Gastrointestinal emergencies Flashcards

Question

x-ray / ultrasound in AKI may see: (2)

Answer 1

Normal or enlarged kidneys Free fluid and omental reaction around the kidneys.

Answer 2

Treatment is generally supportive treatment. Fluid therapy - Ins/OUTs - Monitor for fluid overload Antiemetics Analgesia Diuretics Dialysis Prognosis: Mortality 45 – 60%

Answer 3

usually castrated male cats, 2-6 years old

Answer 4

Physical resistance: - Bladder stones, mucous plugs - Strictures and neoplasia – less common Idiopathic (FIC) - More than 53% of cases - Environment, diet, behavioral factors, stress.

Answer 5

Specific - Pollakisuria (frequent, abnormal urination) - Stranguria (painful urination) - Dysuria (abnormal urination) - Hematuria - Inappropriate urination - Vocalization - Large bladder, pain Less specific - Inappetence - Apathy - Nausea - Vomiting - Respiratory signs: tachypnea, open-mouth breathing - Cardiovascular: bradycardia, dysarrythmias

Answer 6

Clinical examination Blood samples: - Electrolytes - Biochemistry (kidney enzymes) - CBC Further diagnostics (after initial stabilization) - Urine sample (sediment + culture) - Xray - Abdominal ultrasound

Answer 7

IV catheter – collection of blood samples - Opioid or sedation if necessary in angry animals ECG Fluid therapy Analgesia / muscle relaxation Sedation / anesthesia Urinary bladder catheterization

Answer 8

Evaluate the cardiovascular system - HR - Rhythm - Perfusion (pulse, mucous membranes, CRT) - ECG Ri-Lac usually first choice (faster resolution of metabolic acidosis) - Dosages Shock boluses – ¼ - 1/3 of shock dose 15 – 20 min, repeat if necessary If the patient is cardiovascularly stable, then decide the dosages based on dehydration and maintenance.

Answer 9

Hyperkalemia: Potassium, normally excreted by the kidneys, accumulates in the blood when the obstruction prevents urine flow. Clinical signs may be unspecific. - Muscle tremors - Lethargy - Arrhythmias Changes in the ECG may occur.

Answer 10

Fluid therapy and catheterization. Decompressive cystocentesis if needed. K < 6.5 mEq/L - Fluid therapy K 6.5- <8 mEq/L - 0,5 ml/kg 50% dextrose (dilute 1:4 NaCl) K >8 mEq/L, +/- changes in the ECG - 0,5 – 1 ml/kg 10% calcium gluconate IV supports and protects the heart. - 1ml/kg 50% dextrose (dilute 1:4 NaCl) + insulin 0.25 U/kg IV.

Answer 11

K 6.5- <8 mEq/L - 0,5 ml/kg 50% dextrose (dilute 1:4 NaCl) K >8 mEq/L, +/- changes in the ECG - 1ml/kg 50% dextrose (dilute 1:4 NaCl) + insulin 0.25 U/kg IV. This treatment works through an indirect mechanism to temporarily shift potassium from the bloodstream into cells, thereby lowering serum potassium concentrations and reducing the risk of life-threatening complications like cardiac arrhythmias. Glucose -> insulin -> promotes the uptake of glucose into cells, but it also facilitates the movement of potassium into cells via sodium-potassium ATPase pumps.

Answer 12

Analgesia and premedication: Butorphanol (0,1 – 0,4 mg/kg) - Moderate to good sedation - Short duration (60 – 90 min) - Not good for analgesia Methadone (0,05 – 0.6 mg/kg) - Moderate sedation - Duration 2-4h - Good analgesia Sedation and muscle relaxation - Midazolam (0.05 – 0.2 mg/kg) Induction - Propofol (4 – 8 mg/kg) IV

Answer 13

Catheterization! Treatment after catheterization – hospital/stationary treatment. Catheterization and hospitalization reduces the risk for recurrence. Cats, who were sent home after catheterization were 3.7 times more likely to develop urinary obstruction again. Finding out the cause and treating it is the main thing!

