GI 1

Question 1

4yo FS mixed breed, 2 year history of vomiting once a month, now every other week. good appeite, no weight loss. on dry kibble. what kinds of history questions do you want to ask?

Answer 1

age and breed, travel hx, any medications, recent illness, past treatments, other pets in the house, diet and treats, weight or appetite changes, what home remedies have been tried, ask about the presenting complaint specifically.

Question 2

what is the most important part of the GI workup?

Answer 2

getting a good history

Question 3

what is the difference between dietary indiscretion and dietary intolerance?

Answer 3

dietary indiscretion: recent and sudden diet change, usually acute, table scraps or free roaming behavior, ingestion of hair, low quality poor digestible diet

dietary intolerance: also called an allergy, inability to digest something, difficult digestion, usually chronic with no urgency markers

Question 4

if a patient presents for dysphagia, the problem is likely where?

Answer 4

oral cavity, larynx, upper esophagus

Question 5

what history questions are important to ask if a present presents with dysphagia?

Answer 5

trouble grabbing food, trouble chewing, difficulty or painful swallowing, immediate return of food bolus

Question 6

difference between vomiting and regurgitation?

Answer 6

vomiting: active, will see nausea, GI material from stomach or proximal intestine

regurg: passive, no nasuea, GI material from esophagus, issue with swallowing or esophageal disease

Question 7

how to tell small vs large bowel diarrhea?

Answer 7

small: large volumes, no tenesmus, melena, weight loss often

large: small volumes, tenesmus, mucus, fresh blood

Question 8

often the only clinical signs cats will show is

Answer 8

hyporexia/anorexia

Question 9

what diseases are you worried about if a cat is anorexic?

Answer 9

hepatic lipidosis, inflammatory bowel disease

Question 10

how do you tell if something is acute or chronic?

Answer 10

acute: a few days
chronic: lasting more than 2-3 weeks

Question 11

acute GI disease is sometimes _____

Answer 11

self limiting–>acute things may not need as aggressive diagnostics compared to chronic things

Question 12

difference between primary and secondary GI disease?

Answer 12

primary: disease within the GI tract
secondary: disease outside the GI tract

Question 13

true or false: many GI cases will not have a specific diagnosis

Answer 13

true! this is why theraputic trials are so helpful

Question 14

list some differentials youd put on your list if the main problem with your patient was regurgitation

Answer 14

esophagitis, hiatal hernia, ring anomalies, neoplasia, foreign bodies, megaesophagus, GERD, MG

Question 15

list some differentials for primary GI disease

Answer 15

gastroenteritis, dietary indiscretion, dietary intolerance, lymphangiectasia, helicobacter, infections, neoplasia, protein losing enteropathy, inflammatory bowel disease, foreign body, obstruction, allergy, ARD/SIBO

Question 16

true or false: GI ulcers are not common in cats and dogs unless there is a predisposing factor

Answer 16

true

Question 17

how do you decide whether to do a theraputic trial vs a diagnostic test?

Answer 17

you can consider a theraputic trial if there are no GI urgency markers

Question 18

list the GI urgency markers

Answer 18

unstable patient (heart, brain, lungs, kidneys)
marked or rapid weight loss
concerning PE findings such as a painful abdomen
hypoproteinemia
adbominal effusion
hypovolemia, hypotension, hypoperfusion
anorexia if prolonged (more than 1-2 days)
non stop vomiting

Question 19

which of the following is a GI urgency marker: chronic vomiting, chronic diarrhea, acute hematochezia

Answer 19

none!

Question 20

if a patient has no GI urgency markers, how should you proceed?

Answer 20

do a theraputic trial, and if that doesn’t work, then consider diagnostics.

Question 21

what are the 6 steps to a theraputic trial?

Answer 21

1. check for GI urgency markers, if none, then can consider a theraputic trial
2. eliminate simple things first: like a young dog with diarrhea, deworm them
3. eliminate dietary factors: could do a diet trial
4. treat symptoms: give cerenia, probiotics, etc
5. ensure hydration
6. if problems dont resolve or continute, do a diagnostic workup

Question 22

briefly describe treatments for the following:
acute vomiting
acute diarrhea
chronic vomiting
chronic diarrhea

Answer 22

acute vomiting: NPO trial, GI diet, pre/pro biotics, antiemetic, deworm
acute diarrhea: probiotics, GI diet, deworm, antibiotic
chronic vomiting: elimination diet, deworm, pre/probiotics
chronic diarrhea: elimination diet, probiotics, fiber if large bowel, deworm, antibiotics

Question 23

what is the difference between a GI diet and an elimination diet?

Answer 23

GI diet: usually for ACUTE conditions, highly digestible or low in fat, 100% digestion and absorption happens in proximal GI, usually eat it for 1 week and slowly transition the feed

elimination diet: aims to eliminate the offending dietary component (can be protein but not always), usually hydrolyzed diets or novel protein diets, make sure pet is only eating it and nothing else, takes 6-8 weeks to know if it works

Question 24

what medication should you use for anti-parasitic treatment for a patient with GI disease?

