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Canine And Feline Medicine > Gastrointestinal Disorders > Flashcards

Gastrointestinal Disorders Flashcards

1
Q

What is dysphagia

A

Difficulty eating and will typically occur in conjunction with other signs of oral or neuro disease
Dropping food from mouth when eating

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2
Q

What is regurgitation

A

Expulsion of food from the oesophagus

Will normally hold the cylindrical shape of the oesophagus

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3
Q

What are some good questions to ask owners when trying to differentiate between dysphagia, regurgitation and vomiting

A 
Does the dog heave before this happens?
Yes- Vomit
No- regurg
Does the animal try to re-eat the material that comes out?
Yes- regurg
No- vomiting
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4
Q

What signs do you expect to see and what diagnostic tests are you going to carry out with suspected oropharyngeal disease

A

Dysphgia, excessive salivation, inability to chew and weight loss (eating and losing weight)
Carry out a proper oral exam, do it under anaesthesia if you have to or biopsy, include under the tongue

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5
Q

What diagnostic tests are you going to carry out and what do you expect to see with suspected regurgitation

A

Plain and contrast radiography to check for oesophageal obstruction, vascular ring anomalies and strictures
Neuro exam to check for innervation to the distal oesophagus

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6
Q

What diagnostic tests are you going to carry out and what do you expect to see with suspected vomiting

A

Ask the owner questions about heaving and re-eating
Concurrent systemic signs with CBC and biochem
If blood tests are unremarkable, a primary GIT exam is warranted (faecal analysis, biopsy, imaging etc)

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7
Q

Diarrhoea and the elephant

Not all grey things are elephants but all elephants are grey

A

Not all small intestinal disease has diarrhoea but all large intestinal disease has diarrhoea

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8
Q

What are the main mechanisms of diarrhoea

A

Hypersecretory
Maldigestion/malabsorption
Motility disorders

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9
Q

What are some important questions to ask an owner about diarrhoea to find out where it came from

A 
Is the animal straining?
Yes- large intestinal
No- small intestinal
Is there mucus in the faeces?
Yes- large intestinal
No- small intestinal
Have you noticed any weight loss?
Yes- small intestinal
No- large intestinal
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10
Q

What is a Protein Losing Enteropathy

A

Syndrome, not a disease
Mainly small intestinal disease
Hypoproteinaemia (albumin)- cant do surgery because animal wont heal

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11
Q

How will you diagnose SI diarrhoea

A

Determine if malabsorption or PLE exsist with CBC and biochem
Abdo US, biopsy indicated?
Therapeutic trial with parasite control, diet modification and antibiotics

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12
Q

How will you diagnose LI diarrhoea

A

Dietary trial, parasite investigation and management

Diagnostic imaging and colonoscopy

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13
Q

How will you diagnose constipation

A

Dietary history- bones
Opioids predispose to constipation
Examine faeces and do a rectal
Can radiograph if necessary

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14
Q

How can you differentiate between a coagulopathy and GI lesion bleeding

A

Coagulopathy- assess platelets, coagulation profile, CBC, biochem and UA
Gastro lesion- rule out parvo and parasites, US abdo with FNA or scope

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15
Q

Are CBC, biochem and urinalysis useful in diagnosing GI disorders

A

More helpful in identifying extra-GIT causes but also helpful in finding out what is being lost from body
CBC- can detect anaemia and iron def from GI bleeding, sepsis and eosinophilia > parasites
If albumin and globulin low, probs being lost from GIT
Biochem- PLE, dehydration, electrolyes and extra-GIT disease
Urinalysis- PU/PD, concentrating ability

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16
Q

Are cobalamin and folate useful diagnostic tools

A

No but can help guide treatment
If cobalamin is low may be SIBO
If folate is low may be severe disease
If folate is high, bacteria is making it in the SI

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17
Q

When is and when isn’t plain radiography and ultrasound indicated

A

Plain radiography- GDV, megaoesophagus, SI obstruction, good with gas filled abdo. not useful for wall thickness of SI
US- useful in acute abdomen, detecting and sampling abdominal effusions. not useful when abdo is gas distended

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18
Q

Compare the usefulness of ex lap and endoscopy in reference to obtaining biopsies

A

Endoscopy- can only biopsy certain areas and must take multiple small biopsys, good for foreign bodies
Ex lap- biopsy everything if you go in and can’t find anything wrong, can take full thickness biopsies but must suture every site

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19
Q

What things should you consider before deciding whether or not to treat a patient with gastro signs