Answer 14

Fluid therapy varies in patients, evaluate according to the situation. Recheck every 2-4h! Take into account maintenance, dehydration and ongoing losses due to post-obstructive diuresis. - Happens in 46% of cats Be aware of fluid overload! UOP (urine output) Cats 0,5 – 1 ml/kg/h Dogs 1 – 2 ml/kg/h Check UOP, emptying of the bladder, weight, closed system collection bags, RR rate.

Answer 15

refers to the excessive production of urine that occurs after the relief of a urinary obstruction. It is a compensatory response by the body following the restoration of urine flow after a period of urinary blockage. Osmotic Diuresis: The accumulated waste products (e.g., urea) create an osmotic gradient in the renal tubules, drawing water into the urine and further increasing urine output.

Answer 16

Cats 0,5 – 1 ml/kg/h Dogs 1 – 2 ml/kg/h

Answer 17

Opioids - Buprenorphine, methadone, fentanyl - Smallest dosage that ensures analgesia and relaxation of the urethral sphincter. NSAID - Meloxicam (0.05 – 0.1 mg/kg SC, PO q24h). - Only if the patient is stabilized, euvolemic and kidney values have become normal. Tamsulosin Gabapentin, pregabalin

Answer 18

is an alpha-1 adrenergic receptor antagonist (alpha-blocker) that relaxes the smooth muscles in the urinary tract, particularly the bladder neck and prostate. It is primarily used to improve urine flow in conditions where obstruction or spasm of the urinary tract is present. indicated for Benign Prostatic Hyperplasia and urinary retention etc.

Answer 19

Pregabalin is an anticonvulsant and neuropathic pain medication used in veterinary medicine primarily for managing chronic pain, particularly neuropathic pain. It is also used in certain cases for seizure control and to treat anxiety in animals. Pregabalin works by binding to the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system (CNS). This reduces the release of excitatory neurotransmitters (such as glutamate, norepinephrine, and substance P), which are involved in pain transmission and seizure activity.

Answer 20

Bacterial lower urinary tract infections are rare. If the urine culture is negative, there is no reason to start with AB. Rare occasions if there is prior catheterization in history. UTI is rare in sterile catheterization Urine sample for culture when catheter is removed. Always favor cystocentesis for UA.

Answer 21

57 – 72 days

Answer 22

63 – 65 days

Answer 23

Increasing age Nulliparity Breed Administration of exogenous estrogen or progesterone. - Administration of medroxyprogesterone acetate increased prevalence of pyometra by 45%.

Answer 24

Occurs typically during diestrus. - Progesterone stimulates endometrial growth and glandular secretory activity. - It also reduces myometrial contractility and maintains cervical closure. - Diminishes immune function. - Increases endometrial bacterial adherence. Often cystic endometrial hyperplasia (CEF) precedes pyometra, but not always. Many bitches have concurrent urinary tract infections. - E.coli is the most common bacteria.

Answer 25

History - Around 30 days after proestrus - Use of exogenous progesterone - Infertility Clinical signs: - Vaginal discharge (can do cytology) - Fever - PU/PD - Anorexia - Dehydration - Signs of sepsis

Answer 26

Imaging: - U/S – most sensitive - Xray + Blood samples

Answer 27

Neutrophilia – band neutrophils Up to 70% anemia of chronic disease hyperproteinemia/ hyperglobulinemia due to dehydration and inflammation Hypoalbuminemia due to sepsis Elevated kidney and liver enzymes Electrolyte imbalances: especially glucose (hyper-), hyperkalemia (canine pyometra cases typically exhibit hyperkalemia due to factors like renal dysfunction, dehydration, and metabolic acidosis)

Answer 28

Surgical - OHE (Treatment of choice) - Prior stabilization - Use of aglepristone (P4 blocker) Medical - Used in valuable breeding dogs - Has different protocols

Answer 29

Survival rate 92% Most common complication is peritonitis. Recurrence in medical treatment 20-77% within 1 – 2 years. 40 – 90% of bitches whelp a normal litter after medical management

