GI & Alimentary Disease p1 Flashcards
The four main function of a normal GI tract are…
- Digestion of ingredients
- Absorption of nutrients
- Move food thru GI tract
- Eliminate waste (undigested) or bi-products (bile acids, nitrogen)
Gastrointestinal tract (in order) (4)
- Mouth
- Stomach
- Intestines
- Colon
Mouth
1. Anatomy
2. Function in digestion
- Oropharynx connection of mouth to esophagus
- Digestion begins in the mouth!
- Grinding of food w/teeth
- Saliva contains amylase to digest starch in some species
Stomach
1. Anatomy
- Cardia & Pylorus:
2. Function in digestion
- Anatomy
- Cardia: region that attaches to esophagus.
- Pylorus: region that attaches to intestines. - Hydrochloric acid (HCl) further digests food
- Little absorption of nutrients here
Small intestine
1. Anatomy
2. How much digestion happens here?
- DJ Ileum!
- Duodenum, Jejunum, Ileum - Most digestion & absorption of nutrients here due to villi
Large intestine & Colon
- Absorption of water
- Empties into rectum
- Storage containers, no absorption here! - Material exits anus
Villi lines the ___ intestine to…
Lines the small intestine to maximize digestion and absorption by increasing surface area
Liver & biliary tree
1. Function
2. Role in GI tract (3)
- Function
- Functions are associated with the alimentary system - Role in GI
- Fat digestion & processing
- Nutrient storage: Fat soluble vitamins & copper/iron
- Detoxify blood from GI tract
Pancreas digestive function
Make digestive enzymes and transport to duodenum
T/F: Most chemicals of digestion are produced by the pancreas
True!
Enzymes produced by the pancreas (7)
These are the most common, there are more.
1. Amylase
2. Lipase
3. Elastase
4. Trypsin
5. Chymotrypsin
6. Carboxypeptidase
7. Phospholipase
Esophageal Disease
Clinical signs (5)
- Dysphagia - Difficulty swallowing
- Excessive salivation - “Ptalyism” This pairs w/dysphagia
- Regurgitation
- Anorexia
- Teeth grinding (cats) - Sign of pain, likely abdominal
Vomiting vs Regurgitation
Vomiting: From the stomach
Regurgitation: From the esophagus
Vomiting signs (5)
- Retching: “winding” up
- Bile tinged fluid
- Presence of digested food
- Event occurs independent of eating/drinking
- Nausea: Lip licking & Anorexia
Regurgitation (5)
- No retching
- Food or fluid “falls” out of mouth - Clear or foamy fluid
- Food not digested
- Event occurs shortly after eating or drinking (<20min)
- Event triggered by exercise or excitement
Esophagitis
1. Etiology
2. Supportive care
- Etiology:
- Gastric reflux or severe vomiting
- Caustic agent ingestion
- Foreign body ingestion - Supportive care:
- Do not induce vomiting if caustic agent!
