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ECC Boards - Davy > GI > Flashcards

GI Flashcards

1
Q

What is the cut off for feline small intestinal size radiographically?

A

No more than twice the high of the central portion of L4, or 12 mm.

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2
Q

What are the most common causes of hemoabdomen in a cat

A

Non neoplastic- 54%. Neoplastic- 46%

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3
Q

Define pure transudate

A

< 2.5 g/dL TP

<500 cells/ul

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4
Q

Define modified transudate

A

2.5-5 g/dL TP

300-5500 cells/ul

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5
Q

Define an exudate

A

TP >3 g/dL

Cell count > 5000-7000cells/ul

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6
Q

Describe ratio approach to small intestinal diameter measurement in cats

A

Ratio of maximal small intestinal diameter to the height of the cranial endplate of L2 should not be > 2

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7
Q

Describe ratio approach to small intestinal diameter measurement in dogs

A

Ratio of maximal small intestinal diameter to the narrowest width of L5 on a lateral radiograph should not be >1.6

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8
Q

According to silverstein, what is the sense/spec of the SNAP cpLI

A

Sensitivity 92-94%. Specificity 71-78%

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9
Q

According to silverstein, what is the sens/spec of the cPLI

A

82% sent with severe panc, 63.6% with less severe panc.

96.8% specificity

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10
Q

According to silverstein, what is the sens/spec of the SNAP fPLI

A

Sens 79%, Spec 80%

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11
Q

According to silverstein, what is the sens/spec of the fPLI

A

Sensitivity 67% in all cats with panc and 100% in cats with moderate to severe panc

Specificity 100%.

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12
Q

Risk factors for development of AP in dogs

A

Middle aged-older
Overweight
Hx of prior or recurrent GI signs
Concurrent endocrinopathies (DM, hypoT, HAC)
Yorkies, min schn, terriers may be at risk.

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13
Q

What electrolyte abnormality is prognostic in cats with AP?

A

hypocalcemia- associated with poorer outcome

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14
Q

T/F PLI is affected by renal disease and steroid administration

A

false

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15
Q

Evidence for early nutrition in AP in people

A

Fewer complications including fewer infections, decreased risk of MODS, decreased mortality rates, less expense, and shorter duration of hospitalization when compared to parenteral nutrition.

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16
Q

what are the functions of each of these cells in the stomach:
Parietal cells
Chief cells
Mucus- producing cells

A

Parietal cells- secrete hydrochloric acid
Chief cells- secrete pepsinogen
Mucus-producing cells- secrete bicarb

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17
Q

Life span of enterocytes at villus

A

2-5 days

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18
Q

What is the organism is implicated in histocytic ulcerative colitis of Boxer dogs? How diagnosed and treated?

A

E. coli.
Identify organisms with fluorescent in situ hybridization (FISH).
Treat with FQ.

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19
Q

Treatment for campylobacter

A

Erythromycin, enrofloxacin, cefoxitin.

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20
Q

Breeds with congenital megaesophagus

A 
Wire-haired fox terriers 
Min SChn 
GSD
Great danes
irish setters
labs
newfies 
shar peis

Siamese cats

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21
Q

Causes of acquired Megaesophagus

A 
**MG
Addisons
Lead and thallium poisoning 
Lupus
Esophageal neoplasia 
Severe esophagitis 
Inflammatory myopathies 
Peripheral neuropathies
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22
Q

What type of food should be fed to animals with delayed gastric emptying

A

Frequent small meals that are low in fat and protein and high in carbs (cottage cheese, rice, pasta)

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23
Q

What cells store serotonin in the GI tract

A

enterochromaffin cells - secrete serotonin (5-HT) into lamina propria with overflow into portal circulation and intestinal lumen

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24
Q

What is the function of the 5-HT-1p receptors in the GIT

A

Initiates peristaltic and secretory reflexes

No drugs target this

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25
Q

What is the function of the 5-HT3 receptors in the GI tract. What drugs work here?

A

Activates extrinsic sensory nerves and is responsible for sensation of nausea and induction of vomiting from visceral hypersensitivity.

Ondansetron and granisetron are 5-HT3 receptor inhibitors.

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26
Q

What is the function of the 5-HT4 receptors in the GIT?

A

Increase pre-synaptic release of ACH and calcitonin gene-related peptide, thereby enhancing neurotransmission. This promotes propulsive peristaltic and secretory reflexes..

CIsapride is a 5-HT4 receptor agonist

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27
Q

What drugs are known to inhibit the metabolism of cisapride

A

Clarithromycin
Erythromycin
FLuconazole
Itraconazole

(metabolized by the liver by cytochrome p450)

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28
Q

MOA of reglan

A

Central dopaminergic antagonist and peripheral 5-HT3 receptor antagonist and 5-HT4 agonist.

