GI disease Flashcards
1
Q
How are GI disease classified
A
Anatomical location
Functional vs mechanical
Congenital vs acquired
Inflammatory vs non-inflammatory
Infectious vs non-infectious
2
Q
Describe functional vs mechanical classifications of GI disease
A
Functional: increased or decreased motility, altered digestion, altered absorption
Mechanical: intestinal accidents, foreign bodies, choke, fistulas
3
Q
What is halitosis
A
Bad breath
May be due to underlying causes including periodontal disease, infections, neoplasia, uremic or ketotic breath, megaesophagus, tissue necrosis, tumours, ulcerations etc
4
Q
What is dysphagia
A
Difficulty eating or swallowing
Food drops from the mouth before reaching the esophagus.
Oral pain, masses, neurological issues (rabies), can’t open mouth, etc
5
Q
Signs of oral disease
A
Drooling excessively Pawing at face Can’t close or open mouth Malocclusion Bleeding from oral cavity Bad breath
6
Q
What are some examples of oral trauma
A
Wounds Fractures Punctures Dislocations Burns Malalignment Burns (electrical cords) Trauma from chewing on hard objects
7
Q
What are the signs of oral trauma
A
Hungry but reluctant to eat Pawing at mouth Decreased grooming Drooling Halitosis Swelling Bleeding Can’t close mouth Malocclusion
8
Q
What is malocclusion
A
Abnormal alignment of teeth when the upper and lower teeth fit together, normally they are offset slightly (small over bite is normal)
9
Q
True or false
Oral masses are relatively common in dogs and cats
A
True
10
Q
Most oral masses especially in cats are
A
Aggressive tumours
11
Q
Common masses include
A
Squamous cell carcinoma oral melanomas fibrosarcomas Oral papilloma Oral epulis Dentigerous cyst
12
Q
What are oral papillomas
A
Most common in young dogs
Caused by canine papilloma virus
Highly contagious
Frondular masses that appear on the lips, tongue and oral mucus membranes
Normally heal on their own unless interference is necessary
13
Q
What is an oral epulis
A
Pink fleshy mass usually located near a tooth, emerging from a periodontal ligament
14
Q
What are dentigerous cysts
A
Firm masses as a result of impacted teeth
When an adult tooth does not erupt through oral gingiva, it may develop into this cyst
Destructive to surrounding bone
15
Q
What is stomatitis
A
Inflammation of the oral cavity
Extremely painful
Causes: trauma, uremia, periodontal disease, autoimmune disease, infection (FeLV, FIV, calicivirus)
16
Q
What is an oronasal fistula and what are some causes
A
When there is communication between the oral and nasal cavities
Can be congenital (cleft palates) Or
Acquired due to trauma, base narrow lower canine teeth (malocclusions), periodontal disease or iatrogenic from extractions,
17
Q
Describe when a mandibular canine tooth is base narrow
A
They are occluding into the hard palate of the mouth instead of sitting in between the maxillary canine and incisors
Over time, the repeated impaction creates a fistula right through the hard palate into the nasal cavity
Can be from baby tooth still being present
18
Q
What are some clinical signs and complications of oronasal fistulas
A
Can be asymptomatic
A tooth root abscess causing a oronasal fistula could lead to rhinitis
Pain
Very prone to aspiration pneumonia
19
Q
How are oronasal fistulas treated
A
Surgical repair
Acrylic molds made to move teeth
20
Q
What are cleft palates
A
Congenital condition either due to secondary teratogenic process or inherited condition.