Answer 30

Vaginal / uterine prolapse is rare, Poss causes: Stretching / laxity of the pelvic muscles Uterine atony Traumas Dystocia DDx: Tumors of the uterus, vagina and urethra Metritis Pelvic prolapse / edema

Answer 31

Manual reponation (restoration) The prolapsed part of the uterus is rinsed with physiological solution and lubricated with a water-absorbing lubricant. Reinsertion of the uterus is carried out through the vagina, for which continuous manipulations are performed through the abdominal wall. Manual vaginal inspection and abdominal palpation are necessary to confirm position. Once the partial reinsertion is done, a laparotomy is performed for further reinsertion and, if necessary, an ovariohysterectomy. It is also possible to consider pefroming a pexy, where the uterus is attached to the ventrolateral abdominal wall. If vaginal reinsertion is not possible: amputation of the uterus.

Answer 32

Narrowing of the opening of the foreskin (paraphimosis) Hypoplasia of the foreskin Weak muscles of the foreskin Penis enlargement (priapism) - Caused by trauma, neoplasia, drying, or hair retention on the penile mucosa.

Answer 33

Ingrown/misdirected hairs that are stuck to the penis or foreskin mucosa should be removed immediately, as they prevent normal blood supply. Swelling reduction: cold compress, local hyperosmolar solution (e.g. 50% dextrose). Immediate release of the foreskin from pinching/ tightening. Penile aspiration (removal of excess fluid from the corpus spongiosum of the penis). The penis should be placed back into the foreskin to prevent further injury. Surgery If there is an injury or obstruction to the urethra, before dealing with penile trauma, the obstruction must be removed or urine diversion (e.g catheter) should be ensured and the resulting hyperkalemic state stabilized.

Answer 34

A very painful condition Xray of the penile bone should be taken to rule out a fracture of the penile bone, neoplasia, and the presence of a foreign body. Palpation of the prostate gland and foreskin. Vascularity check – foreskin color, CRT and temperature. Lighter ulcers must be cleaned and should heal well with conservative treatment. In case of large and deep ulcers, surgical intervention is necessary. Depending on the findings, the necessary diagnostic examinations (US, contrast urethrography, CT, biopsy, etc.) will be decided. Conservative treatment: local treatment (wound), oral antibiotics, NSAIDs, temporary catheter.

Answer 35

Gastric dilatation and volvulus (GDV) is a life-threatening condition. Risk factors: Deep chest Age Fast eating/feeding once a day Dry food Nervous / fearful temperament Looseness or agenesis of the gastric ligaments

Answer 36

Compression of the portal vein and caudal vena cava Venous blood return to the heart is inhibited, blood pressure lowers Compression of the portal vein causes swelling and distension of the GI system; the volume of blood in the vessel decreases. Oxygen supply decreases

Answer 37

Bacterial translocalization Production of free radicals – direct toxic damage to tissues Tissue hypoxemia and death Lactic acid production – anaerobic metabolism

Answer 38

Anamnesis Xrays - Capture Thorax as well to check for aspiration pneumonia. Lactate - ≤ 6 mmol/L – 99% survival - ≥ 6 mmol/L – 58 % survival - ≥ 9 mmol/L – 1% survival The decrease in lactate levels post-op is more important though. If the drop is more than 50%, then the prognosis is good.

Answer 39

Prognostic indicator Lactate - ≤ 6 mmol/L – 99% survival - ≥ 6 mmol/L – 58 % survival - ≥ 9 mmol/L – 1% survival The decrease in lactate levels post-op is more important though. If the drop is more than 50% from pre-op, then the prognosis is good.

