Gastrointestinal and hepatic Flashcards
What are the broad causes of acute diarrhoea?
Diet
Drugs
Infection
Inflammatory disease
Metabolic disease
Anatomical disease
Neoplasia
Anomalous - stress/anxiety
What is the pre-disposition to getting canine parvovirus (CVP-2)?
Young puppies with low maternal immunity
Older unvaccinated dogs
What is the incubation period of canine parvovirus?
3-6 days
What cells does canine parvovirus infect?
Rapidly dividing cells
What is the general management for canine parvovirus?
Fluid therapy
Antibiotics
Anti-emetics
Pro-motility meds
Antacid drugs and ulcer coating medication
Immunomodulators and ancillary therapies
Oral fluids/nutrients
What are the general prevention measures for parvovirus?
Vaccination, cleaning and disinfection
What are the clinical signs of haemorrhagic gastroenteritis?
Foetid diarrhoea including protein loss. Causes depression and anorexia.
What is the treatment for haemorrhagic gastroenteritis?
Fluid therapy
Colloid/plasma/whole blood
In what cats is feline panleukopenia most common?
Kittens and colonies
What part of the GI tract does coronavirus affect?
Villus destruction of the small bowel
What dogs are pre-disposed for campylobacter?
Usually young, immunocompromised animals or those with additional infectious agents
What are the clinical signs of acute enterocolitis from campylobacter?
D+, blood and mucus
Vomiting
Straining
Fever, abdominal pain
What four routes can salmonella take in the dog?
Transient asymptomatic diarrhoea
Acute gastroenteritis
Carrier state
Bacteraemia
What are the first choice antibiotics for treatment of clostridial enteritis?
Metronidazole - alternatives of Ampicillin and Tylosin
What are the clinical signs of ascarids infections in puppies and kittens?
Failure to gain weight and pot bellied
What are the clinical signs of hookworms in kennelled dogs?
Weight loss and diarrhoea. Anaemia, interdigital dermatitis
How do you diagnose cryptosporidium?
Faecal smear, IFA or PCR
What is the action of prebiotics?
Selective substrate used by beneficial species and can alter the intestinal flora.
What is the action of probiotics?
Living organism that exert benefit beyond nutrition
What are the major differentials for chronic diarrhoea?
Food responsive enteropathy
Dysbiosis
Steroid responsive
Non-responsive
PLE
EPI
Neoplasia
IBD
Non-GI causes
What is a food responsive enteropathy?
Any clinically abnormal response attributed to ingestion of a food or additive. Categorised as either an allergy or intolerance.
What responses can the body have to a food responsive enteropathy?
Intolerance
Toxicity
Disturbed microflora
Dysmotility
Pharmacologic reactions
Maldigestion/malabsorption
Physical
What are the consequences of secondary dysbiosis?
Utilise nutrients/interfere with absorption
Damage epithelium and microvillar enzymes dysfunction
Increase mucosal permeability/fluid loss
Deconjugate bile acids
Hydroxylate fatty acids
Stimulate colonocyte secretion
What are the clinical signs of steroid responsive enteropathy?
Persistent/recurrent GI signs with histopathological evidenc4e for inflammation
What dogs are predisposed to SRE/IBD?
Middle aged animals over 12 months old
What are the clinical signs of SRE/IBD?
Weight loss with more severe mucosal disruption. Appetit very variable and variable abdominal discomfort.
What conditions make up the feline triaditis complex?
Chronic Enteritis
Pancreatitis
Cholangiohepatitis
What is a protein-losing enteropathy?
Loss of protein through the GIT. `
What are the 3 major differentials for protein-losing enteropathy?
IBD
Lymphangiectasia
Neoplasia
What is the management of EPI?
Pancreatic enzyme supplementation
Freeze chopped pig/cow pancreas
Dietary management
Vitamin supplementation
What are the clinical signs of dehydration?
Skin tent, tacky mms, sucken eyes
What techniques can be used to measure fluid losses?
Weigh the patient
Urinary catheter
Weight the bedding
Faecal catheter
What is the best fluid choice for dehydration?
Hartmann’s
What are the clinical signs of hypovolaemia?
Increased CRT, pale mm, cold rectal
Increased HR, RR and weak pulses
What are the clinical signs of sepsis?
Decreased CRT, congested MMs, pyrexia, increased HR, RR, bounding/poor pulses
What vasopressors can be used in hypovolaemic shock?
Dobutamine, noradrenaline, dopamine
What are the roles of the liver?
Digestion/metabolism/nutrient storage
Waste management
Protein metabolism
Production an activation of coagulation factors
Drug metabolism/detoxification
Immunoregulation
In what zone of the liver lobes does hypoxic damage typically occur?
Zone 3
What zone of the liver is typically affected by metabolic and toxic damage?
Zone 1
What are specific signs of liver disease?
Jaundice, hepatic encephalopathy, ascites, drug intolerance, coagulopathy
What neurological signs can be associated to hepatic encephalopathy?