The lip and soft and hard palates may all be affected
Affects all species
Cleft palate creates an opening between the oral and nasal cavities (no separation between the two
Causes: brachycephalic breeds, folate deficiency, teratogens
21
Q
What are the clinical signs of cleft palates
A
Milk dripping from the nose when suckling
Won’t gain weight as their litter mates are
22
Q
Treatment of cleft palates
A
Stomach tubing to prevent aspiration pneumonia and ensure caloric intake
Surgical correction
23
Q
True or false
Animals with cleft palates can be bred and probably won’t pass on condition
A
FALSE
They should not be bred
24
Q
Regurgitation is a ____ process
Vomiting is a ___ process
A
Regurgitation is a passive process
Vomiting is an active process
25
Are there prodromal signs to vomiting or regurgitation
Vomiting
26
Are there abdominal contractions with vomiting or regurgitation
Vomiting
27
Is there bile present with vomiting or regurgitation
Never with regurgitation but may be present with vomiting
28
Is there closure of the epiglottis with vomiting or regurgitation
There is with vomiting, not with regurgitation
29
Why is it significant that there is not closure of the glottis with regurgitation
Higher risk of aspiration with an open glottis
30
What are prodromal signs
What are the prodromal signs of vomiting
Signs that occur prior to something happening
Drooling, licking lips, yawning, restlessness, vocalization, abdominal contractions
31
Why might regurgitation be happening
Obstruction in the esophagus preventing flow
Decreased esophageal motility (can cause Diaphragmatic hernia of the stomach)
Megaesophagus (congenital or acquired)
Foreign bodies (choke in horses)
Gastric dilatation and volvulus)
Esophageal structures, abnormalities, twisting of the stomach can all prevent material from moving into the stomach
32
What is the treatment of regurgitation
Depends on underlying cause
Surgical correction
feeding in upright position with megaesophagus and maintain for 10-15 minutes (Bailey chairs)
Canned food meatballs
33
What are some of the many underlying causes of vomiting
Primary GI problems (infections, obstructions, dietary intolerances) or problems occurring elsewhere such as renal or liver disease, pancreatitis, foreign bodies, inflammation, neoplasia, parasites, toxicities, medications
34
What are some animals that do not vomit
Horses, ruminants some exotics
35
True or false
| Cats don’t easily vomit
False
| There are very very prone to vomiting
36
What are some tests useful for determining cause of vomiting
Radiographs
Ultrasound
Bloodwork
Diet trials
37
What is hematemesis
Vomiting up blood
38
What is the treatment of vomiting
Depends on cause
```
Fluid therapy
Anti-emetics
Pain control
Probiotics or special diets
Surgery
Medication
Treat underlying problem
```
39
What does it mean if the animal is vomiting black blood vs frank red blood
Black: bleeding in the stomach or intestines
Frank: bleeding in the esophagus
40
What is acute abdomen
Severe abdominal pain (like colic in horses)
Fast onset
Vomiting may be present
41
What is more likely with really severe abdominal pain
The more severe the pain the worse the prognosis and more likely surgery is needed
42
What are some causes of acute abdomen
```
Enteritis
Foreign body/impaction
GI torsion
Perforating ulcers
Peritonitis
Urolithiasis
Pyometria
Liver disease
Pancreatitis
```
43
Pain perception in the abdomen is different than on the surface of the body. Pain is perceived with
```
Distension or spasm of the GI tract
Traction
Torsion
Inflammation of the GIT or peritoneum
Vascular compromise
```
44
Diagnostics for acute abdomen
Full history and physical exam
Radiographs or ultrasound
Bloodwork
45
Treatment of acute abdomen
Medical vs surgical management
```
Pain control
Circulatory control
Medications
Dietary changes
Stool softening agents
```
46
What are some stool softening agents used
Magnesium sulphate orally
Mineral oil orally
Oral or IV fluids
47
What is peritonitis
| What can it be caused by
Inflammation of the lining/peritoneum of the abdominal cavity
May be due to an infectious or non infectious cause
Virus or bacteria localized in the peritoneum and other membranes causing inflammation
Perforating ulcer, deviated gut, organ rupture, egg yolk peritonitis in birds, pancreatitis or iatrogenic
48
What are some clinical signs of peritonitis
```
Abdominal pain
Reluctance to move
Abdominal distension
Fever
Anorexia
Depression
Increased HR
Decreased motility
Fluid accumulation
```
49
Why is peritonitis/abdominal pain hard to differentiate from back pain
Because of the method/technique of palpating to abdomen, also puts stress/pressure on the back
50
What is ileus (paralytic ileus)
Temporary cessation of peristalsis of the intestines
