GI Flashcards
what is the most important part of a GI workup
history: ask about diet and presenting complaint
dysphagia is due to
oral cavity/laryngeal/upper esophageal disease
dysphagia C/S, ddx
trouble eating/grabbing food, difficult swallowing, exaggerated head movements, coughing/aspiration
ddx- severe dental disease, oral masses, neuro disease
vomiting vs regurg
vomiting- active process, nausea, GI material from stomach, indicates GI disease
regurg- passive, no nausea, GI material esophagus, indicates esophageal problem
sm vs lg bowel d+
SI- lg volume, melena, can have fat, v+, weight loss
LI- sm volume, tenesmus, mucous, fresh blood
ddx for anorexia in cats
pretty much anything, hepatic lipidosis, IBD
acute vs chronic GI
acute- self limiting, less diagnostics (unless GI urgency markers)
chronic- lasting more than 2-3wks, defined therapeutic trial/more diagnostics
differentials for GI
dysphagia/regurg- separate
anorexia, v+/d+, weight loss
primary vs secondary GI
therapeutic vs diagnostic tests
therapeutic trial- v+/d+ w no urgency markers, chronic w no progression or weight loss
diagnostics- chronic w/ progresion, dysphagia or regurg
GI urgency markers
unstable patients, weight loss, painful abdomen, low TP, effusion, prolonged anorexia, intractable vomiting
steps to therapeutic trial
- initial problem and urgency
- eliminate simple disease first (dewormer)
- eliminate dietary factors- diet trial
- treat symptoms
- hydration
- further workup if no resolution
GI tx (no urgency markers)
acute v+- MPO trial, GI diet, probiotics, antiemetic, deworm
acute d+- probiotics, GI diet +/- deworm, abx
chronic v+- elimination diet, deworm, probiotics
chronic d+- elimination diet, probiotics, fiber for lg bowel, abx
gi diet vs elimination diets
GI- highly digestible, low fat 1wk diet w transition
elimination- hypo diet to eliminate rxns 6-8wks
abx therapeutic trials
metro 8-12mg/kg q12 3-5d
tylosin 10-15mg/kg q12
fenben- 50mg/kg q24 5d
NPO for acute v+
NPO for 12h-> sm amount water q2h (if v+ do diagnostics)-> sm amount food 2-3d-> reintroduce diet 25% for 1-2d
other therapeutic trial meds
prebiotic, probiotics, anti-emetic, antacid, deworm, sucralfate (antacid and sucralfate probably don’t work)
when to use SQ or IV fluids
<5% under 25kg-> SQ
>5% or shocky-> IVF
normal swallowing stages
oral - prehension
pharyngeal- moving towards esophagus
cricopharyngeal- relaxation of upper esophageal sphincter
gastroesophageal reflux
reflux of gastric acid into esophagus. LES (striated and smooth muscle in dogs, smooth only in cats)
causes: LES incompetence, motility disorder, FB, v+, GERD
prolonged fasting >24h, anesthetic
esophagitis C/S, dx
anorexia, regurg, drooling, coughing, loud vocalization after eating, many are subclinical
dx- hx, C/S, TXR, can do contrast rads/scope
esophagitis tx
PPI- omeprazole 1mg/kg PO q12 for 2d then q24 7-10d, panto if IV
+/- cisapride, sucralfate
prognosis good
esophageal FB signalment, C/S
common in dogs, near LES< base of heart-> mucosal damage, ulcers, perf
acute regurg, gagging, hypersalivation, pain
esophageal FB dx, tx
dx- rads, scope
tx- scope to remove, push into stomach-> gastrotomy?
prognosis good, risk stricture
esophageal strictures
secondary to esophagitis (FB, reflux)
dx- esophagram w contrast, scope
tx- balloon dilation (3tx) can perforate
hiatal hernias
repeated protrusion of abd contents into thorax-> reduced LES tone
congenital- bulldogs, brachys
trauma induced
C/S- regurg, v+, repeated aspiration pneumonia
dx- rads, scope
hiatal hernia tx
medical- PPI, low fat diet, prokinetic
surgical- hernia reduction
PRAA
embryonic R aortic arch becomes aorta
GSD, greyhounds
regurg solid food, underdeveloped puppy, aspiration pneumonia
PRAA dx
contrast rads, fluoroscopy
tx- surgical correction
prognosis fair to poor
megaesophagus causes
congenital- schnauzer, GSD, great dane
acquired- idiopathic, chronic esophagitis, myasthenia gravis
megaesophagus C/S, dx
regurg, weight loss, cough/fever if acute
dx- TXR
megaesophagus tx
acute- abx to prevent aspiration
feed elevated, prevent weight loss, treat diseases for secondary
secondary megaesophagus diseases
myasthenia gravis, lupus, addisons, hypothyroid
acute gastritis/gastroenteritis
sudden gastric insult causing vomiting
C/S- v+, hematemesis, anorexia, d+
usually primary GI causes
acute gastritis dx
clinical, hx- no urgency markers
tx with therapeutic trial
chronic gastritis
chronic/intermittent or daily vomiting
cause rarely found-> likely dietary intolerance
tx- therapeutic trial (hypo diets)
GI diagnostics for failed trial or urgency
AXR (FB), U/S (chronic), scope (biopsy), sx biopsy (full thickness), GI panel, fecal float
helicobacter pylori
chronic v+ that doesnt respond, found in healthy and vomiting dogs, can respond to tx
helicobacter dx,tx
scope w biopsy (bacteria seen on histopath)
urease test- not sensitive
tx- metro, amoxiciliin, famotidine
delayed emptying/motility disorders
C/S- vomiting hrs after a meal, abd distension, bloating
causes- pyloric hypertrophic, neoplasia, pancreatitis, idiopathic, IBD
dx- scope, biopsies
tx- dietary low fat
hairballs in cats
considered abnormal if frequent
vomiting hairballs-> delayed gastric emptying, neoplasia
hairball tx
- special hairball diet
- dietary modification
- grooming
- small meals
- gastric lubricants
- prokinetics
gastric ulcers
causes: decreased blood flow, hypersecretion of acid, NSAIDs, exercise-induced, addisons
C/S: v+, hematemesis, melena, pale MM, abd pain, shock
gastric ulcers dx
CBC- regenerative anemia
chem panel- high BUN
rads, U/S, biopsies
gastric ulcers tx
IVF, PPIs, sucralfate, anti-emetics, abx, opioids
bilious vomiting syndrome
chronic intermittent vomiting early morning of bile
dx- clinical
tx- feed late, antacids
HGE
acute hypersensitivity, hematochezia, acute dehydration.
