Gastrointestional Flashcards
Main lymphatic duct is located where?
Thoracic duct
Reglan affects what part of the GI?
gastric motility (to empty stomach)
COX 1 enhances blood flow to what?
the gut
What does the spleen hug?
The stomach - left side
Common pancreatitis CBC changes
high WBCS (neuts) w/ left shift
inflammatory cascade of events - start with neuts/macrophages
neuts/macrophages attack bacteria
Activation releases cytokines
Cytokines signal to t-cells
T-cells signal macrophages and it begins again
Hepatic lipidosis prognosis
75%
RER calculation
70(k)^3/4
Maintenance fluid rate - dog
66ml/kg/day
parenteral nutritrion risks (3)
- infection
- fluid shifts (high osmolality)
- refeeding syndrome including HYPERglycemia
A neurokinin receptor antagonist that affects substance P
cerenia
What does the liver do if it has not glycogen to convert to glucose?
Glucogenesis - create glucose from amino acids/pyruvic acid or glycerol
LPE characterized by what?
increase in lymphs and plasma cells overpopulating the mucosa of the GI
TPN must be administered via what? Why?
Central line, high osmolality (700)
Is it usually best to over feed or underfeed?
Underfeed - HYPER ailmentation leads to refeeding syndrome
Does Cerenia or Ondansetron affect GI motility?
Cerenia
Megaesophagus common disorder
myasthenia gravis
GIT water flow is ____ times that of blood volume or what % of body weight
1-2 x blood volume, 7% body weight
Treatment for IBD
steroids - calm down the attacking of the GI
Glucogenesis uses what for energy?
Amino Acids
How do you choose an enteral feeding tube?
Bypass the area of concern
Metoclopramide is a what type of drug
dopamine antagonist
Lymphangiectasia definition
Dilation of the lymph vessels
Lymph/anig/ectasia
Lymph/vessel/dilation
What percent dehydration should require IV fluids instead of SQ?
5% dehydration
Three common signs of mega esophagus
- big esophagus
- vomiting/regurge
- esophagitis
In a normal state, glucose is used for ___ and protein for ____
Glucose - energy
Protein - growth
PLE can cause DIC - why?
Uses all the clotting factors to plug the holes, less protein
Four chemistry changes besides Amy/lip with panc
low calcium
low albumin
high BG
high liver
You should avoid hyperailmentation in refeeding syndrome cases - why?
Need to re-feed slowly
The panc secreted digestive enzymes through the pancreatic duct into the what?
Duodenum
Name a serotonin antagonist antiemetic
ondansetron
Elemental diets should be used with what type of tube
J- tube - food should already be broken down by the time it reaches the jejunum
Three forms of IBD
LPE (lymphocytic plasmacytic enteritis)
EE (eosinophilic)
GE (granulomatous)
Refeeding syndrome is characterized by what three lab abnormalities?
Damn glucose scoops up everything: K+, Mg, Phos
- Hypokalemia
- hypomagnesaemia
- hypophosphatemia
What is hyperailmentation?
total parenteral nutrition apparently
What happens when the panc releases the hormone glucagon?
The liver converts glycogen to glucose
Shock dose dogs
90ml/kg total
Cat vs. dog protein requirement
Cat 6g/100kcal
Dog 4g/100kcal
Why do 26% of panc cases develop icterus
panc inflames and blocks bile duct (rude)
With acute gastritis, patients should be fasted for how long before reintroducing a bland diet?
12 hours
When to increase protein in diet?
burns, sepsis
A lactate decrease by _____% in _____ hours is good prognostic indicator for GDV patients
50% in 12 hours
Elemental vs. polymeric diets
elemental are broken down already - polymeric require breakdown
EE is characterized by what?
Eosinophils overtaking the mucousa
Abdominocentesis will yield fluid when >__ml/kg of fluid is present?
> 6ml/kg
GDVs with a lactate greater than _____ are associated with gastric necrosis
> 6mmol/L
Glutamine and arginine are what?
essential amino acids
Approx what percent of hepatic blood flow comes from the GI tract?
80%
What type and kind of enteral feeding should be used with a jejunostomy tube?