May be from abdominal surgery (iatrogenic), handling of the GIT, peritonitis, electrolyte imbalances (low K or Ca) or from opioids
51
What are clinical signs of paralytic ileus
```
Anorexia
Vomiting
No intestinal sounds on auscultation
Nausea
Abdominal distension/discomfort
Little/no feces produced
Swollen incision sites
```
52
What is the most common signalment observed by RVTs associated with paralytic ileus
Post operative patients
53
describe intestinal stasis in rabbits
Happens in monogastrics and hind gut fermenters
Fibrous diets needed to promote gut motility
Obstructions can occur if motility is disrupted (inappropriate diet ( high carbs low fiber), dehydration, stress, pain)
54
What is the treatment of paralytic ileus
Nasogastric tube +/- suction to relieve fluid build up
IV fluids
K+ supplements
pain control
55
What is acute gastritis or gastroenteritis
Inflammation of the stomach and/or the small intestine
56
What are some causes of gastritis/gastroenteritis
```
Dietary indiscretion
Sudden diet changes
Infections (bacterial/viral/fungal)
Toxins
Ingestion of foreign material
Parasites
Medications
```
57
Signs of gastroenteritis
Anorexia
Nausea
Vomiting
Decreased appetite
+/- diarrhea, abdominal pain, dehydration
58
What is the treatment of gastroenteritis
```
Bland diets
Small frequent meals
Antiemetics/Antacids/gastroprotectants
Fluid support
Meds to target parasites or antibiotics
```
59
What is a gastric ulcer
Can be superficial or deep
Occurs when the submucosa is exposed to stomach acid
Risk factors: NSAIDs, finely ground feed pellet sizes (pigs), stressed, intense exercise
Common in pigs and horses
60
Clinical signs of gastric ulcers
Can be subclinical or can lead to death
```
Bruxism (grinding teeth)
Ptyalism (drooling)
Decreased appetite
Melena (digested blood in stool)
Hematemesis
Abdominal discomfort
Septicemia
```
61
Treatment of gastric ulcers
Antacids
Gastroprotectants
Discontinue meds contributing to ulcers (NSAIDs, steroids)
Aggressive therapy for perforation of ulcers
62
What can intestinal obstructions be from
Foreign material
Masses (neoplasia, abscess, granuloma)
Accidents (sudden change in structure of intestine) (intussusception, mesenteric torsion, incarcerations, GDV) when the SI twists upon itself
All prevent forward movement of ingesta and compromises blood flow
Often need surgical repair FAST or it can become necrotic
63
What are the clinical signs of intestinal accidents
Very painful
Vascular compromise and damage
Shock
Death
Treatment is often euthanasia or surgery (with foreign bodies treatment is medical management or surgery)
64
What is mesenteric torsion
When a section of the small intestine twists around itself. Inflow and outflow of ingesta and blood flow to the area are cut off.
Prognosis is very poor, often ends in euthanasia or surgery
Very painful
Will see a swollen, distended SI
65
What are incarcerations
Occurs when a section of the GIT gets trapped within a structure in the abdomen. Intestine May protrude through a hernia in the abdominal wall or diaphragm, fill with ingesta and then not be able to move back out to its normal position.
Can lead to necrosis
66
What is intussusception
When a portion of the intestine folds into the adjacent lumen telescoping upon itself (folds inward like rolling a sock)
Often secondary to hypermotility, infections or neoplasia
67
What is gastric dilatation and volvulus (GDV)
When the stomach becomes enlarged due to presence of gas, fluid or ingesta and twists upon itself
Most common in deep cheated dogs
Surgical emergency
Blood flow to the stomach is compromised and can cause necrosis
Decreased blood flow from the caudal body back to the heart leading hypovolemic shock
Compression in the chest will decrease breathing
68
Digestion and absorption of nutrients primarily occur in the
Small intestine
69
Bile and pancreatic enzymes enter the gut at the proximal
Duodenum
70
The small intestine is lined with ___ to increase surface area and increase absorption
Villi that are covered in microvilli
71
The absorption of fluids occurs in the ___ and to a lesser extent the ___
Mainly in the large intestine
To a lesser extent in the small intestine
72
True or false
| Diarrhea is a clinical sign, not a diagnosis
True
73
What is diarrhea
Can be peracute to chronic
Many different causes and types of diarrhea
74
Describe secretory diarrhea
usually from bacteria or viral infections, pathogens secrete a toxin that stimulates epithelial cells to secrete excessive fluids and electrolytes into the lumen
75
Describe malabsorptive diarrhea
The gut is not able to absorb nutrients or fluids as normal. This is often due to villous atrophy and fusion of the villi which decreases surface area and absorption.