A

Chronicity
Severity
Concurrent signs
Most likely DDx

20
Q

When would you take a conservative approach

A

Mildly ill or fairly happy patient with self limiting or mild gastro signs may need minimal work up

21
Q

When would you decide that you need to admit this animal for treatment or further testing

A

5%+ dehydrated and expected on going losses with patient not able or not willing to take oral fluids

22
Q

How much fluid would you give to a 10kg dog that has V&D and 5% dehydrated and what fluid would you use

A

Use isotonic fluids as replacement fluids
Existing fluid deficeit- body weight x % dehydrated x1000
=500mL
Maintenance- 40-60mL/kg/day = 50mL/kg/day
=500mL/day
Estimated losses- 55-60mL/kg/day
=500mL/day
Ongoing losses- vomit and diarrhoea
=500mL
Therefore this dog will need 2000mL/day
83mL/hr

23
Q

How much potassium can you give and how long for

A

0.5mEq/kg/hr on infusion is absolute max

24
Q

What diets can you consider in a patient with gastro

A

Bland easily digestible diets- low fat and fibre like chicken and rice or Hills i/d is a good choice
High fibre diet- LI disease, cooked pumpkin, Metamucil
Hypoallergenic diets- not really that great
Hydrolysed hypoallergenic diet- better than above, pull the machinery apart and clean
Novel protein diets- must be home cooked, not convenient

25
Q

What value should be calculated for every hospitalised patient and at what point should you consider tubing the animal

A

RER(kcal/day)= 30 x (kg BW) + 70
Should be divided into 3-4 small meals
48hr + anorexia you should consider a feeding tube

26
Q

What are some different antiemetics and their modes of action

A

Maropitant- centrally acting, lasts 24hrs
Metoclopramide- inhibits CRTZ and increases gastric motility, contraindicated in obstruction
Ondansetron- serotonin receptor antagonist for severe vomiting

27
Q

How might you induce emesis and when is it contraindicated

A

Apomorphine is good and safe. SC or conjunctival sac
H2O2, damp ball of table salt
Xylazine in cats and can be reversed
Don’t use if abnormal mentation or ingested substance is caustic

28
Q

What is the cause, clinical features, diagnosis and treatment of feline stomatitis/fauciitis

A

Many causes including foreign bodies and renal failure
Dysphagia, salivation, anorexia, cant close mouth and weight loss are seen
Diagnosed by history, oral exam, radiographs and systemic evaluation
Treatment always depends on the underlying cause

29
Q

Are most oral tumours benign or malignant and how should they be treated

A

Most are malignant and should be surgically excised with good margins

30
Q

What is the cause, clinical features, diagnosis and treatment of megaoesophagus in a dog

A

Can be due to neuropathy, NMJ or myopathy but normally idiopathic
‘Vomiting’ but actual regurgitation, weight loss and good apetite, aspiration pneumonia and may be other neurological deficits
Do a full neuro exam, thoracic radiographs, fluoroscopy and bloods
Upright feeding and dietary management or a gastrostomy tube may be beneficial

31
Q

What is the cause, clinical features, diagnosis and treatment of oesophagitis in a dog

A

Caused by reflux, persistent vomiting or foreign bodies
Signs include regurg, drooling, reluctant to eat, ulcerated oral tissue
Diagnose by diff regurg or vomit, plain and contrast radiographs, possible biopsy
Treatment include proton pump inhibitors, metoclopramide to stop reflux, opioid for pain and may need feeding tube

32
Q

What is the cause, clinical features, diagnosis and treatment of oesophageal obstruction

A

Most obstructions occur at thoracic inlet, base of heart or cranial to diaphragm from foreign bodies
Acute regurg, pain, may have liquids but not food
Diagnose by plain radiographs or oesophagoscopy which can also allow retrieval or push into stomach

33
Q

What is the cause, clinical features, diagnosis and treatment of vascular anomalies

A

Caused by persistence of embryonic aortic arch and squashes oesophagus
Signs include regurg after weaning, poor growth and aspiration
Diagnose by contrast oesophogram or oesophagoscopy
Treated by surgical resection but may get stricture afterwards

34
Q

What is the cause, clinical features, diagnosis and treatment of acute gastritis

A

Dietary, FB, NSAIDs and viral/bacterial causes
Acute onset of vomiting with or without blood, inappetant, no fever or pain
Presumptive diagnosis but should rule out foreign body (only work up if been longer than 48hrs), US
Treat with SC fluids if dehydrated and antiemetics

35
Q

What is the cause, clinical features, diagnosis and treatment of Haemorrhagic Gastroenteritis (HGE)

