Gastrointestinal Flashcards
Causes of protein losing enteropathy
Inflammation (idiopathic IBD)
Neoplasia
Infection (salmonella, parvovirus, campylobacter, pythium and histolasma (not UK)
Lymphangiectasia (primary or secondary)
Endoparasites (giardia, ancyclostoma and uncinaria species
Anatomical (intussusception, chronic obstruction)
Negative prognostic factors for canine chronic diarrhoea in dogs
Low serum albumin <2g/L (not cats)
Low serum cobalamin (cats too and supplementation helps regardless of whether an underlying cause is found or not)
Concurrent pancreatitis
Normal wall thickness of the stomach in cats and dogs (between Rugae)
Dogs 3-5mm
Cats 1-3.6mm
Normal wall thickness of the duodenum dogs and cats
Dogs
<20kg - <5.1mm
20-30kg - <5.3mm
>30kg - <6mm
Cats
<2.4mm
Normal wall thickness of the jejunum
Dogs and cats
Dogs
<20kg - <4.1mm
20-40kg - <4.4mm
Over 40kg - <4.7mm
Cats
<2.5mm
Normal wall thickness of the ileum
Cats and dogs
Dogs - no specific ranges reported
Cats - <3.2mm
Normal wall thickness of the colon in cats and dogs
Dogs - 2-3mm
Cats <1.7mm
Corrugation of the small intestines is often seen with….
Pancreatitis
Inflammation
Peritonitis
Neoplasia
Normal mesenteric lymph node size
<8mm
Normal wall thickness of the stomach in cats and dogs (between Rugae)
Dogs 3-5mm
Cats 1-3.6mm
Normal wall thickness of the duodenum dogs and cats
Dogs
<20kg - <5.1mm
20-30kg - <5.3mm
>30kg - <6mm
Cats
<2.4mm
Normal wall thickness of the jejunum
Dogs and cats
Dogs
<20kg - <4.1mm
20-40kg - <4.4mm
Over 40kg - <4.7mm
Cats
<2.5mm
Normal wall thickness of the ileum
Cats and dogs
Dogs - no specific ranges reported
Cats - <3.2mm
Normal wall thickness of the colon in cats and dogs
Dogs - 2-3mm
Cats <1.7mm
Causes of hepatic enlargement
Steroid hepatopathy Lipidosis Amyloidosis Diabetes Hepatitis Congestion Neoplasia (lymphoma, histiocytic sarcoma, mast cell tumour and hepatocellular carcinoma)
Diffuse hepatic parenchyma diseases
Cholangiohepatitis Diffuse prenodular metastatic carcinoma or sarcoma Round cell neoplasia Patchy or diffuse fatty infiltration Vacuolar hepatopathy Storages diseases (amyloidosis, copper) Toxic hepatopathy Early degenerative changes assoc with micronodular hyperplasia and fibrosis
Ddx honey-comb like echotexture of liver on ultrasonography
Hepatocutaneous syndrome
High cobalamin causes
Supplementation
High dietary intake
Low cobalamin causes
EPI
Ileal disease
Dietary deficiency
Intestinal bacterial metabolism
High folate causes
EPI Diet Intestinal bacterial metabolism Low intestinal pH Parenteral supplementation
Low folate causes
Small intestinal disease
Dietary deficiency
Drugs - antibiotics
Low intestinal pH
Assessment of intestinal motility and what is the gold standard
Barium
BIPS
Ultrasound
Breathing test
Scintigraphy - gold standard
Causes of delayed gastric emptying
Outflow obstruction: Congenital pyloric stenosis Neoplasia FB Mucosal hypertrophy Extra-gastric neoplasia/granuloma/FB/lymphadenomegaly
Defective propulsion: GI inflammation Neoplasia Ulcers Drugs Metabolic dz (hypokalaemia, Addison’s, hypocalcaemia) Surgery Other
Treatment of GIST
Surgery and imitanib if necessary
Treatment of intestinal adenocarcinoma
Surgery and carboplatin
Treatment of histiocytic ulcerative colitis and prognosis
Diet Antibiotics (enrofloxacin +/- amoxyclav+ metronidazole) for 4-6 weeks or longer
Anti-inflammatories or immunosuppressants and not recommended
Prognosis: guarded
What is pathognomonic for histiocytic ulcerative colitis?
