chem, or UA on a dog that is vomiting?
To rule out possible underlying disease
Why would you run a cortisol test on a dog that is vomiting?
Rule out addison’s
T/F: If you are using U/S, you do not have to take rads on a pet that is vomiting.
False. US is complimentary
What can U/S tell you on a pet that is vomiting?
The alterations of the stomach lining and small intestine
What are some medical management treatments for patients that come in with acute vomiting, but are not ill?
antacids, fluids, and monitoring.
No water for 6-8 hours and taper in slowly. Bland diet
What are some medical treatments for patients that come in with vomiting and ARE ill?
catheter, fluids, antacids, pain mangement, nutrition
What are some risks to think about before giving a vomiting dog fluids?
Volume overload in heart failure patients, severe hypoproteinemia
What are the common H2 antacids used?
Famotidine, ranitidine, cimetidine
What are the proton pump inhibitors used?
omeprazole and pantoprazole
What do antiemetic medications do?
Block the neurotransmitters at the receptor sites associated with emesis
What histamine antagonists are commonly used?
Diphenhydramine and meclizine
What histamine antagonist is useful with vestibular disease associated with vomiting?
Meclizine
What is the dopaminergic antagonist drug commonly used? Where does it work on the body?
Metoclopramide. Distal esophagus stimulation
What is the NK-1 receptor antagonist drug used?
Maropitant (cerenia)
What is the gastric mucosal protectant used? What does it do?
Sulcralfate. Stimulates PG and reacts with HCl to form a paste that sticks to ulcers
What drugs might you use in advanced vomiting related disease?
Misoprostol, octreotide
What are some prokinetics used?
Metoclopramide, cisapride, ranitidine, erythromycin
How does erythromycin stimulate intestinal motility?
Stimulates motilin in the gut which promotes movement
What are some appetite stimulants used?
Cyproheptadine (H1 blocker, serotonin antagonist)
What is the appetite stimulant used that is a tetracyclic antidepressant?
Mirtazapine
T/F: Dogs and cats secrete lots of intrinsic factor from their parietal cells
False
What is the nerve group in the submucosa of the stomach called?
Meissner’s plexus
What is the nerve group in the muscularis of the stomach called?
Auerbach’s plexus
What are some issues that can happen with the stomach?
Inflammation, ulceration, obstruction, neoplasia, infection
What chemistry signs will you see with primary gastric disease?
Hypochloremia, hyponatremia, hypokalemia, azotemia
What does an elevated BUN, greater than creatinine suggest with the upper GIT?
Bleeding inside of the GIT
What test would probably give the most information for the stomach?
Abdominal ultrasound
When would endoscopy of the stomach be indicated?
When you rule out non-GI causes and have treated for the common ones like parasites, and diet change
What are the pros and cons of gastric endoscopy?
Pros: Can detect ulcers, perform biopsies, find masses, foreign bodies, short recovery
Cons: cannot detect deeper diseases
What are the pros and cons of gastric surgery?
Pros: full thickness biopsy, foreign bodies
Cons: longer recovery
How do you approach a case of an animal with acute gastritis?
Check for systemic illness and treat according to symptoms.
ex: fluids, antacids, anti-emetics, r/o foreign body, pain meds
T/F: The clinical signs for gastric foreign body is always persistent.
False. Persistent and intermittent
What happens to the contents of the abdomen with GDV?
Compression of the caudal vena cava -> hypovolemic shock
Necrosis of gastric wall, splenic torsion, congestion, endotoxemic shock, DIC
What types of dogs are predisposed to GDV?
Large breed dogs, barrel chested. Also those that eat fast and play right after
What are some CxS seen with GDV?
Retching, ptyalism, abdominal distension, collapse
What will you see on PE with GDV?
Tympany of abdomen, tachycardia, hypothermia, depression
What do you see in radiographs on a dog with GDV?
“Popeye arm” shape fof the volvulus.
How do you treat GDV?
