GI CVT Flashcards
Name 2 infectious diseases that are associated with Feline Caudal Stomatitis?
- Feline Herpes
- Feline Calcivirus
??Bartonella??
What is the BEST long term outcome for cats with caudal stomatitis?
Extractions (potential full mouth)
Up to 60% resolution
Name a non-traditional treatment that can be used for feline caudal stomatitis.
Coenzyme Q - Recommended in cats with residual inflammation following extarctions (anecdotal evidence only, used in humans) = Studies are needed
Name the 5 nerves that can involved with swallowing.
- Sensory and motor of trigeminal n.
- Facial n.
- Glossopharyngeal n.
- Vagus n.
- Hypoglossal n.
What are the 3 types of dysphagias?
- Oropharyngeal dysphagia
- Esophageal dysphagia
- Gastroesophageal dysphagia
What is cricopharyngeal achalasia?
Rare form of dysphagia → Inadequate relaxation of cricopharyngeal muscle § Very young animals, tx with myotomy
What are the 3 stages of oropharyngeal dysphagia?
- Oral Stage - Prehending, tranporting food to oropharynx
- Pharyngeal Stage
- Cricopharyngeal Stage - Relaxation of cricopharyngeal muscles (upper esophageal sphincter)
What neuromuscular disease should be consider in a dog with acute onset of dyphagia?
Acquired myasthenia gravis (alone or as part of generalized neuromuscular disorder)
What percentage of dogs with acquired MG has focal signs (pharyngeal, esophageal, laryngeal weakness) without limb weakness?
About 43% of dogs
What test should be performed to assess for myasthenia gravis?
Ach Receptor Antibody Titer
When would myotomy be contraindicated in animals with cricopharyngeal relaxation abnormality?
If asynchrony btwn pharyngeal constrictors and relaxation of cricopharyngeal muscle
What are common causes of oropharyngeal dysphagia in dog?
- Myasthenia Gravis
- Myositis
- Endocrine myopathies (hypoT4, hypoadrenocorticism)
In which spp is chronic esophagitis well documented?
Cats = result of hiatal hernia or lower esophageal sphincter abnormalities
What is a very common cause of esophagitis?
Anesthesia - 65% of strictures were attributed to prior anthestic event
What can occur with chronic gastroesophageal reflex?
Severe histology changes in distal esophagus (metaplasic changes) = Barrett’s esophagus in humans
What imaging modality can be used to assess for esophageal FB?
Fluoro with iodinated contrast
What can be more sensitive way to diagnose hiatal hernia?
Could see with fluoroscopy when applying pressure to abdomen
More sensitive to diagnosis with endoscopy
What is the most sensitive and specific way to diagnose esophagitis?
Endoscopy - Erythema, friability, erosions, exudative pseudomembranes
Why is the esophagus so easily damaged by gastric acid?
The mucosa has NO mucus-bicarbonate pre-epithelial barrier!!! NOT protected
Why is the esophagus so easily damaged by gastric acid?
The mucosa has NO mucus-bicarbonate pre-epithelial barrier!!! NOT protected
What are H2 blockers? Competitive inhibitors of gastric acid secretion (famotidine)
What is a proton pump inhibitor?
Noncompetitive inhibitor of gastric acid secretion (omeprazole)
How long can it take for a PPI to reach maximum effectiveness?
2-5 days
What is benefit of sucralfate?
Needs to be administer when high acid production, otherwise neutral esophagus will not allow sucralfate to function
Minimal to no benefit in humans
What are the 2 techniques commonly used to treat esophageal strictures?
Ballooning and Bougienage (similar results)
Which technique for esophageal strictures allows you to apply more force?
Bougienage
Which method is the best for esophageal strictures to minimize trauma and prevent recurrence?
Better to do several less aggressive procedures
What is the reported number of dilations needed for esophageal strictures?
2-4 dilations (can be up to 10-15)
If GER is secondary to congenital hiatal hernias what is the treatment?
