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Internal Medicine > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Causes of protein losing enteropathy

A

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)

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2
Q

Negative prognostic factors for canine chronic diarrhoea in dogs

A

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

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3
Q

Normal wall thickness of the stomach in cats and dogs (between Rugae)

A

Dogs 3-5mm

Cats 1-3.6mm

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4
Q

Normal wall thickness of the duodenum dogs and cats

A

Dogs
<20kg - <5.1mm
20-30kg - <5.3mm
>30kg - <6mm

Cats
<2.4mm

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5
Q

Normal wall thickness of the jejunum

Dogs and cats

A

Dogs
<20kg - <4.1mm
20-40kg - <4.4mm
Over 40kg - <4.7mm

Cats
<2.5mm

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6
Q

Normal wall thickness of the ileum

Cats and dogs

A

Dogs - no specific ranges reported

Cats - <3.2mm

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7
Q

Normal wall thickness of the colon in cats and dogs

A

Dogs - 2-3mm

Cats <1.7mm

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8
Q

Corrugation of the small intestines is often seen with….

A

Pancreatitis
Inflammation
Peritonitis
Neoplasia

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9
Q

Normal mesenteric lymph node size

A

<8mm

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10
Q

Normal wall thickness of the stomach in cats and dogs (between Rugae)

A

Dogs 3-5mm

Cats 1-3.6mm

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11
Q

Normal wall thickness of the duodenum dogs and cats

A

Dogs
<20kg - <5.1mm
20-30kg - <5.3mm
>30kg - <6mm

Cats
<2.4mm

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12
Q

Normal wall thickness of the jejunum

Dogs and cats

A

Dogs
<20kg - <4.1mm
20-40kg - <4.4mm
Over 40kg - <4.7mm

Cats
<2.5mm

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13
Q

Normal wall thickness of the ileum

Cats and dogs

A

Dogs - no specific ranges reported

Cats - <3.2mm

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14
Q

Normal wall thickness of the colon in cats and dogs

A

Dogs - 2-3mm

Cats <1.7mm

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15
Q

Causes of hepatic enlargement

A 
Steroid hepatopathy
Lipidosis
Amyloidosis
Diabetes
Hepatitis
Congestion
Neoplasia (lymphoma, histiocytic sarcoma, mast cell tumour and hepatocellular carcinoma)
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16
Q

Diffuse hepatic parenchyma diseases

A 
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
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17
Q

Ddx honey-comb like echotexture of liver on ultrasonography

A

Hepatocutaneous syndrome

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18
Q

High cobalamin causes

A

Supplementation

High dietary intake

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19
Q

Low cobalamin causes

A

EPI
Ileal disease
Dietary deficiency
Intestinal bacterial metabolism

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20
Q

High folate causes

A 
EPI
Diet
Intestinal bacterial metabolism
Low intestinal pH
Parenteral supplementation
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21
Q

Low folate causes

A

Small intestinal disease
Dietary deficiency
Drugs - antibiotics
Low intestinal pH

22
Q

Assessment of intestinal motility and what is the gold standard

A

Barium
BIPS
Ultrasound
Breathing test

Scintigraphy - gold standard

23
Q

Causes of delayed gastric emptying

A 
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
24
Q

Treatment of GIST

A

Surgery and imitanib if necessary

25
Q

Treatment of intestinal adenocarcinoma

A

Surgery and carboplatin

26
Q

Treatment of histiocytic ulcerative colitis and prognosis

A 
Diet
Antibiotics (enrofloxacin +/- amoxyclav+ metronidazole) for 4-6 weeks or longer

Anti-inflammatories or immunosuppressants and not recommended

Prognosis: guarded

27
Q

What is pathognomonic for histiocytic ulcerative colitis?

Common in boxers

A

Presence of macrophages positive for periodic acid-schiff (PAS) in biopsies
(Obtained by colonoscopy)

28
Q

Primary and secondary causes of lymphangiectasia

A

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)

29
Q

Lymphangiectasia treatment

A

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
30
Q

Causes of pharyngeal disease

A 
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)
31
Q

Oesophageal dz

A

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

32
Q

Tx oesophageal dz

A

Peg tube
Sucralfate
Antacids

33
Q

Diagnosis of oesophageal dz

A

Functional:
Imaging - CT, x-ray, endoscopy, direct exam

Functional
Nerve or muscle biopsies
Ach receptor antibody titre
Fluoroscopy
EMG
34
Q

Causes of megaoesophagus

A

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

35
Q

Abdominal effusion categorisation

Cell types, specific gravity and cell numbers

A

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

36
Q

Gold standard for diagnosing pancreatitis

A

Biopsy

37
Q

Complications of pancreatitis in felines

A

Thrombus formation
DM
Pancreatic abscess
EPI

38
Q

Four main actions of UDCA

A

Replacement of hydrophobic (toxic) bile acids

Choleresis

Stabilisation of mitochondria

Immunomodulation (reduce inflammation)

39
Q

Method of SAMe

A

Precursor of glutathione-peroxidase production (anti-oxidant)

40
Q

Chronic idiopathic hepatitis treatment

A

Prednisolone 1mg/kg SID for 6-12 weeks

41
Q

Treatment of copper toxicosis

A

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

42
Q

Things than can cause or worsen hepatic encephalopathy

A 
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
43
Q

Antibiotics concentrating well in bile

A 
Flouroquinolones
Metronidazole
Clindamycin
Cephalexin
Amoxicillin
Ampicillin
44
Q

Causes of hepatic jaundice in cats

A 
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

45
Q

Causes of hepatic jaundice in dogs

A

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

46
Q

When are steroids contraindicated in liver disease

A

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)

47
Q

Antibiotics to avoid in hepatic disease (rely on hepatic clearance or are hepatotoxic)

A

Sulphonamides
Tetracyclines
Chloramphenicol
Erythromycin

48
Q

Copper chelators

A

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)

49
Q

Vitamins to and to not supplement in liver dz

A

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

50
Q

Treatment of low albumin ascites

A

Increase protein diet eg cottage cheese

May also req plasma/colloid but not usually needed unless acute

51
Q

Diuretics for ascites due to portal hypertension

A

Spirinolactone (counteracts RAAS which is causing fluid retention and spares potassium reducing chance of hepatic encephalopathy)
Can use furosemide to speed up action

52
Q

Prognosis of feline intestinal adenocarcinoma

A

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

Internal Medicine (11 decks)

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