c/s- dehydration, v+/d+, acute abdomen
hypovolemia, shock
tx- shock treatment , NPO, metro?
canine parvovirus
fecal oral route, infect rapidly dividing cells
C/S- 4-7d post infection
acute v+/d+, depression, fever
dx- leukopenia, anemia, fecal Ag ELISA 10-12d after infection
parvo tx
supportive care: fluids, nutritional support (NGT), albumin transfusions, opioids
feline panleukopenia mortality?
mortality 50-90%
giardia
acute d+, v+
young animals, shelter
dx ELISA, PCR, zinc sulfate floats
tx- fenbendazole 50mg/kg SID 5d, repeat 3wks
describe fecal tests and what they detect
fecal float- parasites
fluorescent Ab- crypto
fecal PCR- bacteria, but interpret carefully (w C/S)
chronic SI diseases
food allergy- hypo food trial
gluten sensitive enteropathy- irish setters, celiac
dietary intolerance- individual specific ingredient intolerance
ARD/SIBO
dysbiosis-> malabsorption, d+
primary- GSD, igA deficiency
secondary- abnormal GIT, chronic enteropathy (IBD)
dx- sm bowel d+, v+, weight loss (r/o other causes)
advanced GI dx
cobalamin- low w IBD and bacterial overgrowth
folate- increased w ARD/SIBO decreased- mucosal disease
EPI causes
insufficient pancreatic enzymes
primary in dogs- genetic (GSD)
secondary- cats (chronic pancreatitis)
EPI dx, tx
C/S- loose stool, increased appetite, weight loss
dx- low TLI
tx- supplement enzymes, cobalamin, high quality diet
key words for IBD
chronic
immune
inflammation
progressive
IBD definition
collective disorders w persistent or recurring GI signs, histo evidence of inflammation
chronic, immune mediated enteropathy
IBD pathophys
structural (tight junction, mucosal barrier)
environmental (dysbiosis, dietary)
genetic (local immune dysfunction, loss of self tolerance)
what does the microbiome do
metabolic- fermentation to provide energy for cells
trophic effect- protective, influence nutrient uptake
crosstalk- chemokines/cytokines, GALT
IBD C/S
chronic v+/d+, borborygmi, abd discomfort, altered appetite, weight loss
IBD workup
history-> bloodwork (CBC/chem/UA, cortisol)-> GI panel (folate cobalamin, TLI,PLI)-> imaging (thickening , layer changes)-> GI biopsy (sx or scope), targeted therapy (deworming, diet, pred, abx)
pros/cons of GI biopsy
inflammation is present w many disease, including IBD
use WSAVA grading system and C/S
most common IBD
lymphoplasmacytic IBD
other: eosinophilic
IBD tx
- hypo diet, pred 2mg/kg/d
cobalamin, probiotic, metro, tylosine - add cyclosporine, new diet
- other immunosuppressive, injectables
IBD prognosis?
good to guarded, success not guaranteed
PLE/lymphangiectasia
marked dilation and dysfunction, more than IBD
leakage of lymph
primary idiopathic (most common), secondary (obstructive)
C/s- D+, weight loss, hyporexia, ascites
dx- panhypoproteinemia, hypocholesterolemia
r/o PLN, Gi biopsy
lymphangectasia tx
fat restriction, pred, cobalamin supplementation
prognosis good to poor
histiocytic ulcerative colitis
young boxers- e coli in macrophages
hx, C/S- severe chronic lg bowel d+, weight loss, hematochezia
histiocytic ulcerative colitis dx, tx
colonic biopsy via scope
tx- enrofloxacin, 5-10mg/kg SID 4-8wks
relapse frequent, good prognosis
constipation causes
pelvic fx, neuro disease, diet change, dehydration, CKD, idiopathic megacolon
megacolon
C/S- cats w progressive dilation of colon, loss of smooth muscle function
dx- PE, rads
tx- enema if mild, deobstipation if severe
chronic therapy for megacolon
weight loss if overweight
chronic laxatives (lactolose, restoralax)
low fat diet
prokinetics
sx- subtotal colectomy
tritrichomonas fetus
chronic lg or sm bowel d+ in cats
shelter cats
dx- PCR (fecal)
tx- ronidazole
anal gland abscess tx
sx (flush) amoxiclav for 5-7d
perianal hernias cause, C/S, dx, tx
chronic straining, IBD
C/S- none, swelling, tenesmus, painful defecation
dx- rectal exam
tx- sx
perianal fistula signalment, cause, ddx, dx, tx
chronic progressive immune disease older GSD
immune dysfunction
ddx: neoplasia, anal gland disease
dx- C/S, biopsies
tx- cyclosporine
good prognosis