Require sx, but prognosis is good
What is the reported success rate of esophageal strictures?
77-88% with stricture dilation
What are 3 classic CS associated with esophageal disease?
Regurgitation, dysphagia, ptyalism
What is a common complication of megaesophagus?
Aspiration pneumonia
Which nerves controls the upper esophageal sphincter?
Glossopharyngeal, pharyngeal , recurrent laryngeal branches of vagus n.
Explain the muscles of the canine esophagus.
Two layers of skeletal muscle (innervated by somatic branch of vagus n)
Explain the muscles of the feline esophagus.
Smooth muscle in distal 1/3 (different from dog that is all skeletal muscle)
What is different about the LES?
Physiological sphincter (rather than anatomical, no distinct muscle mass)
Name 4 factors that increase tone of LES to prevent reflux?
- Increased intragastric pressure
- Acid in Cardia
- High protein diet
- Hormones (gastrin, histamine, ACh)
What are the 2 types of contractions that occur in the esophagus?
- Primary peristalsis: In response to swallowing
2. Secondary peristalsis: In response to food in the lunen (afferent receptors)
What are the steps in primary peristalsis in the esophagus?
o Afferent vagal receptors (pharynx and proximal esophagus) stimulated by presence of food (solids more effective than liquids in stimulating swallowing reflex) → initiates efferent response via somatic nerve fibers of vagus (ends at myoneural junction) → coordinated contraction of UES and propagation of peristaltic wave aborally along esophagus through LES into stomach
In which breed is congenital megaesophagus inherited?
Wirehaired fox terrier, miniature schnauzer
Name 6 breeds that have an increased prevalence of congenital megaesophagus.
- Great Danes
- GSD
- Labs
- Newfoundlands
- Shar Peis
- Irish Setter
Up to what age can congenital megaesophagus be seen?
Normally CS by 3 months, but can be as long as 1 year
Which 4 breeds are at increased risk of acquired megaesophagus?
- GSD
- Goldens
- Irish Setters
- Great Danes
What is acquired megaesophagus?
· Caused by any disorder that inhibits esophageal peristalsis either by disrupting esophageal neural pathways or by causing esophageal muscular dysfunction
What is the most common cause of acquired megaesophagus in dogs?
Myasthenia Gravis
What is the pathogenesis of myasthesia gravis?
§ Acquired auto-immune dz: Interferes with neuromuscular transmission, production of autoantibodies against nicotinic ACh receptors →Decreased receptors = skeletal muscle weakness
What are the 2 forms of myasthenia gravis?
- Generalized (exercise-related generalized muscle weakness, worsens with exercise)
- Focal (muscle weakness affecting esophagus, pharyngeal, facial muscles
What is the diagnostic test for myasthenia gravis?
Increased antibody titer to ACh receptors
Can you have seronegative animals that have myasthenia gravis?
Yes, estimated to be about 2% of generalized MG are seronegative, unknown in focal MG
How does hypoadrenocorticism result in megaesophagus?
Impaired muscle carbohydrate metabolism and depletion of muscle glycogen from glucocoricoid deficiency and decreased catecholamine activity
Is hypothyroidism proven with megaesophagus?
NOT proven! 1 case that improved with supplementation of Thyroid meds
Consider that both diseases are immune mediated - association?
What is dysautonomia?
Idiopathic condition - Failure of sympathetic and parasympathetic NS = Motility issues
Mydriasis with absent PLRs, decreased tear production, dry mucous membranes
What percentage of dogs with dysautonomia had megaesophagus?
In one paper about 60%
What disease affects the vagus n. and is though to be a risk factor for acquired megaesophagus?
Laryngeal paralysis
What is the classic signalment for idiopathic megaesophagus?
· Spontaneously, large breed dogs (5-12 yrs), no sex or breed predisposition
· Majority of adult dogs are diagnosed with idiopathic megaesophagus
Name 3 types of imaging that can be performed to assess for megaesophagus?