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29
Q

What drug can be used to restore dopamine to ACH balance if adverse effects noted from raglan?

A

Diphenhydramine

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30
Q

Oral absorption of cisapride INCREASES/DECREASES with food.

A

INCREASES. Give 15 minutes before feeding.

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31
Q

What is MOA of erythromycin and clarithromycin’s effect in the GIT

A

Motilin receptor agonists. Stimulate migrating motility complies and integrate peristalsis in the GIT.

Also stimulate cholinergic and noncholinergic neuronal pathways that increase motility.

Increases gastroesophageal sphincter pressure, increases gastric emptying, accelerates colonic transit, stimulates canine but not feline colonic smooth muscle in vitro.

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32
Q

MOA of ranitidine/ nizatidine

A

Histamine H2 receptor antagonists.
Prokinetic activity due to acetylcholinesterase inhibition

Greatest activity in the proximal GIT.

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33
Q

What BUN/creatinine ratio is suggestive of GI Hemorrhage

A

> 20:1

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34
Q

What can cause a false positive result on the occult fecal blood test? What does this test measure?

A

Test detects peroxidase activity.
Diets containing red meat or with high peroxidase activity (fish, fruits, vegetables).
Peroxidase-producing bacteria in GI tract can also cause false positive result.

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35
Q

What % of feline esophagus is smooth muscle

A

Caudal 1/3.

In dogs, esophagus is entirely striated muscle

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36
Q

Where is the CRTZ and what is unique about it vs. the rest of the brain

A

Floor of the fourth ventricle- lacks intact blood-brain barrier.

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37
Q

What receptors are located in the emetic center? Where is the emetic center?

A

Medulla oblongata of the brain stem

Serotonergic (5HT1) and adrenergic (alpha2) receptors.

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38
Q

What receptors are located in the CRTZ

A 
Dopaminergic (D2)
Histaminergic (H1)
Andrenergeic (alpha2)
Serotonergic (5HT3)
Cholinergic (M1)
Neurokinergic (NK1) 
Enkephalinergic (ENK u, d)
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39
Q

What receptor does apomorphine stimulate to induce vomiting?

A

Dopaminergic receptors in CRTZ

40
Q

Differences in vestibular stimulation of vomiting in dog vs. cat?

A

In the dog, vestibular stimulation feeds directly into CRTZ before activating the emetic center, vs. the vestibular system acts directly on the emetic center in the cat.

41
Q

What receptors are located in the vestibular system to induce vomiting?

A

Histaminergic (H1)
Cholinergic (M1)
NMDA

42
Q

what receptors are located in the cerebral cortex to induce vomiting and what stimulates them?

A

Anxiety/anticipation stimulates
Benzodiazepine receptor
Enkephalinergic opioid receptor

43
Q

List at least 12 medications commonly assoc with diarrhea

A 
H2 blocker
Misoprostol
PPI
Oral antacids
Quinidine, procainamide, digoxin 
ACEI 
B-blockers
Azathioprine
Cyclophosphamide
Cyclosporine
Mitotane 
Trilostane
Methimazole
acarbose 
Amitriptyline
Parasiticides
Bethanechol
Clomipramine
Cochicine
Acetazolamide 
NSAIDS
44
Q

T/F:

Diarrhea is most common from increased peristalsis rather than decreased segmental contractions

A

FALSE.

Diarrhea typically from decreased segmental contractions

45
Q

T/F:

Anticholinergics decrease propulsive peristalsis and segmental contractions

A

TRUE.

Predispose to ileus.

46
Q

MOA of opioid-containing antidiarrheals
Decrease/Increase propulsive contractions
Decrease/increase segmental contractions

A

Decrease propulsive contractions and increase segmental contractions.

47
Q

Risk factors for leakage following intestinal anastomosis

A

pre-op peritonitis
intestinal FB
serum albumin <2.5
intraoperative hypotension

48
Q

Where do the histamine blockers specifically work in the GIT?

A

H2RAs block histamine receptor on gastric parietal cell- competitively inhibiting gastric acid secretion.

49
Q

Which of the following histamine receptor blockers have delayed absorption by food

Famotidine
Ranitidine
Cimetidine

A

Cimetidine

not ranitidine or famotidine.

50
Q

which H2RA are metabolized by liver and which excreted in urine?

A

Famotidine- excreted unchanged in urine

Ranitidine and cimetidine- metabolized by liver.

51
Q

What is cimetidine’s effect on hepatic blood flow?

