Gastrointestinal Disease Moodle Book

Question 1

Dysphagia

Answer 1

defined as difficulty swallowing food and is usually detected at an early stage as it is relatively easily noticed by the owner.

Question 2

Dysphagia may be classed as

Answer 2

Functional- where there is an underlying problem with the physical mechanics of swallowing, this may due to an underlying neuromuscular disorder affecting the physiological conduction of the swallowing reflex. In some cases functional dysphagia may be of unknown cause.

Question 3

Dysphagia may be classed as;

Answer 3

Morphological- where problems in the anatomical structures of the oral or pharyngeal cavities result in difficulty swallowing. This can arise where a patient has severe dental disease or other condtions causing infection and inflammation of the oral and pharyngeal cavities, where trauma has damaged the tissues or where a neoplastic lesion (tumour) has formed.

Question 4

Signs of dysphagia

Answer 4

dropping food from the mouth

excessive salivation

coughing

reluctance to eat

gagging

excessive motion of the head/head shaking

Question 5

Diagnosis of Dysphagia

Answer 5

Diagnosis is based on history taking and clinical examination of the patient and may require further testing such as biopsy, culture and radiography to establish an underlying cause.

Question 6

Treatment of Dysphagia

Answer 6

Treatments are based on addressing the underlying cause and providing symptomatic therapy (for example analgesia and amended constituency of food/assisted feeding if required).

Question 7

Vomiting

Answer 7

an active process where gastric (and potentially dudodenal) content that is usually partly digested is forcibly ejected from the stomach

abdominal muscles strain during the process of vomiting

often occurs several hours after eating

if severe can be associated with loss of electrolytes and dehydration

Question 8

Regurgitation

Answer 8

a passive process where mainly undigested food is returned from the oesophagus

there is no active contraction of the abdominal muscles

usually occurs shortly after eating

Question 9

Regurgitation is generally a sign of oesophageal disease

Characteristics of regurgitation include

Answer 9

passive explusion of undigested food

occuring shortly after eating

patient may be anorexic or ravenous depending on the underlying pathology

may lead to pneumonia due to aspiration of food material

may eventually lead to cachexia - loss of body mass

Question 10

Characteristics of vomiting include the forcible nature by which ingesta is expelled from the mouth.

Clinical signs may include;

Answer 10

nausea and salivation which may be accompanied by restlessness

retching and active abdominal effort

production of digested or semi-digested food or bile

possible anorexia, polydipsia and dehydration

depending on the underlying cause the content of the vomit may vary and the nature of the vomiting episodes may be acute or chronic.

Question 11

Causes of vomiting may be classed as ;

PRIMARY - originating from the gastro intestinal tract. Examples include;

Answer 11

dietary indiscretion

infectious disease

GDV

inflammatory GI disease

foreign bodies

neoplasia

pyloric stenosis

poisoning

intussusception

endoparasites

Question 12

Causes of vomiting may be classed as primary, for example -

Answer 12

dietary indiscretion

infectious disease

GDV

inflammatory GI disease

foreign bodies

neoplasia

pyloric stenosis

poisoning

intussusception

endoparasites

Question 13

Causes of vomiting secondary

Answer 13

These could include examples such as;

hepatic failure

renal failure

severe infection eg. pyometra

diabetes mellitus

pancreatitis

drug reactions

motion sickness

Question 14

Secondary causes of vomiting are causes…

Answer 14

SECONDARYcauses of vomiting are conditions elsewhere in the body that lead to activation of the ‘vomiting centres’ in the brain.

Question 15

Primary causes of vomiting are causes…

Answer 15

PRIMARY - originating from the gastro intestinal tract.

Question 16

Diagnosis and treatment of vomiting

Answer 16

History and presenting clinical signs particularly if there is known ingestion of a toxic or inappropriate substance.

A full physical examination including abdominal palpation may provide some clues as to the underlying cause in many cases.

In addition further diagnostics such as radiography (possibly with contrast media), ultrasound or endoscopy may be utilised.

In addition analysis of blood and vomit/urine/faeces may be required particularly if systemic causes of poisoning is suspected.

In some cases an exploratory laparotomy may be necessary to obtain a definitive diagnosis

Treatment of the vomiting patient invariably includes treatment of the primary underlying cause of disease, a short period of gastric rest , use of anti-emetics and/or gastro protectants and fluid therapy to correct any dehydration or electrolyte imbalance.

Question 17

Diarrhoea

Answer 17

The term diarrhoea is used to refer to the frequent discharge of abnormally soft or liquid faecal matter.

Question 18

Diarrhoea, like vomting, may be classified according to the origin of the problem. Primary causes are …
Seconary causes are …

Answer 18

those that directly affect the GI tract whereas

secondary causes are systemic in nature.