Aggressive fluid therapy, decompress abdomen, SURGERY
What happens in the stomach when it erodes or ulcerates?
Disruption of the normal proteins, decreased blood flow, hypersecretion of acid, decreasted mucus and bicarb
What causes gastric ulcers and erosions?
Neoplasia, hypotension/volemia, trauma, medications
What is the best way to diagnose a gastric ulcer/erosion?
Endoscopy
What is the primary treatment to enhance the mucosal protection of the stomach?
Sucralfate
What does helicobacter cause? (CxS)
Acute or chronic vomiting
How do you treat helicobacter?
2 weeks of antibiotics (amoxicillin, metro, clarithromycin)
What CxS are seen with gastric pythiosis?
Chronic vomiting, pyogranulomatous inflammation
T/F: Pythiosis is nonfatal
False
What is seen with gastric esophageal reflex?
Chronic vomiting
How would you treat GER?
Find and treat the primary cause
How do you diagnose inflammatory gastritis?
Endoscopy, surgical biopsy
What is the major CxS with inflammatory gastritis?
Chronic vomiting
What is the #1 sign of inflammatory gastritis on a CBC?
Lymphoplasmacytic infiltrate
How would you treat lymphoplasmacytic and eosinophilic gastritis?
Symptomatically with antacids, sucralfate, antiemetics, deworms, diet change
IMMUNE MODULATION (taper prednisone after response)
What CxS is seen with atrophic gastritis?
Chronic vomiting
what CxS is seen with hypertrophic gastropathy?
Chronic vomiting, projectile
What kinds of dogs typically have hypertrophic gastropathy?
small, older breeds
What happens with pyloric stenosis/hypertrophy?
muscular thickening of the pyloric sphincter, delayed gastric emptying
How can an animal get pyloric stenosis?
Congenital: breed
Acquired: inflammation, neoplasia
What CxS do you see with a gastrinoma?
Chronic vomiting
What is a gastrinoma?
a tumor in the pancreas of the APUD which leads to the hypersecretion of gastric acid
How do you diagnose gastrinoma?
Measure gastrin levels, and see what happens 48 hours after antacids are stopped
How do you treat gastrinoma?
Surgical removal, PPI, octreotie
T/F: Gastrinoma is non malignant and does not metastasize
False. Mets are often found at diagnosis
What is the most common malignant tumor in the stomach of the dog?
Adenocarcinoma (70%)
What is the most common malignant tumor in the stomach of the cat?
Lymphosarcoma
What usually causes a delayed emptying of the stomach and/or motility disorders?
Inflammation, infection, obstruction, electrolyte imbalance, surgery, meds (opioids)
How long does it normally take for the stomach to empty its contents into the small intestine?
8 hours
How can you treat delayed gastric emptying disorders?
Cisapride*
T/F: If you see a dog with vomiting and you see bacteria in gut, it is most likely helicobacter.
False
T/F: Small intestine absorbs the nutrients, large intestine absorbs the water
True
T/F: With diarrhea, the reabsorption of water from the lumen exceeds its secretion
False
What is considered acute diarrhea, and chronic?
Acute < 3 weeks
Chronic > 3 weeks
What are some things to think about to help guide the diagnosis in a pet that has diarrhea?
Onset, duration, appearance, frequency, food/diet, environment, toxin, meds, vomiting, systemic
What may you see with small bowel diarrhea?
Weight loss, vomiting, high fecal volume, melena, steatorrhea
What may you see with large bowel diarrhea?
High frequency of defecation, urgency, tenesmus, mucus, blood
What might cause melena?
Ingestion of blood from GIT, ulcers, IMTP, foreign body, coagulopathy
What drugs can cause melena?
NSAIDs, aspirin
What PE techniques should be done on an animal that comes in with diarrhea?
Rectal exam, palation of abdomen, lymph node check, systemic illness check, hydration status
When should you be more aggressive with tests and treatment on a patient with diarrhea?