A

Decreases by 20%

52
Q

MOA of PPIs

A

irreversibly inhibit hydrogen-potassium adenosine triphosphatase on the luminal side of the parietal cell, thus stopping secretion of hydrogen ions into the gastric lumen.

53
Q

Absorption of omeprazole is increased/decreased by food

A

Decreased

54
Q

MOA of sucralfate

A

Binds to epithelial cells especially at erosions and ulcers, remaining there for 6 hours. Serves as physical barrier protecting ulcer from pepsin and bile acids.
Stimulates local production of prostaglandins and binding to epidermal growth factor, which favors mucosal repair

55
Q

Adverse effects of sucralfate

A

Constipation

Adsorption of other drugs (enrofloxacin)

56
Q

MOA of misoprostol

A

Prostaglandin E1 analog
Antacid and mucosal protective properties:
Stimulates secretion of mucus and bicarbonate and increases gastric mucosal blood flow

Antisecretory effect on gastric acid, acting directly on parietal cells.

57
Q

Adverse effects of misoprostol

A

Uterine contractions, diarrhea

58
Q

SE of maropitant in young dogs and what age?

A

Bone marrow hypoplasia when given to puppies younger than 11 weeks.

59
Q

What affect do NK1 antagonists have on anesthetic drugs?

A

Reduce the MAC of sevoflurane.

60
Q

Route of elimination of raglan

A

kidneys

61
Q

What is the MOA of promazine derivative antiemetics

A

Antidopaminergic and antihistaminergic effects that block CRTZ and at higher doses the MVC.
Also have anticholinergic, antispasmodic and alpha blocking effects

62
Q

MOA and contraindications of aminopentamide

A

anticholinergic used as antiemetic.
Used with caution in patients with glaucoma, cardiomyopathy, tachyarrythmias, hypertension, MG and gastroesophageal reflux.

63
Q

Examples and MOA of cholinomimetic drugs as pro kinetic agents

A

Ranitidine and nizatidine- inhibit acetylcholinesterase.
Bethanecol - true cholinomimetic drug, binding muscarinic receptors.
Bethanecol works throughout GIT but ranitidine and nizatidine seem most effective for promoting gastric emptying

64
Q

Define intra abdominal hypertension

A

Sustained or repeated pathologic elevation of IAP more than 12 mm Hg

65
Q

Define abdominal compartment syndrome

A

Sustained increase in IAP of more than 20 mmHg that is associated with new organ dysfunction or failure

66
Q

Four risk factors for ACS

A

1- diminished abd wall compliance
2- increased intraluminal content
3- increased abdominal content
4- capillary leak syndrome

67
Q

Describe 4 grades of IAH and recommendations for treatment

A

1- IAP 12-15 mmHg - maintain normovolemia, look for underlying disease
2- IAP 16-20 mmHg- Volume resuscitation, consider decompression
3- IAP 21-25 mmHg- volume resuscitation, decompression
4- IAP >25 mmhg - decompression required

68
Q

How much fluid should be used to fill the bladder for IAP monitoring?

A

0.5-1 mL/kg, maximum of 25 mL per patient of sterile 0.9% NaCl

69
Q

How is IAP monitoring done

A

Insert urinary catheter, connect to 3 way stop-cock with syringe of saline and manometer. Fill bladder with 0.5-1 mL/kg saline. System is zeroed to the patient’s midline at symphysis pubis with the patient in lateral recumbency and the manometer filled with saline. Stopcock closed to fluid source so that meniscus in the manometer can drop and equilibrate with pressure in urinary bladder. Difference between the reading at the meniscus and the zero point is the IAP

70
Q

What is the normal IAP

A

0-5 cm H2O - dogs. 4-8 cmH2O cats

71
Q

What factors influence the IAP reading

A 
body position
body condition
pregnancy
increased abdominal wall tone- pain, anxiety
eternal pressure- belly bandages 
volume of infusate
72
Q

What is abdominal perfusion pressure

A

MAP- IAP

73
Q

What are the sites for TFAST exam

A
  • bilateral chest tube site (ribs 7-9)
  • bilateral pericardial chest site - 5-6 ICS over heart
  • sub-xyphoid view
74
Q

What are A-lines

A

horizontal lines of decreasing echogenicity in far field of image, similar and equidistant from pleural line.
These are result of reverberation artifact.
May be seen in patients with and without pneumothorax

75
Q

What are B-lines

A

A type of comet tail artifact.
These are reverberation artifacts originating from visceral pleura.
Hyperechoic vertical lines extending from pleural line to far edge of image, passing through A lines without fading.
Occasional B-line is normal but excessive B-lines or close together are indicative of interstitial-alveolar lung abnormality

76
Q

What is the lung point

A

When moving the probe from a dorsal to ventral direction in a patient with pneumothorax, the point where the glide side returns = lung point.