This can lead to osmotic diarrhea causing fluids to be drawn into the gut lumen
Can often be from viral infections
76
Describe inflammatory diarrhea
Often due to infectious origin
Damage occurs to the villi and crypts. This affects vascular and lymphatic drainage and leads to the loss of water, electrolytes and bicarbonate into the lumen
77
What are some causes of diarrhea
```
Bacterial/viral/parasitic infections
Dietary indiscretion
Immune mediated
Inflammation
Neoplasia
Toxins/irritants
Medications
```
Secondary to medical conditions (Addison’s disease, exocrine pancreatic insufficiency (EPI), liver disease, heart failure)
78
Describe the chronicity of diarrhea and give an example of each
Peracute: clostridium perfringens in lambs and calves -necrotizing toxins, death occurs in a few hours
Acute: parvoviral infections in puppies
Chronic: EPI, inflammatory bowel disease (IBD)
79
True or false
| There may be more than one type of diarrhea occurring at once
True
80
Describe small bowel diarrhea
Large amounts of diarrhea
Infrequent
Weight loss (since nutrient absorption occurs in small intestine)
Melena (digested blood in stool)
81
Describe large bowel diarrhea
```
Small amounts of diarrhea
Frequently
Frank blood (hematochezia) or mucus
Urgency to defecate often
Straining
```
82
Diagnostics for diarrhea
```
Full history and physical exam
Fecal flotation
Fecal SNAP tests
Fecal cultures
Bloodwork
Necropsy
```
83
What is the treatment for diarrhea
```
Treat dehydration and ongoing losses
Toxin absorbers
Treat underlying causes
Parasiticides
Correct acid-base disorders
Bland diets
Antibiotics
Environmental management
Treat underlying cause
Vaccination
Fluid support
```
84
How do you prevent diarrhea
Isolation of sick animals
Environmental decontamination
Vaccination
85
What is constipation
When an animal is having difficulty having a bowel movement
86
What is obstipation
An animal is not able to pass feces
87
What are some causes of constipation
Dehydration (often secondary to chronic renal failure in cats)
Due to reduced peristalsis (decreases feed intake, electrolyte imbalances, drugs like opioids, foreign materials, lack of fiber in diet which stimulates motility when it builds up feces)
Pelvic abnormalities (may be from trauma)
Neoplasia
Megacolon in cats
88
Treatment of constipation
Laxatives (stool softeners, bowel irritants, lubricants, osmotic agents, bulking agents)
Fluid therapy
Enemas
Dietary management and increase water intake
Prokinetic agents (motility stimulators)
Surgical management
89
What are some congenital abnormalities that affect neonates that involve the GIT
Cleft palates
Vascular ring anomaly -persistent right aortic arch (PRAA)
Umbilical and inguinal hernias
Atresia ani
90
What is persistent right aortic arch (PRAA)
During embryonic development, there are blood vessels that encircle the esophagus. Normally these regress prior to birth, but that may not occur.