- Fluoroscopy
- Manometric
- Scintigraphic
When a dog has megaesophagus why would you want to perform a fecal examination?
To assess for Spirocerca lupi
What diagnostic should be performed if ACh receptor antobody test is negative?
Submit muscle bx for immunocytocehmical staining (less specific for MG but highly suggestive for seronegative myasthenics)
What test can be performed if you are concerned about dysautonomia?
If affected: Miosis in response to ocular pilocarpine, no change in HR with atropine, no flare with intradermal histamine
What is the treatment of choice for MG?
Long-acting anticholinesterase drugs (pyridostigmine, neostigmine)
Improves CS and decreased ACh receptor antibody concentratuon
What percentage of MG has clinical and immunological remission with anticholinesterase drugs alone?
About 89%
Name 2 other treatments for MG?
Immunosuppression (steroids, azathioprine)
Plasmapheresis - filtration of plasma to eliminate circulating antibodies
What is the MOA of prokinetic drugs like metoclopramide and cisapride?
Increased motility by bindings to 5-HT4 (serotonin) receptors on enetric cholinergic neurons
What is the estimated recovery rate of congenital megaesophagus and which breed has it been reported in?
About 20-46%
Miniature schnauzers acquire improved or normal esophageal function by 6 -12 months of age
Which bone disorder has been seen in humans with achalasia?
Hypertrophic osteoarthropathy (seen in 1 GSD)
What is the relationship btwn spiral bacteria and chronic gastritis in dogs/cats?
· Direct causal relationship btwn spiral bacteria and chronic gastritis/vomiting has NOT been firmly established (dogs/cats)
What type of bacteria is Helicobacter?
Gram Negative
What enzyme does Helicobacter spp have lots of?
Urease (production of ammonia and bicarbonate when in contact with urea)
Alters pH surrounding bacteria and helps to colonize in acidic environment
What is different about the Helicobacter in cats/dogs?
Larger - Helicobacter heilmannii o Helicobacter felis, Helicobacter bizzozeronii, and Helicobacter salomonis (NOT H. pylori)
Name a diagnostic that can be performed on a sample from gastric brush cytology?
Rapid urease test - detects presence of bacteria urease (produced by Helicobacteria spp) - CLOtest (gel with urea and pH indicator (phenol red) - Bacteria will hydrolyze urea to ammonia with change pH of gels leading to a color change from yellow to magenta
What is the treatment of choice for Helicobacter spp?
· Triple Therapy: Amoxicillin, metronidazole, bismuth subsalicylate (Pepto Bismol) or dual tx with clarithromycin and amoxicillin = q12hrs for 2 weeks; quadruple therapy (adding on famotidine)
What is the eradication rates with triple therapy for Helicobacter spp?
o Eradication rates: 70% and 78.5% 4 wks after triple and quadruple tx; at 6 months 44.4% and 41.7%; 8 dogs were negative at 4 wks and positive at 6 months (Leib, Duncan, and Ward, 2007)
What percentage of dogs/cats with chronic gastritis and Helicobacter spp will improve with treatment?
About 50%
What are the 3 main secretagogues to stimulate acid production in parietal cells? acetylcholine (M3), gastrin (CCKB) and/or histamine (H2) receptors on basolateral membrane via secondary messengers
What are the 3 main secretagogues to stimulate acid production in parietal cells?
acetylcholine (M3), gastrin (CCKB) and/or histamine (H2) receptors on basolateral membrane via secondary messengers
What are the 3 lines of defense against injury from acid/pepsin?
- Pre-epithelial - Mucus and bicarbonate barrier
- Epithelial - Barrier function of apical plasma membrane, intrinsic cell defense
- Subepithelial - Blood flow mediated removal of back diffused H+ and supply of energy
How do prostaglandins play a KEY role in protecting gastric mucosa against injury?
§ Inhibition of acid secretion and enhancement of mucosal resistance to injury by mechanisms independent of acid secretion inhibitor called cytoprotection
How do NSAIDs result in mucosal injury?