Question 19

Primary Acute diarrhoea-

Answer 19

Infection – viral (e.g. Parvovirus) or bacterial (e.g. Salmonellosis)

Giardiasis

Dietary Indiscretion

Question 20

Primary Chronic diarrhoea

Answer 20

Endoparasites

Inflammatory Bowel Disease

Neoplasia

Colitis

Question 21

Secondary diarrhoea

Answer 21

Addison’s disease

Renal failure

Pancreatic disease

Liver disease

Question 22

There are several methods available to diagnose cases of diarrhoea…

Answer 22

History and clinical signs which may suggest an aetiology

Clinical examination and abdominal palpation

Radiography (+/- contrast) used to identify lesions within the GI tract

Endoscopy/biopsy may be required to obtain samples from the intestinal wall for definitive diagnosis

Faecal analysis often used to determine presence of parasite eggs, viral or bacterial pathogens

Question 23

Treatment of diarrhoea

Treatment of diarrhoea will consist of specific treatments if an underlying cause has been identified (this could include worming of the patient, antibiotics where indicated, or treatments for renal or hepatic disease) combined with more non-specific symptomatic treatments such as….

Answer 23

Anti-diarrhoealsor drugs to reduce gastrointestinal motility

Absorbantdrugs to decrease faecal water content.

Anti-inflammatorieswhere colitis or IBD has been identified

Pro-Bioticsto support normal intestinal flora

Question 24

Constipation can be due to either ….

Answer 24

the nature and content of the faecal matter making the process more difficult. Examples include scavenging and feeding inappropriate substances, particularly bones, low residue diets, foreign bodies, hairballs and dehydration

OR

structural problems leading to problems with the mechanics of defaecation. Examples include pelvic/hind limb fractures, rectal strictures, perineal hernia, enlarged prostate, megacolon, neoplasia, anal sac disease or neurological dysfunction

Question 25

Clinical signs of constipation Clinical signs may include;

Answer 25

Absence of defaecation Tenesmus or straining to pass faeces Dyschezia or pain on defaecation Haemochezia or passage of fresh blood with the stool Discomfort, pain If severe may affect appetite

Question 26

Diagnosis and treatment of constipation

Answer 26

Diagnosis —History and clinical signs —Physical examination —Radiography —Colonoscopy Treatment —Treat the cause —Diet —Stool-softening agents - Removal of impacted material

Question 27

Cirrhosis

Answer 27

 is the term used to describe fibrosis of the liver tissue that occurs as a result of degenerative changes to the tissue

Question 28

Jaundice

Answer 28

Jaundice is the yellow pigmentation of skin and mucous membranes often observed in patients suffering from liver disease.  It is caused by an increase is serum levels of bilirubin.

Question 29

Pre-hepatic jaudice

Answer 29

caused by haemolysis of red blood cells causing increased circulating bilirubin.  This may be seen in patients with immune mediated haemolytic anaemias, those who have received an incompatible blood transfusion or in certain blood borne infections.

Question 30

Hepatic jaundice

Answer 30

 where the liver itself does not function correctly.  There are various causes and they may be acute or chronic in nature

Question 31

Examples of hepatic causes of jaundice include....

Answer 31

Infectious, e.g. ICH, leptospirosis Genetic, e.g. copper toxicity in Bedlington terriers Metabolic e.g. lipidosis Toxic insults Immune mediated hepatitis Primary neoplasia affecting the liver tissue

Question 32

Post-hepatic jaundice

Answer 32

where a disease of lesion elsewhere prevents the liver secreting bile

Question 33

Post-hepatic jaundice examples,

Answer 33

Examples include; —Gall bladder disease e.g. Gall stones, cholangitis —Pancreatitis —Intestinal obstruction

Question 34

Diagnosis of liver disease

Answer 34

History and clinical signs - patients with liver disease may exhibit signs such as anorexia, weight loss and ascites as well as jaundice depending on the severity of their condition.  Hepatic encephalopathy - nervous signs related to high blood ammonia levels may be seen in advanced cases of cases of PSS (see later)  Additional signs related to reduced production of bile acids and plasma proteins may occur such as passing of pale faeces or clotting disorders. Physical examination may reveal hepatomegaly. Blood biochemistry -  liver profile may be undertaken measuring liver enzymes such as alkaline phosphatase (ALKP) and alanine aminotransferase (ALT) and assessing bile acid function and plasma protein levels Imaging -  radiography or ultrasonography may be used to determine liver size or presence of lesions Liver biopsy - to obtain a definitive diagnosis

Question 35

PSS - portosystemic shunt

Answer 35

A portosystemic shunt is most often observed as a congenital condition in which the presence of a 'shunting vessel' diverts blood from the small intestines directly to the venous system bypassing the liver.  This means that the liver cannot then process the products of digestion leading to build up of toxins and proteins in the blood and reduced liver function.