A

Unknown aietiology- mainly small breed dogs
Haematemesis and haematochezia
Haemoconcentrated with normal TP and may progress to DIC
Treat aggressively with fluid therapy and antibiotics are controversial

36
Q

What is the cause, clinical features, diagnosis and treatment of chronic gastritis

A

Possibly an immune reaction to foreign antigens
More common in cats than dogs and have a reduced appetite and vomiting variable
US to show mucosal thickening, gastroscopy and biopsy everything and examine vomitus for parasites
Treat by response to dietary therapy by trying to increase gastric emptying, may need pred if biopsy confirms (last to add, first to remove)
Diet > antibiotics > pred give in that order and take away in reverse

37
Q

What is the cause, clinical features, diagnosis and treatment of Gastrointestinal ulceration/erosion (GUE)

A

Stress ulceration following shock, NSAIDs or extreme exertion
Vomiting, anorexia, no abdo pain
Presumptive diagnosis > upper GI bleeding without coagulopathy
Symptomatic therapy and sucralfate

38
Q

Outline a preoperative stabilisation plan for a dog with GDV. What complications in operative and perioperative period should be discussed

A

Stabilise the patient: balance between delaying the surgery and taking a highly compromised animal to surgery so give aggressive IV fluid therapy, give analgesia and decompress stomach if it is not going to delay the surgery
You need to tell the owner that you are taking a compromised animal to surgery and it may not handle the anaesthesia and you may have to remove the spleen and part of the gastric wall if it isn’t viable

39
Q

Outline a post-operative treatment plan for a dog that has just had GDV fixed with a gastropexy and splenectomy. Explain complications and monitoring you will use

A

Must monitor electrolytes, platelets, heart, ventricular arrhythmias common as well
If not monitored dog can get DIC because of the cytokine release and reperfusion injury

40
Q

What tips are you going to give the owner on preventing GDV

A

Don’t feed close to vigorous exercise
2+ smaller feeds per day
Don’t feed solely dry food

41
Q

What is the cause, clinical features, diagnosis and treatment of acute enteritis

A

Infectious, dietary, parasites and unknown causes
SI diarrhoea, abdo pain, anorexia and dehydration
Dietary changes, parasite control, vaccination and hygiene
Treat by re-establishing fluid losses, probiotics and antiemetics if needed

42
Q

What is the cause, clinical features, diagnosis and treatment of parvovirus

A

Caused by canine parvovirus
Clinical features include bloody diarrhoea and vomiting + history of no vaccination and exposure, hookworm as well until proven otherwise
Diagnosis is typically a cage side ELISA test that may not work if its too early in the disease or the faeces are already haemorrhagic (coats Abs), can use PCR
Treatment includes barrier nursing, IV fluids, antibiotics and multiple anti-emetics

43
Q

Explain the terms “antibiotic responsive enteropathy,” “dietary responsive enteropathy,” inflammatory bowel disease.” What do they have in common? How do they differ? How would you discriminate between them?

A

ARE (SIBO): allergic reaction due to small intestinal bacterial overgrowth with abnormal host response
DRE: allergic reaction due to food intolerance
IBD: anything that is not dietary or antibiotic responsive
They all are a type of immune system reaction

44
Q

What is the cause, clinical features, diagnosis and treatment of intestinal lymphangiectasia

A

Lymphatic obstruction causing rupture of lymphatic vessels
Inconsistent diarrhoea, transudative ascities and loss of anticoagulant protein
Hypoalbuminaemia, need biopsies to diagnose
Treat symptomatically, low fat diet and pred

45
Q

What are some causes of PLE in dogs and cats

A

Dogs- IBD, lymphoma, hookworm, GI ulceration

Cats- lymphoplasmacytic IBD and intestinal lymphoma

46
Q

What is the cause, clinical features, diagnosis and treatment of lymphoplasmacytic colitis (LI IBD)

A

Cause is idiopathic normally
Large bowel diarrhoea only sign except in cats, they have haematochezia
Diagnose by ruling out other causes of LI diarrhoea
Treat with hypoallergenic diet to start with then add antibiotics if unresponsive
Prognosis better for LI IBD than SI IBD because of PLE

47
Q

What is the cause, clinical features, diagnosis and treatment of histiocytic ulcerative colitis

A

Caused by adherent and invasive E.coli facilitated by some sort of immune system dysfunction
Present with chronic colitis and LI diarrhoea
Diagnosis based on breed, cobblestone rectum on palpation
Treat with enrofloxacin for minimum of 8wks

Canine And Feline Medicine (2 decks)

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