Impairing prostanglandin-dependent mucosal protective mechanisms by nonselective inhibitor of 2 isoforms of cyclooxygenase (COX) = COX-1 and COX-2
Cox-1 inhibitor can lead to reduced bicarbonate levels
Direct topical effect of NSAID on gastric mucosa
What steroid has the most ulcerogenic property?
Dexamethasone
What is the diagnostic test of choice for gastric ulcers?
Gastroscopy
How does sucralfate work?
Suiplhated disaccharide-aluminium hydroxide complex that adheres to ulcerate tissue and provide barrier to acid and pepsin penetration
Effective at acidic to neutral pH
What type of gastric acid suppressor results in suppression from hsitamine, acetylcholine, and gastrin induced gastric acid secretion?
PPIs (inhibit that final step in acid secretion = gastric pump)
What is another treatment for gastric ulcerations that is not indicated if an ucler is already present?
· Misoprostol – Synthetic prostaglandin analog
o Similar to endogenous prostaglandins (stimulation of mucus secretion, increase bicarbonate secretion, gastric mucosal blood flow, reduced acid secretion)
What is soraprazan?
K+ competitive acid blocker - Blocks action of H/K ATPase by competing with K+
What are the 2 most common types of inflammation in IBD?
Lymphoplasmocytic and eosinophilic
What is a very rare type of inflammation in IBD?
Neutrophilic
In what breed is PLE and PLN complex most common?
Soft-coated wheaten terriers
In what breed is immunoproliferative enteropathy common?
Basenjis
In what breed is IBD common?
Norwegian Lundehunds
In what breed is histocytoc ulcerative colitis common?
Boxer
Which disease is enrofloxacin responsive and why?
Histiocytic ulcerative colitis of Boxer
Selective intramucosal colonization of E. coli strains that are adherent and invasive phenotype
What is the suggested pathogenesis of IBD?
• Reportedly has immune-mediated pathogenesis à intestinal mucosa has barrier function (immune exclusion) and controls exposure of antigens à IBD develops when normal decision-making process of what to be tolerant of and what to react to breaks down
• Genetic factors thought to play a role as well
○ End effect of tolerance breakdown is uncontrolled inflammation
What may be a more sensitive marker of early disease in PLE than albumin?
Fecal a1-proteinase inhibitor
What does cobalamin deficiency alter the doctor to?
Intestinal malabsoprtion (it is not specific for a particualr GI disease)
How useful is measurement of intestinal wall thickness in the diagnosis of IBD?
Not useful! In the future we may consider use of doppler to investigate intestinal diseases
What is essential to prove the presence of intestinal inflammation and confirm diagnosis of IBD?
Intestinal bx
What is a marker with potential use in IBD and has been suggested to correlate with cases that respond to dietary therapy rather than steroids?
Mucosal perinuclear antineutrophilic cytoplasmic antibody (pANCA) - When high pretreatment expression it correlated with cases that responded to dietary therapy rather than steroids
What marker has been shown to correlated with patients that failed to response to steroids?
Lamina propria lymphocyte P0glycoprotein expression = transmembrane protein that is drug-efflux pump in intestinal epithelium
High values = poor response to steroids; Low levels = good response to steroids
Name 2 markers for IBD that would require repeat endoscopy in order to monitor case.
Mucosal perinuclear antineutrophilic cytoplasmic antibody (pANCA) and lamina propria lymphocyte P-glycoprotein expression
What are the 4 main treatments given if being used a diagnostic for IBD?
○ Anthelmintic/Antiparasitic (Fenbendazole, 50 mg/kg PO q3-5 days)
○ Dietary Modification: Antigen-limiting or hydrolyzed protein diet for 3-4 weeks
○ Antibacterial trial: Tylosin 10 mg/kg PO q8hrs OR metronidazole 10 mg/k PO q12hrs for 3-4 weeks
○ Immunosuppressive trial: Prednisolone 1 mg/kg q12hrs PO
What can be used to monitor IBD in dogs?