Hyperactive and/or depressed/dull/clumsy
Circling, pacing, central blindness
Salivation in cats
Seizures and coma
Why can liver enzymes be within normal limits with end stage liver disease?
Decreased liver mass
What markers are relevant in hepatocellular injury?
ALT, AST, GLDH
What markers are relevant in cholestasis?
ALP and GGT
What are negative prognostic indicators of acute liver disease?
Ascites and splenomegaly
What is the main encephalopathic toxin involved in hepatic encephalopathy?
Ammonia
How do you manage hepatic encephalopathy?
Identify, remove and treat causes
IVFT
Glucose
Diet
Ampicillin IV
What is the most common liver disease in dogs?
Idiopathic chronic hepatitis
What breeds are pre-disposed to copper-associated liver disease?
Lab, Dalmatian, Skye terrier, Doberman pinscher, WHWT
What is the typical histopathology of chronic hepatobiliary disease?
Variable mononuclear or mixed inflammatory infiltrate, apoptosis/necrosis, regeneration and fibrosis
What are the important clinical findings in chronic hepatobiliary disease?
Poor BCS, jaundice and ascities
What treatment should be used for chronic hepatobiliary disease?
Urodeoxycholic acid, antioxidants, corticosteroids, antibiotics, diuretics
What are the common clinical signs of neutrophilic cholangitis?
Lethargy, pyrexia, vomiting, jaundice
What are some causes of extrahepatic bile duct obstruction?
Pancreatitis, tumour, local trauma, cholelithiasis
What is bilirubin a product of?
Haemoglobin metabolism
What causes the yellow colour of urine?
Urobilin
What causes the brown colour of faeces?
Stercobilin
What is the pathophysiology of pre-hepatic breakdown of haemoglobin?
Oversupply of precursors into the system, flooding the body with bilirubin that can’t be excreted quickly enough
What are the clinical signs of post-hepatic haemoglobin breakdown?
Ecchymoses/bruising
Peripheral oedema
Pain
Neurological exam
BCS
Abdominal enlargement
Where is the endocrine tissue located in the pancreas?
Islets of Langerhans
What are the clinical signs of acute pancreatitis?
Lethargy/weakness
Anorexia
Vomiting and diarrhoea
Severe: Shock and collapse
What are the risk factors for pancreatitis?
Hereditary
Hyperlipidaemia
High fat meal and obesity
Pancreatic ischaemia and hypoxia
Trauma
How do you treat pancreatitis?
IVFT, electrolytes, underlying cause, analgesia, antiemetics, antibiotics, steroids
What are the three basic principles of toxin exposure?
Decontamination, assessment of effects and treatment of symptoms
How can toxins be absorbed?
Through mucus membranes, intestinal mucosa, skin, inhalation
What are the time frames in which emesis or gastric decontamination can be performed after toxin exposure?
2-8 hours in the dog
2-12 hours in the cat
What are the clinical signs of ibuprofen/NSAID exposure?
Haemorrhagic vomiting, diarrhoea, AKI
What specific treatments can be used for ibuprofen/NSAID exposure?
H2 blockers
Proton pump inhibitors
Prostaglandin analogue
Intralipid infusion
What are the clinical signs of paracetamol toxicity?
Brown mucus membranes
Jaundice, abdominal pain, lethargy, vomiting
AKI
Signs of hypoxia to tissues
How do you treat paracetamol toxicity?
N/acetyl cysteine, H2 receptor antagonists
Ascorbic acid
Liver, AKI and GI support
What are the clinical signs of chocolate toxicity?
Hyperactivity, vomiting/diarrhoea, arrythmias, seizures, coma and death
What is the treatment for chocolate toxicity?
Charcoal every 4-6 hours. May need intubation and urinary catheterisation
What common products can contain xylitol?
Chewing gum and peanut butters
What are the clinical signs of xylitol toxicity?
Prolonged hypoglycaemia, liver failure, weakness, collapse, seizures, coma, jaundice, death
What are the specific treatments for xylitol toxicity?
Hepato-protectants
Glucose supplementation
What are the clinical signs of pyrethroids toxicity?
Ataxia, tremors, disorientation, seizures, dyspnoea, hypersalivation, vomiting
What are the specific treatments for ethylene glycol (anti-freeze)?
Medical ethanol
Vodka diluted with saline
What is the biggest issue with rat poison/warfarin ingestion?
Inhibits vitamin K epoxide reductase so caused coagulopathy 36-72hours post injection
What is the definition of regurgitation?
Passive expulsion of food from pharynx/oesophagus
What is the definition of dysphagia?
Failure to prehend/bite and initially swallow
Pain on closing or opening of mouth
What is the breed pre-disposition of megaoesophagus?
Labrador, newfoundland, Shar Pei
What is the breed pre-disposition of vascular ring anomaly?
GSD, Irish setter, Great Dane
What is intussusception?
Vigorous contraction of a segment of intestine into the lumen of the adjacent relaxed segment