77
Q

What is Meissner’s plexus

A

Inner plexus lying in submucosa of GIT.

78
Q

What is the stimulus for secretion, site of secretion and action of secretin

A

stimuli: acid, fat
site: S cells of duodenum, jejunum, and ileum
Action: stimulates pepsin secretion, pancreatic bicarbonate secretion, biliary bicarbonate secretion, growth of exocrine pancreas

Inhibits gastric acid secretion

79
Q

What is the stimulus for secretion, site of secretion and action of gastrin

A

Stimuli: protein, distension, nervous control
Site: G-cells of antrum, duodenum, and jejunum
Actions- stimulates gastric acid secretion, mucosal growth

80
Q

What is the stimulus for secretion, site of secretion and action of cholecystokinin

A

Stimulus: protein, fat, acid
Site: I cells of duodenum, jejunum, ileum
Action: stimulates pancreatic enzyme secretion, pancreatic bicarb secretion, gall bladder contraction, growth of exocrine pancreas
Inhibits gastric emptying

81
Q

What is the stimulus for secretion, site of secretion and action of glucose-dependent insulinotropic peptide

A

Stimuli: protein, fat, carb
Site of secretion: K cells of duodenum and jejunum
Action: stimulates insulin release
Inhibits gastric acid secretion

82
Q

What is the stimulus for secretion, site of secretion and action of motilin

A

stimuli: fat, acid, nervous system
Site: M cells of duodenum and jejunum
Action: stimulates gastric motility, intestinal motility

83
Q

What hormonal signals are released after a meal to increase intestinal motility

A

gastrin, cholecystokinin, and insulin

84
Q

Which two hormones inhibit intestinal motility

A

secretin and glucagon

85
Q

What are the main electrolytes in saliva

A

high K and bicarb

low sodium and chloride

86
Q

What is released by pyloric glands in antrum of stomach

A

Mainly mucus but also some pepsinogen and hormone gastrin

87
Q

What do parietal cells secrete

A

hydrochloric acid as well as intrinsic factor, which is essential for absorption of vitamin B12 in the ileum.

88
Q

What does acetylcholine stimulate, compare to gastrin and histamine

A

secretion of pepsinogen by peptic (i.e., Chief) cells, hydrochloric acid by parietal cells and mucus by mucous cells

Gastrin and histamine strongly stimulate secretion of acid by parietal cells but have little effect on other cells

89
Q

At what gastric pH is gastrin secretion inhibited

A

less than 3
This is bc high acidity stimulates release of somatostatin from delta cells, which in turn suppresses gastrin secretion by G cells
AND the acid causes inhibitory nervous reflex that inhibits gastric secretion

90
Q

What three hormones stimulate pancreatic secretion

A

acetylcholine, cholecystokinin, secretin

91
Q

What are the crypts of lieberkuhn and what do they secrete

A

Lie between intestinal villi, have goblet cells, which secrete mucus and enterocytes secrete large quantities of water and electrolytes.

92
Q

What are the following disaccharides broken into?
lactose
sucrose
maltose

A

Lactose- galactose + glucose
Sucrose - fructose + glucose
Maltose- glucose

93
Q

Which glucose transporter is in the gut and causes transport of sodium with glucose into intestinal cells

A

GLUT1

94
Q

Which neuroendocrine peptides inhibit vagal and spinal afferent neurons to result in delayed gastric emptying?

A

CCK

5HT- via 5-HT3 receptors

95
Q 
Which of these increase and which decrease GI motility: 
Ach
GABA 
Substance P/Neurokinin A
NO
Serotonin
VIP 
Somatostatin
A 
Ach - increase 
GABA - decrease 
Substance P/Neurokinin A - increase 
NO - decrease 
Serotonin -increase 
VIP -decrease 
Somatostatin- decrease
96
Q

what electrolyte abnormalities have been shown to slow intestinal motility?

A

hypokalemia
hypermagnesemia
hyper- and hypo-calcemia

97
Q

Haworth JVECC 2014: Diagnostic accuracy of the SNAP and Spec cpl tests for pancreatitis in dogs presenting with c/s of acute abdominal disease.

Findings?

A

SNAP and spec cpl may provide false positive diagnosis for pancreatitis in up to 40% of dogs presenting for acute abdominal disease. Good overall agreement between tests but 4/38 dogs with positive SNAP and normal Spec.

ECC Boards - Davy (10 decks)

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