Canine IBD Activity index (CIBDAI)
Increased value when increase in severity of GI signs but does NOT confirm diagnosis of IBD
Which breed is known to have gluten intolerance?
Irish Setter
What is a hydrolyzed protein diet?
Native chicken or soy protein has undergone chemical or enzymatic treatment - Low molecular weight protein derivatives
Name a low solubility fiber and how it works.
Cellulose - Increasing bulk in intestine, binding nonabsorbed fluid, helping regulate intesta
Name a high solubility fiber and how it works.
Beet pulp, pectins (carrots/fruit), gumlike fiber: Easily be fermented by intestinal bacteria, SCFA (butyric acid) that can be used by colonic mucosa
Why is budesonide good for IBD?
Glucocorticoid that has high first pass metabolism, still suppresses HPA axis and can induce steroid hepatopathy
What is the prognosis with IBD?
Only 26% completely resolved, intermittent signs in about 50%, 4% completely uncontrolled, 13% euthanized because of poor response
What is the main negative prognostic sign in IBD patients?
Hypoalbuminemia
What type of antibiotic is tylosin?
Macrolide, Bacteriostatic
Good for Gram+ and Gram - cocci, gram + rods, Mycoplasma
Which bacteria are intrinsically tylosin resistant?
E. coli and Salmonella spp
What the normal amount of time that it takes for an animal to respond to tylosin?
Normally animals respond in 3-5 days
How are Trichomonads transmitted?
NOT form cysts! Reproduce by binary fission, transmitted directly from host to host in form of trophozoites
Why are antibiotics justified in IBD?
Bacterial antigens are thought to drive the pathogenetic pathway
What is a protozoal cause of chronic diarrhea in cats?
Tritrichomonas foetus - colonized distal ileum and colon (LP and neutrophilic inflammation)
What are the classic CS of T. foetus in cats?
Large bowel diarrhea +/- fresh blood or mucus (semiformed, malodorous,
What disease should cats diagnosed with Giardia spp on fecal smear that fail to respond to antimicrobials be tested for?
T. foetus
Name 4 ways that T. foetus can be diagnosed in cats?
- Direct fecal smear
- Selective protozoal culture
- PCR
- Seen on colonic bx
What is the key microscopic difference btwn trichomonads and Giardia spp?
Giardia spp = Falling leaf motility
Trichomonads = Undulating membrane
What is the sensitivity of a direct fecal smear for evaluation of T. foetus?
LOW!! 2% in experimentally infected and about 14% in spontaneous disease
Do + In Pouch TF culture preclude the possibility of coinfection with P.hominis or Giardia spp?
No! Although these 2 organisms cannot survive in the pouch longer than 24 hours - you could have a co-infection.
Why is it imperative to get multiple bx of colon if you are trying to find T. foetus?
They can occur in multiple clusters. Need a minimum of 6 bx to get 95% or > confidence that trichomonads will be identified
Name several coexisting infectious diseases that can occur with T. foetus?
Cryptosporidiosis, Giardia spp, parasites
What percentage of cats will have spontaneous resolution of diarrhea within 2 years of T. foetus infection?
About 88%, but 57% remained infected when tested 2-5 yrs later!
What is the recommended treatment for T. foetus and what is a potential side effect?
Ronidazole - Neurotoxicity (common)
What are several reasons that PLE can develop.
Loss of mucosal barrier function = increased permeability
Malfunction or abnormalities of intestinal lymphatic drainage
In which spp is PLE more common in?
Dogs
Name several diseases that can result in PLE.
Tons of things cause PLE: intestinal lymphangiectasia, inflammatory disorders, GI ulceration, GI neoplasia, intestinal fungal or parasitic infection (histoplasmosis, pytiosis, trichuriasis, ancyclostomiasis), foreign bodies, chronic intussusceptions, acute or chronic viral or bacterial infections, immune-mediated and allergic diseases (SLE), constrictive pericarditis, right-sided heart failure, hypoadrenocorticism
What is considered to be the most common disorder associated with PLE?