The presence of weight loss, inappetence, dehydration
What is a big goal of running labwork on an animal with diarrhea?
Rule out non-GI diseases, and get info on the extent of possible primary GI
What tests can be done to check the extent of primary Gi disease?
CBC for anemia, thrombocytosis, leukopenia, eosinophilia, or normal values
What does hypoproteinemia in a dog with diarrhea tell you?
Malabsorption of the small intestine
What does hyperglobulinemia in a patient with diarrhea tell you?
FIP, infectious causes, neoplasia
What does hypercalcemia ina patient with diarrhea tell you? Hypocalcemia?
Hyper - cancer, fungus
Hypo - Pancreatitis
What does hypoglycemia in a patient with diarrhea tell you?
Septic abdomen, paraneoplastic syndromes, Addisons
What does a hyponatremia with hyperkalemia tell you about a patient with diarrhea?
Addisons, pseudo addisons
T/F: B12 values tell you the type of GI disease and helps rule out the presence of it
False. but it can tell you the animal is malabsorbing
What does high pancreatic lipase tell you?
Pancreatitis
T/F: Testing TLI is helpful for indirectly diagnosing pancreatitis
True.
T/F: High TLI and low PLI is a strong sign for pancreatitis
False. Low TLI and High PLI
What coagulation assessment can be found with malabsorptive diseases?
Decreased anti-thrombin
What are the common antibiotics used to treat diarrhea?
Metronidazole, tylosin, clavamox, enrofloxacin
How can you treat diarrhea?
Antibiotics, diet change, fluids, vitamin supplements, fiber, steroids (prednisone), probiotics
What topical steroid can be applied to treat diarrhea that has less side effects and is more potent than prednisolone?
Budesonide
T/F: You can’t give cyclosporine to cats
False. Can’t give azothioprine
What immune modulators are commonly used with diarrhea?
Cyclosporine, azothiopine, chlorambucil
What can Peptiobismol do to the stool?
Darken it. Also radioopaque
T/F: B12 and folate levels are assessed to test suspected primary large intestine disorders
False. Small intestine. Normal values does not mean there is no primary disease
T/F: Decreased albumin and cholesterol is a marker for primary large intestinal disease
False. Small intestine
Why is it important to give nutritional supplementation when dealing with GI disease?
If the enterocytes are damaged, they cannot absorb any nutrients
What is the new term for hemorrhagic gastroenteritis?
Acute hemorrhagic diarrhea syndrome (AHDS)
What are the CxS seen with AHDS?
Hematemesis, hematochezia
What is the expected PCV to be with AHDS?
> 60%
How do you treat AHDS?
IV fluids, antibiotics, sucralfate, antiemetics, nutrition
What is a sign of poor prognosis for AHDS?
Severe hypoproteinemia, sepsis
What is the minimal fecal sample size required to run a fecal exam?
1 gram
How does a cat or dog usually get dipylidium caninum?
Ingestion of fleas
How do you treat tapeworms?
Praziquantel, fenbendazole
T/F: Roundworms can be fatal
True with pulmonary involvement
T/F: Is a parasite is suspected, just deworm the pet
True
What types of animals are most affected by protozoa?
Young and immune compromised
What do you primarily see with protozoal infections?
Diarrhea, maybe weight loss
How do you diagnose giardia?
Fecal float, ELISA (do not use as recheck)
How do you diagnose tritrichomonas for the cat?
Fecal PCR
What is the cytological difference between giardia and trichomonas?
Giardia - falling leaf
Trichomonas - undulating, wavy membrane
How do you treat giardia?
Fenbendazole x 5 days
How do you diagnose and treat coccidia?
Fecal smear or float
Sulfadimethoxine (ALBON)
T/F: Cryptosporidium is a severe life threatening disease
True, but only to immunocompromised. Self-limiting for all others
What are the chances that a toxoplasmosis infected cat will shed its oocytes?
Very low
What do antibody titers tell you about toxoplasma?