Common in boxers
Presence of macrophages positive for periodic acid-schiff (PAS) in biopsies
(Obtained by colonoscopy)
Primary and secondary causes of lymphangiectasia
Primary - congenital, can be focal involving intestines only or generalised and include thoracic and limb lymphatics
Secondary to right sided heart failure, constrictive pericarditis, neoplasia, budd-chiari syndrome and IBD (inflammation)
Lymphangiectasia treatment
Low fat diet with high quality protein
Immunosuppressants if IBD is also present
Supportive: B12 Treat enteric pathogens Colloids - hetastarch 20mg/kg IV slowly over 2-4hours daily or 2-3x weekly Soluble fibre added to food
Causes of pharyngeal disease
Physical: FB Neoplasia Inflammation (nasopharyngeal polyp) TMJ issue Trauma
Functional: CNS dz CN dz NM dz Cricopharyngeal achalasia (failure of cricopharyngeal m to relax -cocker spaniels - can be congenital or acquired eg secondary to hypothyroidism)
Oesophageal dz
Physical:
Extramural: PRAA
Mural: neoplasia
Intramural: FB, oesophagitis (trauma, caustic substances, hiatal hernia) can cause strictures too
Functional:
Muscle - polymyopathy, dermatomyositis, addisons
Nerve - polyneuropathy, dysautonomia
NM junction: myasthenia gravis
Idiopathic
Tx oesophageal dz
Peg tube
Sucralfate
Antacids
Diagnosis of oesophageal dz
Functional:
Imaging - CT, x-ray, endoscopy, direct exam
Functional Nerve or muscle biopsies Ach receptor antibody titre Fluoroscopy EMG
Causes of megaoesophagus
Idiopathic
CNS: distemper, brainstem lesions, neoplasia, trauma
Peripheral neuropathies: polyneuritis, polyradiculoneuritis, ganglioradiculitis, dysautonomia, bilateral vagal damage toxicity- lead, thallium, acrylamide
NM junction: MG, botulism, tetanus, anticholinesterase toxicity
Myopathy: SLE, oesophagitis, glycogen storage dz, polymyositis, dermatomyositis, cachexia, trypanosomiasis, addisons, hypothyroidism
Miscellaneous: pyloric stenosis, GDV, pituitary dwarfism, thymomax mediastinitis, IDIOPATHIC
Persistent right aortic arch
Stricture/neoplasia
Abdominal effusion categorisation
Cell types, specific gravity and cell numbers
Transudate: monocytes, mesothelial cells
SG < 1.015
TP < 25
Cells x10^9 <5
Modified transudate: lymphocytes, neutrophils, Monocytes, mesothelial SG 1.015 - 1.025 TP > 25 Cells x10^9 >5
Exudate: neutrophils, monocytes, lymphocytes, RBCs
SG >1.025
TP >25
Cells x10^9 >50
Gold standard for diagnosing pancreatitis
Biopsy
Complications of pancreatitis in felines
Thrombus formation
DM
Pancreatic abscess
EPI
Four main actions of UDCA
Replacement of hydrophobic (toxic) bile acids
Choleresis
Stabilisation of mitochondria
Immunomodulation (reduce inflammation)
Method of SAMe
Precursor of glutathione-peroxidase production (anti-oxidant)
Chronic idiopathic hepatitis treatment
Prednisolone 1mg/kg SID for 6-12 weeks
Treatment of copper toxicosis
Penicillamine (chelates copper, increases urinary excretion, mobilisation, induces metallothionein) longterm tx
GI side effects
(Alternative is trientine)
Reduce absorption: zinc (induced metallothionein in enterocytes preventing uptake) long term tx
Things than can cause or worsen hepatic encephalopathy
GIT bleeding (increased protein) Azotaemia Hypokalaemia (more ammonia than ammonium due to ion shifting and ammonia is more capable of crossing GIT into blood) Alkalosis Hyponatraemia Infection Sedative drugs Excess protein intake Catabolic state Constipation
Antibiotics concentrating well in bile
Flouroquinolones Metronidazole Clindamycin Cephalexin Amoxicillin Ampicillin
Causes of hepatic jaundice in cats
Acute: Suppurative cholangitis Toxicity eg paracetamol Hepatic lipidosis Reactive eg diabetic hepatopathy, toxoplasmosis, FIP
Chronic:
Lymphocytic cholangitis
Neoplasia eg lymphoma
Cirrhosis
Extrahepatic causes - FIP
Post-hepatic:
Pancreatitis
Biliary rupture/neoplasia/choleliths
Causes of hepatic jaundice in dogs
Acute:
Infections eg lepto or infectious canine hepatitis
Toxicity eg onions
Reactive eg diabetes
Chronic: Copper storage dz Chronic hepatitis Cholangiohepatitis Cirrhosis Drugs eg phenobarbital Neoplasia eg carcinoma, lymphoma
Extrahepatic causes - septicaemia
When are steroids contraindicated in liver disease
Portal hypertension (can precipitate GI ulceration and therefore hepatic encephalopathy due to bleeding into intestinal lumen)
Infectious conditions
Advanced bridging fibrosis or non-inflammatory fibrosis (usually have portal hypertension)
Ascites (usually caused by portal hypertension)
Hepatic encephalopathy (causes further protein catabolism and production of ammonia)
Acute hepatitis (such animals have infectious dz or toxicity and have a high risk of GI ulceration)
Antibiotics to avoid in hepatic disease (rely on hepatic clearance or are hepatotoxic)
Sulphonamides
Tetracyclines
Chloramphenicol
Erythromycin
Copper chelators
Penicillamine (not helpful in acute crises as takes months to work)
222-tetramine tetrahydrochloride for acute but not available in the UK
Zinc can help (most hepatic diets supp with this)
Vitamins to and to not supplement in liver dz
Vitamin E - antioxidant
Vit K - if clotting times are prolonged
Vit B - loss with PUPD
No:
Vit A can cause hepatic damage
Vit D - can cause calficication of tissues
Vit C - can increase tissue damage assoc with metals in liver
Treatment of low albumin ascites
Increase protein diet eg cottage cheese
May also req plasma/colloid but not usually needed unless acute
Diuretics for ascites due to portal hypertension
Spirinolactone (counteracts RAAS which is causing fluid retention and spares potassium reducing chance of hepatic encephalopathy)
Can use furosemide to speed up action
Prognosis of feline intestinal adenocarcinoma
Good - can survive years with surgery if no metastasis and can still do well if having surgery and there are mets
Poor if no treatment - 3 days