Intestinal Lymphangiectasia
Name the 2 forms of intestinal lymphangiectasia.
○ Primary – congenital disease where lymphatic vessels are insufficient or malformed
§ Poor lymphatic flow and drainage, may also have systemic lymphatic abnormalities
§ Rare in dog and cat
○ Secondary – obstruction to lymphatic flow in lymphatic system or due to venous hypertension
§ Increased pressure in lymphatic vessels = dilation of lacteals = leakage of lymph into the intestine
§ Leakage of chylomicrons, proteins and lymphocytes
§ Underlying disease may also limit resorptive capacity for the injured GI
§ May see lipogranulomas around lymphatics in inflammatory disorders
What is the most common form of IBD (diffuce infiltration of cells into lamina propria of intestinal mucosa?
Lymphoplasmocytic
Which breed has PLE that is associated with hypoalbuminemia and hyperglobulinemia?
Basenjis
Which breeds have PLE that are predisposed to LP enteritis?
Basenjis, SCWT, Lundehunds
What is the hallmark chem changes with PLE?
Low albumin and globulins (PLE is non-selective)
Although PLE normally results in low albumin and globulins, which two diseases are the exception?
- Intestinal histoplasmosis
- PLE of Baenjis
= HYPERglobulinemia
What is the purpose of Sudan staining of feces?
Detect steatorrhea = malassimilation of fat
What is the purpose of oral D-xylose?
Assess carbohydrate malabsorption
What test can be performed to quantify protein loss in feces? Why can it be used?
○ Fecal alpha-1 proteinase inhibitor – used to quantify protein loss in feces
§ Has molecular weight similar to albumin but unlike albumin is not broken down in the feces after it’s leaked out
§ Valuable for diagnosis and treatment
§ Needs to be performed on 3 samples, freshly voided (NOT with loops)
What is important to consider in a diet for intestinal lymphangiectasia?
○ Diet low in TGs and LCFAs (require lymphatics for transport into circulation)
§ SCTGs transported directly into portal system
§ Medium chain triglycerides (MCT) - Does not provide essential fatty acids, may not be absorbed directly, may need normal lymphatic flow = CONTROVERSIAL!
How does the colon play a role in digestion and metabolism?
Colonic bacteria ferment undigested carbs from dietary fibers
What is the most common form of colitis in dogs and cats?
Lymphoplasmocytic
What is different about granulomatous colitis compared to histiocytic colitis?
Macrophages are NOT periodic acid-Schiff + in granulomatous colitis
In which 2 breeds should T. foetus be considered if large bowel diarrhea is present?
Abyssinians and Bengals
What are the two main components of sulfasalazine?
○ Good large intestinal absorption, metabolized by colonic and cecal bacteria
§ Mesalamine acts locally to reduce inflammation
§ Sulfapyridine is systemically absorbed and blamed for side effects of the drug
○ Side-effects – vomiting, KCS
Why is sulfasalazine not used in cats?
Not use in cats – very long T ½ due to reliance on glucuronyl transferase for liver metabolism
What are the 3 things that are recommended for treatment of chronic colitis in cats?
Steroids, metronidazole, and dietary change
Why is tylosin good for colitis?
macrolide antibiotic that interferes with bacterial adhesion to mucosa and has immune-modulating effects
What does PAS stand for?
Periodic acid-Schiff
What is the thought about macrophages in ulcerative colitis being PAS +?
PAS+ may be due to defective phagocytosis and accumulation of bacterial cell wall glycoprotein
What is an uncommon type of IBD that is found in Boxer dogs < 4 yrs old?
Granulomatous colitis (also seen in French bulldogs)
What is a unique and pathognomonic feature of granulomatous colitis in dogs?
Marcophages are PAS +
What is FISH and how is it used?