Only helps if the patient is sick, does not tell you if the pet is shedding oocytes or has disease
How do you treat toxoplasmosis?
Clindamycin, TMS
T/F: A dog with pythiosis can show both GI and cutaneous lesions
False. These do not occur together
How do you diagnose pythiosis?
ELISA for antibody detection, biopsy of the lesions - SEVERE thickening of tissue
How do you treat pythiosis?
Surgical removal, itraconazole treatment
What is the prognosis of pythiosis?
Poor if the affected area is not removed
What type of organism is histoplasma?
Dimorphic fungus
What CxS is seen with histoplasmosis?
Diarrhea, weight loss, fever, respiratory disease
How can you diagnose histoplasmosis?
FNA of tissue and fluid, biopsy, ELISA antigen
How do you treat histoplasmosis?
Prolonged meds
What is the prognosis for histoplasmosis?
Acute is fatal, multisystem involvement is poor, one organ affected is better
How does an animal get sick from candida albicans?
It is an opportunistic bacteria that causes disease once the mucosal integrity of the GI tract is disrupted
What are the top 3 bacteria associated with intestinal disease?
Salmonella, E. Coli, Campylobacter (large bowel)
T/F: Fecal cultures alone are definitive to diagnose the disease
False. Interpret with CxS and other data
When would you perform a fecal culture?
Chronic diarrhea, severely debilitated, sick with bloody stool
What CxS do you see with salmon poisoning disease?
Fever, hematemesis, diarrhea, vomiting, lethargy, nasal/ocular discharge
How do you diagnose salmon poisoning?
Fluke eggs in feces, history of fish eating, PCR, cytology of organisms inside the lymphocte
How do you treat salmon poisoning and what is the prognosis?
Hospitalize, antibiotics, praziquantel
Prognosis is good if treated aggressively
What does canine parvovirus type 2 like to target?
Rapidly dividing cells - GI, bone marrow, lymph nodes
How do you definitively diagnose CPV?
PCR
What are some major complications when treating CPV?
Sepsis, intussusception, pneumonia, DIC
What is the prognosis for CPV?
If they survive the first 3-4 days, then good. Need supportive care
What can feline panleukopenia cause?
Similar signs to CPV, but cerebellar hypoplasia
T/F: You use CPV snap test to diagnose feline panleukopenia?
True
What can feline coronavirus turn into?
Feline Infectious Peritonitis
What must you do in order to diagnose intestinal neoplasia?
FNA or biopsy, cancer may not show up on imaging
How do you treat small cell lymphoma? What is the response rate?
Chlorambucil, prednisolone (cats)
Response: 96%
What does EPI lead to, malabsorption or maldigestion?
Maldigestion
What is the #1 CxS for EPI?
weight loss
How do you diagnose EPI?
Tripsin like immunoreactivity levels (TLI), and B12 (low with EPI)
How can you treat EPI?
Give dried pancreatic extract, fresh raw pancreas from the butcher, B12 supplements (SQ)
If the treatment for EPI fails, what is the next Ddx?
Inflammatory bowel disease, antibiotic responsive diarrhea, diabetes mellitus
What should you rule out before considering ARD, food sensitivity, and IBD?
Infectious diseases, EPI, neoplasia, obstruction
What is the next step if treatment with empiric therapy does not work, or the animal is getting worse?
Diet change, deworm, BIOPSY
What breeds often have gut diseases?
Wheaton terriers, Irish setter, GSD, yorkie, sharpeis, boxers, main coon (IBD)
How can you diagnose a food allergy or hypersensitivity?
Change the food and see the signs resolve
How does antibiotic responsive diarrhea cause symptoms?
The competition for nutrients from overgrowth of bacteria leads to malabsorption and damage to the mucosal border
What CxS might you see with ARD?
Small bowel diarrhea, stunted growth, borborygmi, gas accumulation
How do you treat ARD?
Antibiotic trial with metronidazole or tylosin