Answer 24

fenbendazole

Question 25

how do you properly do an NPO trial

Answer 25

for acute vomiting ONLY!

1. nothing per os including water for 12 hours
2. after 12 hrs, give small amounts of water every 2 hours for 6 hours
3. then give small amounts of GI diet in 4-6 meals per day for 2-3 days
4. if desired, reintroduce old diet, 25% old diet for a few days, then can do 50/50, etc

Question 26

which antiemetics drugs can you use?

Answer 26

maropitant/cerenia
metroclopramide
DO NOT USE FAMOTIDINE

Question 27

should you use antacids?

Answer 27

almost no evidence that they help, UNLESS GERD or esophagitis

Question 28

does surge say that sulfacrate helps?

Answer 28

NOOOOO it doesnt do anything apparently and can make cats vomit

Question 29

if your patient is 5% dehydrated or less and under 25kg, you can consider

Answer 29

SQ fluids

Question 30

what diagnostics should consider for acute cases? chronic?

Answer 30

radiographs or ultrasound
CBC/chem/urinalysis
GI panel or endocrine testing

chronic: full labwork, GI panel, endocrine testing, GI biopsy, ultrasound, referral

Question 31

clinical signs of dysphagia

Answer 31

exaggerated head movements, exaggerated prehension, dropping food, coughing, aspiration pneumonia, gagging, retching, drooling, regurgitation

Question 32

what causes gastroesophageal reflux in dogs and cats?

Answer 32

secondar to transient or permanent changes in the barrier between the esopagus and the stomach. can be a problem with the LES, a hiatal hernia, motility disorder, foreign bodies, vomiting, GERD, and in cats tetracycline and clindamycin can burn the esophagus.

Question 33

in dogs, the lower esophageal sphincter is made of what kind of muscle? compared to cats?

Answer 33

dogs: outer layer is striated, inner layer is smooth
cats: only smooth

Question 34

list some contributing factors to gastroesophageal reflux

Answer 34

anesthetic agents, anticholinergics, acepromazine, diazepam, narcotics, prolonged fasting, abdominal procedures

Question 35

what are clinical signs of esophagitis?

Answer 35

many animals are subclinical

anorexia
drooling, regurg, retching, gagging, coughing, repeated swallowing, discomfort, lethargy, weight loss. in cats, they vocalize loudly after eating

Question 36

how can you diagnose esophagitis?

Answer 36

typically based on history and clinical signs

rads: can look like megaesopahgus because the esophagus is paralyzed and becomes dilated, do NOT confuse the two!!
contrast rads
endoscope

Question 37

how do you treat esophagitis?

Answer 37

try to find a cause (GERD is dx of exclusion)
proton pump inhibitors: omeprazole, pantoprazole
cisapride: a prokinetic, increase LES tone
metoclopramide: a prokinetic, increase LES tone
sulfacrate: controversial

Question 38

what causes esopahgeal strictures?

Answer 38

secondary to esophagitis like FBs, caustic material, reflux from anesthesia, doxy or clindamycin

Question 39

what is a hiatal hernia?

Answer 39

repeated protrusion of abdominal contents through the esopahgeal hiatus of the diapragm into the thorax. usually a congenital problem, common in bulldogs

Question 40

what do hiatal hernias look like on rad?

Answer 40

an alien according to serge

Question 41

how do you treat hiatal hernias

Answer 41

proton pump inhibitors
low fat diet
prokinetics such as ranitidine, cisapride

surgical: hiatal hernia reduction, usually works better than medical management

Question 42

what is PRAA

Answer 42

persistent right aortic arch: embyronic right aortic arch rather than the left becomes the functional adult aorta, causing circular entrapment of the esopahgus by the ligamentum arteriosum and aorta

Question 43

which breeds are more at risk of a PRAA

Answer 43

german shepherds, greuhounds, irish setters, weimeraners

Question 44

what signs on rads indicate a PRAA

Answer 44

tracheal deviation to the left, a notch in the ventral or dorsal border of the esopagus, proximal megaesopagus. difficult to diagnose

Question 45

the most common caus of regurg in dogs is

Answer 45

megaesophagus: a dilated, hypoperistaltic esopahgus. can be congenital or acquired

Question 46

list some causes for acquired megaesopagus

Answer 46

idiopathic
secondary to PRAA, chronic esophagitis, myasthenia gravis, addison’s disease, hypothyroidism

Question 47

how to diagnose megaesopahgus and how to treat?

Answer 47

rads +/- contrast

broad spec antibiotics, raised feedings, nutritional support

can’t treat dogs with prokinetics because it doesn’t effect their striated muscle, cats it could work