CRI - elemental liquid
CRI to mimic slow moving from stomach
Two mega E treatment meds
- sucralfate
- famotidine
Effects of lymphagiectasia?
Lymph vessels dilate/leak or are obstructed –> loss of protein
What sided heart failure affects the GIT?
right sided
What’s the gallbladder’s job?
Store bile between meals/reabsorb water
What part of the SI is most permeable?
Duodenum
How do NSAID toxicities cause DIC?
GI bleeding uses up all of the coag factors
What side should you trocharize a GDV?
patient in Left lateral - trocharize right side (avoid the spleen)
Hypertonic saline dosing
4ml/kg over 2 min
Malfunction in the transmission of signals between the nerves and muscles … what disorder?
myasthenia gravis
Patients in sever malnutrition (5 days) should get 60-90% of energy from what?
lipids
When to decrease protein in diet?
renal disease
Partial parenteral nutrition vs total percentages
Partial 40-60%
Where does the pancreas live?
Along the stomach and duodenum V shaped
GE characterized by what?
Macrophages taking over mucousa
Dolasetron can cause what
arrythmias
Colloid shock doses
10-20ml/kg
How much and what type of fluid should be used in a diagnostic peritoneal lavage?
10-20ml/kg of something isotonic
Why do some TPN avoid lipids?
pro-inflammatory and immunosuppressive
Shock dose cats
45-60ml/kg total
Replacement fluid calculation… how long do you replace over?
% dehydrated x body weight
replace 75% over 24 hours
CO2 enhances what?
mucosal healing
Body tries to plug big floppy vessel holes with what? leading to ________
plug w/ clotting factors, leading to DIC
E-tube diet type
thicker - less diarrhea
How often should open-abdomen bandages be changed?
3-4 times a day or when soiled
COX inhibitors regulate what?
renal function
Ace should be used cautiously in what breeds?
Sighthounds, giant breeds
COX inhibitors cause GI upset - HOW (2 things)?
blocks blood flow to the guts
blocks mucosal healing
Dogs vs. cats in RER use during malnutrition - where do they prefer to get calories?
Dogs - 90% dextrose
Cats - 60-90% lipids
VES daily rates - dogs vs cats
Dogs 20ml/kg/day
Cats 10-15ml/kg/day
Within 24 hours of no nutrition, what happens to the mucosal lining?
atrophy and increased permeability
LPE common in what breed
basenjis
hyperglycemia with PN or TPN can be managed how?
insulin CRI 0.5u/kg/day
Lymphatic system transports what?
transport of fatty acids, immune cells
How do NSAIDS cause GI ulcers?
Inhibit bicarb production (which balances GI acidity)
Approx 50% of cats with _____ have prolonged coags
hepatic lipidosis
Why does HYPERglycemia occur in refeeding syndrome cases?
Less efficient at converting glucose –>glycogen
Where does the breakdown of protein begin?
The stomach
The large intestines have no ______
villa or digestive glands
The liver destroys what?
old RBCs
The liver stores excess glucose in the form of what?
glycogen
J-tube benefits for panc
j-tube feeding does not stimulate pancreatic enzyme production
Parvo develop hypoglycemia - why?
Can’t absorb any glucose
Phenothiazine antiemetics act on what? Two examples
CNS blocking dopamine
Acepromazine
Chlorpromazine
Maintenance fluid rate - cat
50-60ml/kg/day
RER adjustments for refeeding syndrome
1/4 to 1/3 RER and adjust up over 3-4 days
The liver metabolizes what 3 things?
Carbs, fat, protein
How does Panc cause petichia?
Loss of albumin -> loss of antithrombin -> uses up clotting factors
Antiemetics are better absorbed how?
Orally…
Refeeding syndrome - main issue
Low Lytes
Insulin scoops up glucose AND LYTES - causing low phos, k, etc
RER adjustments for burn victims, cancer patients, head trauma and sepsis
1.1-1.5x RER
Since 80% of hepatic blood flow comes from the GIT - alterations in GIT can affect perfusion - including
mechanical ventilation, heart failure
Can TPN or PN be stopped suddenly?
NO - wean it off over several days
What is osmotic diarrhea?
Leaky GI - osmotic pressure pulls in fluid
Abdominal radiograph finding with panc:
loss of detail right cranial quadrant
