GI 1 Flashcards
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?
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.
what is the most important part of the GI workup?
getting a good history
what is the difference between dietary indiscretion and dietary intolerance?
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
if a patient presents for dysphagia, the problem is likely where?
oral cavity, larynx, upper esophagus
what history questions are important to ask if a present presents with dysphagia?
trouble grabbing food, trouble chewing, difficulty or painful swallowing, immediate return of food bolus
difference between vomiting and regurgitation?
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
how to tell small vs large bowel diarrhea?
small: large volumes, no tenesmus, melena, weight loss often
large: small volumes, tenesmus, mucus, fresh blood
often the only clinical signs cats will show is
hyporexia/anorexia
what diseases are you worried about if a cat is anorexic?
hepatic lipidosis, inflammatory bowel disease
how do you tell if something is acute or chronic?
acute: a few days
chronic: lasting more than 2-3 weeks
acute GI disease is sometimes _____
self limiting–>acute things may not need as aggressive diagnostics compared to chronic things
difference between primary and secondary GI disease?
primary: disease within the GI tract
secondary: disease outside the GI tract
true or false: many GI cases will not have a specific diagnosis
true! this is why theraputic trials are so helpful
list some differentials youd put on your list if the main problem with your patient was regurgitation
esophagitis, hiatal hernia, ring anomalies, neoplasia, foreign bodies, megaesophagus, GERD, MG
list some differentials for primary GI disease
gastroenteritis, dietary indiscretion, dietary intolerance, lymphangiectasia, helicobacter, infections, neoplasia, protein losing enteropathy, inflammatory bowel disease, foreign body, obstruction, allergy, ARD/SIBO
true or false: GI ulcers are not common in cats and dogs unless there is a predisposing factor
true
how do you decide whether to do a theraputic trial vs a diagnostic test?
you can consider a theraputic trial if there are no GI urgency markers
list the GI urgency markers
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
which of the following is a GI urgency marker: chronic vomiting, chronic diarrhea, acute hematochezia
none!
if a patient has no GI urgency markers, how should you proceed?
do a theraputic trial, and if that doesn’t work, then consider diagnostics.
what are the 6 steps to a theraputic trial?
- check for GI urgency markers, if none, then can consider a theraputic trial
- eliminate simple things first: like a young dog with diarrhea, deworm them
- eliminate dietary factors: could do a diet trial
- treat symptoms: give cerenia, probiotics, etc
- ensure hydration
- if problems dont resolve or continute, do a diagnostic workup
briefly describe treatments for the following:
acute vomiting
acute diarrhea
chronic vomiting
chronic diarrhea
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
what is the difference between a GI diet and an elimination diet?
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
what medication should you use for anti-parasitic treatment for a patient with GI disease?
fenbendazole
how do you properly do an NPO trial
for acute vomiting ONLY!
- nothing per os including water for 12 hours
- after 12 hrs, give small amounts of water every 2 hours for 6 hours
- then give small amounts of GI diet in 4-6 meals per day for 2-3 days
- if desired, reintroduce old diet, 25% old diet for a few days, then can do 50/50, etc
which antiemetics drugs can you use?
maropitant/cerenia
metroclopramide
DO NOT USE FAMOTIDINE
should you use antacids?
almost no evidence that they help, UNLESS GERD or esophagitis
does surge say that sulfacrate helps?
NOOOOO it doesnt do anything apparently and can make cats vomit
if your patient is 5% dehydrated or less and under 25kg, you can consider
SQ fluids
what diagnostics should consider for acute cases? chronic?
radiographs or ultrasound
CBC/chem/urinalysis
GI panel or endocrine testing
chronic: full labwork, GI panel, endocrine testing, GI biopsy, ultrasound, referral
clinical signs of dysphagia
exaggerated head movements, exaggerated prehension, dropping food, coughing, aspiration pneumonia, gagging, retching, drooling, regurgitation
what causes gastroesophageal reflux in dogs and cats?
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.
in dogs, the lower esophageal sphincter is made of what kind of muscle? compared to cats?
dogs: outer layer is striated, inner layer is smooth
cats: only smooth
list some contributing factors to gastroesophageal reflux
anesthetic agents, anticholinergics, acepromazine, diazepam, narcotics, prolonged fasting, abdominal procedures
what are clinical signs of esophagitis?
many animals are subclinical
anorexia
drooling, regurg, retching, gagging, coughing, repeated swallowing, discomfort, lethargy, weight loss. in cats, they vocalize loudly after eating
how can you diagnose esophagitis?
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
how do you treat esophagitis?
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
what causes esopahgeal strictures?
secondary to esophagitis like FBs, caustic material, reflux from anesthesia, doxy or clindamycin
what is a hiatal hernia?
repeated protrusion of abdominal contents through the esopahgeal hiatus of the diapragm into the thorax. usually a congenital problem, common in bulldogs
what do hiatal hernias look like on rad?
an alien according to serge
how do you treat hiatal hernias
proton pump inhibitors
low fat diet
prokinetics such as ranitidine, cisapride
surgical: hiatal hernia reduction, usually works better than medical management
what is PRAA
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
which breeds are more at risk of a PRAA
german shepherds, greuhounds, irish setters, weimeraners
what signs on rads indicate a PRAA
tracheal deviation to the left, a notch in the ventral or dorsal border of the esopagus, proximal megaesopagus. difficult to diagnose
the most common caus of regurg in dogs is
megaesophagus: a dilated, hypoperistaltic esopahgus. can be congenital or acquired
list some causes for acquired megaesopagus
idiopathic
secondary to PRAA, chronic esophagitis, myasthenia gravis, addison’s disease, hypothyroidism
how to diagnose megaesopahgus and how to treat?
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