Fluorescence in situ hybridization (FISH) - Fluorescent molecules attaches to oligonucleotide probes that hybridize to bacterial 16S ribosomal DNA (rDNA) - Enables clear visualization of bacterial morphology and spatial localization
What is thought to be the causative agent of granulomatous colitis?
Adherent and invasive E. coli
What is a candidate gene that has been identifies in granulomatous colitis in boxers?
NCF2 (gene associated with CGD in humans) - related to neutrophil function (respiratory burst)
What is the suspected enrofloxacin resistance that is seen in granulomatous colitis cases?
About 43% - Need to culture all colonic bx that are being submitted for FISH
What other antibiotics can be considered for granulomatous colitis if resistant to enrofloxacin?
Need to penetrate macrophages - Chloramphenicol, TMS, tetracyclines, clarithromycin
What is a major concern about treating with enrofloxacin for granulomatous colitis empirically?
Has been associated with isolation of resistance E. coli esp if inadequate duration of treatment - Need to treat for at least 6 wks
Name several diseases that have been associated with flatulence.
EPI, IBD, SIBO, wheat-sensitive entropathy, food sensitivity, lymphangiectasia
Which carbohydrate is thought to reduce flatuence?
Rice
What are the major gases in the intestine?
Nitrogen, oxygen, hydrogen, carbon dioxide, methane
What is a carminitive?
Used to relieve flatulence
activated charcoal, bismuth subsalicylate, alpha-galactosidase, pancreatic enzyme supplements, probiotic
What are the 4 primary sources of gas in the intestines?
○ Aerophagia (O2 and N2)
§ This contributes the most!
○ Gastric acid interacting with food, saliva or pancreatic HCO3- (CO2)
○ Diffusion from blood (CO2, O2, N2)
○ Large amount of gas comes from bacterial fermentation in the colon
§ Foods with large amounts of oligosaccharides produce gas
§ High fiber and fructose diets also create gas
§ Foods with sulfates are converted by sulfate reducing bacteria to H2S and others
§ High protein foods may also contribute
What are the 3 components of innervation to the anus?
○ PSNS – controls defecation (contraction of rectum, relaxation of internal anal sphincter)
○ SNS – control storage of feces (relaxation of rectum, contraction of internal anal sphincter)
○ Pudendal n. – striated muscle of external anal sphincter
What is atresia ani?
congenital anal agenesis - grave prognosis ○ May develop recto-vaginal, recto-urethral or recto-vestibular fistulae
What neoplasia is malignant, locally aggressive, and can result in PU/PD in patients (hypercalcemia)?
Adenocarcinoma of Apocrine Gland of Anal Sac
Most have mets at diagnosis (sublumbar LNs)
What chemo options are available for adenocarcinoma of Apocrine Gland of the Anal Sac?
Melphalan and mitoxantrone - Need to also be sx and radiation
What is the most common perianal tumor?
Perianal adenoma - Most commonly seen in intact males (growth is hormone mediated) - Sx and castration = excellent prognosis
What is anal furunculosis?
perianal fistula disease ○ Progressive inflammatory condition with perianal ulceration and sinus tract formation
○ GSD predisposed, also described in Labs, Irish setters, OESD and collies
○ Etiology not known – contributing factors include breed specific anatomy, infectious agents and endocrine or hormonal influences
What is the recommended treatment for perianal fistula disease and what is the rate of recurrence in these patients?
Cyclosporine
Recurrence 30-50%
What is the classic signalment for perineal hernia?
Older, intact male dogs, esp brachycpehalics (though to be related to relaxin secreted by prostate that results in weakening of pelvic diaphragm
Which cat breed is predisposed to rectal prolapse?
Manx cats
What portion of the exocrine pancreas must be lost to get EPI CS?
Need to have lost about 90%
Name 4 causes of EPI in dogs.
pancreatic acinar atrophy, chronic pancreatitis, pancreatic hypoplasia, pancreatic neoplasia