- Sucralfate is drug of choice to treat mucosa
- Treat underlying problem ASAP
- Soft food: Liquid has low calorie content & may exacerbate reflux
Esophageal Foreign Body
1. Clinical signs
2. Etiology
3. Diagnosis
- Clinical signs:
- Hypersalivation
- Exaggerated swallowing efforts
- Anxious/painful
- Anorexia - Etiology:
- Foreign object swallowed but unable to advance to stomach - Diagnosis:
- Hx of foreign body
- Physical exam
- Rads/barium study
- Endoscopy
Esophageal Foreign body
Therapy (3)
- Endoscopic or Gastrotomy retrieval
- DVM makes every effort to avoid Sx on the esophagus due to high risk of stricture formation
- Strictures cause severe problems w/regurgitation & animal may starve! - Aggressive therapy w/sucralfate & other drugs to treat/prevent esophageal ulcers
- Sx or endoscopic placement of gastric feeding tube may be indicated
Megaesophagus is…
The development of a flaccid esophageal wall w/poor contractility. When visible on rads they may be greatly dilated w/air or food
Megaesophagus
1. Clinical signs
2. Etiology
3. Diagnosis
4. Supportive care
- Clinical signs
- Regurgitation
- Aspiration pneumonia
- Weight loss - Etiology
- Congenital, myasthenia, hypoadrenocorticism, severe esophagitis, neoplasia & idiopathic - Diagnosis
- Rads & barium study - Supportive care
- Tx primary cause
- Prevent aspiration pneumonia by hand feeding meatballs of food & maintain dog in upright position for at least 20min after meals
Gastritis
1. Clinical signs (3)
2. Etiology (3)
3. Supportive care (5)
- Clinical signs
- Vomiting, lip licking, anorexia - Etiology
- Dietary
- Infection
- Toxin
- Medication ( NSAIDS, etc) - Supportive care
- Support hydration
- NPO for 12hrs, no food 24hrs
- After, small meals w/bland diet
- Meds for symptoms
- Further eval if it doesn’t rapidly resolve
Gastric Ulceration
1. Clinical signs
2. Etiology
3. Supportive care
- Clinical signs
- Vomiting fresh/digested blood (“coffee grounds”)
- Anorexia
- Lip licking - Etiology
- NSAID meds, caustic agents, neoplasia, foreign body, Helicobacter - Supportive care
- Histamine blockers
- Comfort meds
- Tx primary cause
Gastric Dilation Volvulus (GDV)
1. Clinical signs
2. Etiology
- Clinical signs
- Weakness/collapse
- Restless/anxious
- Enalrged “bloated” abdomen
- Large breed dog (deep chested)
- “Dry vomiting” - Etiology
- Exercise after large meal is most common trigger (esp deep chested dogs).
- The volvulus of the stomach results in obstruction of the blood supply to the stomach (sometimes spleen).
- The tissue necrosis releases vast amount of toxins.
- Death is combo of shock, enterotoxins, heart arrhythmias & bleeding disorders
Gastric Dilation Volvulus (GDV)
1. Dx
2. Supportive care
- Dx
- Right lateral radiograph - Supportive care
- Shock dose of fluids
- Immediate decompression of stomach
- Pain meds
- Anti-arrhythmia drugs (patient usually develops arrhythmias post op)
- Sx correction when patient stabilized
- Other additional care as needed
Gastric Dilation Volvulus (GDV) is…
A disorder in which the stomach distends with food or air & then twists on its axis at the esophagus. Complete GDV is fatal within hours if not aggressively treated
Diarrhea
Small intestine (Enteritis) vs Large intestine (Colitis)
Small intestine
- Large vol 1-3x/day
- “Tarry” appearance or other extreme color
- Weight loss
- Change in appetite
- Borborygmi (GI sounds that are increased)
Large intestine
- Small vol freq >3x/day
- Mucous on feces (irritated colon protecting itself)
- Frank blood on feces (one stripe of blood isn’t a worry tho)
- Straining
Acute diarrhea - Enteritis or Colitis
1. Clinical signs
2. Etiology
3. Supportive care
- Clinical signs
- Small or large bowel diarrhea
- Otherwise normal
- Animals that are lethargic, vomiting, v young or old, or fever should be fully eval-ed - Etiology
- Dietary indiscretion
- Stress
- Mild virus - Supportive care
- Support hydration