Answer 40

Hypovolemic, Obstructive & Distributive

Answer 41

Hypotension treatment with: - Dopamine 3 – 10 μg/kg min CRI - Dobutamine 5 – 15 μg/kg min CRI Antibiotics - Broadspectrum - Prior to surgery - Cefazolin 20 – 22 mg/kg IV Antiarrhythmics - Ventricular arrhythmias - Start prior to surgery - Lidocaine 1 – 2 mg/kg IV Analgesia - Methadone - Fentanyl - FLK Antiemetics Gastric lavage if possible with a tube Decreasing the bloat (Biggest IV catheters as trocar)

Answer 42

Gastric Invagination for GDV Induced Necrosis is a surgical technique. The necrotic area of stomach, instead of being removed by partial gastrectomy, was pushed into the stomach lumen and over sewn with inverting suture patterns. The devitalized tissue was left to be digested by the stomach enzymes allowing the healthy tissue to heal.

Answer 43

Belt-loop gastropexy is a simple and commonly used method. Create a 3- to 4-cm-long by 3- to 4-cm-wide seromuscular flap in the pyloric antrum. Incorporate one or two branches of the right gastroepiploic artery into the flap. Using atraumatic forceps or a stay suture, pass the seromuscular flap in a caudal to cranial direction through the "belt loop" in the abdominal wall. Suture the seromuscular flap back into its original position by using a 3-0 absorbable monofilament suture with a simple interrupted suture pattern.

Answer 44

Monitor hydration, BP Vasopressors / positive inotropes if necessary MAP above 60 mmHg Oxygen therapy Monitoring for arrhythmias – intervention if necessary Analgesia (FLK / methadone) Do not use NSAIDs Do use Gastroprotectants Feeding is important as well

Answer 45

57 – 72 days (65 d)

Answer 46

Body temperature drops below 37.6'C, Labor will start in 12 – 24h. Progesterone drops below 2 ng/ml.

Answer 47

abdominal contractions and clear vaginal discharge may last 12-24 hours the first puppy should be delivered in 2-4 hours from onset of contractions

Answer 48

10-25 min after each puppy

Answer 49

Prolonged gestation without signs of labor Body temperature decrease below 37.6 for 12 – 24h, without signs of labor Body temperature increase for prolonged time Vaginal discharge for more than 2 -3 h Labor activity stops for more than 8h Active and strong abdominal contractions for 30min, without expulsion of a puppy. Labor stage 2 lasting for more than 12h. Abnormal discharge Signs of systemic illness

Answer 50

the green pigment of the dog's placenta

Answer 51

General examination Vaginal examination Mammary glands Xray (Number, position, size of fetuses) Ultrasound (HR and movement of fetus)

Answer 52

Ca Glu PCV/PP UREA, CREA WBC RBC

Answer 53

Secondary to reasons caused by the mother or the fetus – the fetus is either in the wrong position, too big, dead, or the mother’s birth canal is not wide enough.

Answer 54

Primary uterine inertia +/- atony

Answer 55

Exogenous oxytocin (0.25 U/ per animal, SC/IM. Max doose 4U/per animal) Calcium gluconate (proper ECG monitoring required) Consider the clinical condition of the dam and the number of fetuses (If the dam is tired and there are still many puppies to come, a C-section is indicated)

Answer 56

The pressure-sensitive contraction transducer, called a tocodynamometer or TOCO for short, records the pressure force produced by the contorting abdomen during uterine contractions. When a patient goes into labor or is experiencing contractions, a TOCO, which resembles a belt, is placed on the abdomen of the patient.

Answer 57

Progesterone has a thermogenic effect, meaning it helps to maintain the body's basal temperature at a slightly elevated level. As labor approaches, progesterone levels sharply decline. The drop in progesterone is typically triggered by the production of prostaglandins from the fetal membranes and the uterus. Prostaglandins cause the regression of the corpus luteum. With the drop in progesterone, the thermogenic effect is lost. This leads to a drop in the dog's core body temperature. After the temperature drop, labor usually starts within 12 to 24 hours. The drop in progesterone not only affects body temperature but also facilitates uterine contractions and cervical dilation, key processes for the birthing of puppies.

Answer 58

normal fetal heart rate approx. 200-220 beats per minute critical lower limit is approx. 160 bpm (if you can count the heart rate then its too low)