- NPO for 12hrs, no food for 24hrs (“rest GI tract”)
- Then small freq meals, bland diet
- Meds for symptoms
- Further eval if doesn’t rapidly resolve
Inflammatory Bowel Disease (IBD) is…
A disease complex which is a collection of clinical signs that may have many possible causes that varies from patient to patient
Inflammatory Bowel Disease (IBD)
1. Chronic clinical signs (5)
2. Etiology: Many possible “triggers” (4)
3. Secondary problems (3)
- Chronic clinical signs
May or may not:
- Vomiting
- Diarrhea
- Weight loss
- Decreased appetite
- Borborygmi - Etiology
- Food allergies
- Infections
- Food intolerances
- Genetic - Secondary problems
- Ulcers
- Bacterial overgrowth
- Gastric reflux
Inflammatory Bowel Disease Therapy
List the 4 steps
Step 1: Diet trial
Step 2: Patient comfort
Step 3: Treat GI inflammation w/immune system modifiers
Step 4: Monitoring
IBD Therapy
Step 1: Diet Trial (5)
- Novel antigen
- Hydrolyzed protein
- Minimum 6w duration
- Calculate & confirm meeting calorie needs
- May need to feed 4x/day
- May need to feed 2x normal amount if malabsorption is present
IBD Therapy
Step 2: Patient comfort (4)
- Treat nausea
- Treat acid reflux or ulcers
- Treat inappetence
- Treat all concomitant conditions
- UTI
- EPI
- Dermatitis
- Parasites
IBD Therapy
Step 3: Treat GI inflammation with immune system modifiers (2)
- Important to taper drugs to lowest effective dose
- May be needed for rest of animals life
IBD Therapy
Step 4: Monitoring (3)
- Diary!! Have O record observations of their pet
- Weekly patient update
- Recheck exam - 2w initially, then quarterly or as needed
Infectious Intestinal Diseases:
Parasites (2)
1. Common in who?
2. Zoonosis concern?
- Common of animals <1yr, exposure to young animals or immunosuppressed.
- Zoonotic potential
Infectious Intestinal Diseases:
Bacterial (3)
1. Common in who?
2. Primary or secondary to other conditions?
3. Zoonosis concern?
- Occasional of young animals, certain breeds or immunosuppressed
- Secondary to other conditions
- Zoonotic potential
Infectious Intestinal Diseases:
Viral
Common in who?
Common in young or unvax animals
Parasitic Diarrhea
1. Clinical signs (2)
2. Dx (3)
3. Supportive care (5)
- Clinical signs
- Large or small BM
- Unthrifty, pot-belly appearance
- Hx: poor care or raw diet - Dx
- Fecal centrifugation eval
- Giardia ELISA
- Can be more than one para!! - Supportive care
- Maintain hydration
- V digestible diet (i/d or EN)
- Specific therapy for Dx parasite
- Client ed (zoonosis)
- Re-eval within 3w
Viral Diarrhea
1. Clinical signs (5)
2. Etiology (3)
- Clinical signs
- Diarrhea w/ or w/o blood
+/- Fever
+/- Vomiting
- Anorexia/depression
- Juvenile or unvax - Etiology
- Parvovirus
- Distemper virus
- Corona, etc
Viral Diarrhea
1. Dx (3)
2. Supportive care (4)
- Dx
- Fecal parvo ELISA
- Distemper titer (if unvax)
- Leukopenia (CBC) - Supportive care
- Isolation facilities (V contagious!!)
- Aggressive IV fluids & antiB (risk of sepsis)
- Comfort care (clean, nausea)
- Client ed:
Contagious for 6w
Yard contagious for 6mo
Isolation Procedures (8)
- Utilized for suspect cases of URI, Parvo, ringworm, salmonella, lepto, etc
- Separate room w/air exchange
- One-way flow thru hospital
- Bleach in-out foot bath
- All items in Iso stay! Or throw away
- Patient doesn’t step where other humans or patients walk
- Staff carrying patient must wear PPE and that must stay in the unit
- Separate supplies for each patient in Iso
Intussusception is
The “telescoping” of one bowel loop into another where it remains.
This results in GI obstruction & damaged blood supply of the intestine.
Most common in puppies w/parvo or similar GI disorder
Intussusception
1. Clinical signs
2. Supportive care
- Clinical signs
- Vomiting/diarrhea
- Abdominal pain/abdominal mass
- Depression/shock - Supportive care
- Aggressive IV fluids for shock
- Aggressive IV antiB for sepsis
- Sx emergency