A structure is created around the esophagus at the base of the heart
Affected animals will present with regurgitation
Contrast studies show megaesophagus that ends at the base of the heart where the stricture occurs
91
What is the treatment of PRAA
Surgical ligation of the tissue to eliminate the structure (may have a good prognosis if caught early enough)
92
What is an umbilical hernia
More common in puppies than kittens
When the abdominal wall fails to close completely after birth
Can be congenital problem or due to too much traction being applied to the umbilicus when the placenta is removed
93
When are umbilical hernias classified as reducible
If you are able to push the herniated tissue back through the abdominal defect into the cavity
94
When is a umbilical hernia considered not reducible
When you cannot push the tissue (normally the greater omentum) back through the defect
95
True or false
| Small hernias usually close in there own
True
96
When can hernias become a serious problem
When it involves intestinal loops which become trapped
The hernia becomes swollen and painful
Tissue can become necrotic when it fills with food and gets occluded
97
What is atresia ani
A congenital issue when the colon does not communicate with the anus
Normally present at about 6 weeks old with abdominal distension, absence of defecation, straining and failure to thrive
A dimple or pouch may be present in place of the anus
Surgical repair is needed but complications include fecal incontinence and recurrent urinary tract infections
Animal is usually euthanized
98
What are the functions of the liver
Production of proteins (albumin)
Coagulation
Digestion
Metabolism and storage of nutrients
Metabolism of drugs and toxins
Extramedullary hematopoesis (produce blood cells)
Metabolism of hemoglobin (converted to bilirubin)
99
Properties of the liver
Has the ability to regenerate
Large reserve capacity (more than 60-80% of function needs to be lost to see clinical signs)
Susceptible to injury
Underlying causes of disease must be treated quickly
100
How do you classify liver pathology
Underlying etiology
Severity
Time frame
Type of pathology present
101
What are some underlying causes of liver disease
```
Infections
Toxins
Iatrogenic
Nutritional deficiencies
Neoplasia
Ischemia
Genetics
Inflammation
Idiopathic
Secondary to other issues
```
102
Give an example of when liver disease is subclinical
Minor liver damage, may show liver enzyme abnormalities in blood work
103
Give an example of when liver disease is acute
Fast onset, diffuse, severe liver disease
Infections, toxicities, fatty liver syndrome
104
Give an example of when liver disease is chronic
Gradual onset
Diffuse damage
Fibrosis
Copper storage disease
105
What is hepatitis
Inflammation of the liver secondary to infections (often viral)
106
What is hepatic lipidosis
Anorexic cats and pregnant or lactating animals
Excess accumulation of fat in the liver
107
What is hepatic necrosis
Secondary to toxins or infection (viruses)
108
What are some nonspecific signs of hepatic disease
```
Anorexia
Lethargy
Vomiting
Diarrhea
Weight loss
Fever
Decreased production
```
109
What are some more specific signs of hepatic disease
Jaundice
Abdominal pain
Hepatic encephalopathy (seizures, head pressing, behavioural change, ataxia, coma)
Photosensitization (sensitive to sunburns)
Petechia or abnormal clotting
Ascites
110
Diagnosing hepatic disease
Blood work (liver enzymes)
Ultrasound
Fine needle aspirates (FNAs)
Biopsies
111
What is the goal of treatment for liver disease
To minimize fibrosis and maximize regeneration
112
What is the treatment of liver disease
```
Based on underlying cause
Medications
Low protein diet
Liver support
With hepatic encephalopathy: mineral oil, lactulose, neomycin/metronidazole
```
113
True or false
| The pancreas cannot regenerate
True
114
What is pancreatitis
Inflammation of the pancreas due to early activation of pancreatic enzymes in the pancreas which causes inflammation of the tissue. These enzymes start to digest the pancreatic tissue
Can be from direct trauma or infection
Acute and chronic forms and can have acute flare ups
Common in cats and dogs (Yorkshire terriers, mini schnauzers)
115
What causes pancreatitis
Often when the animal ingests a high fat meal (often pork)
Genetics: trysinogen may be more prone to self activation
Part of feline triaditis and inflammatory bowel disease
116
What are the signs of pancreatitis
```
Lethargy
Cranial abdominal pain
Play/pray stance
Anorexia
Vomiting/diarrhea
```
117
What is the treatment of pancreatitis
```
IV fluids
Anti-emetics
Diet changes (low fat for dogs, hypoallergenic for cats)
Pain control
Supportive therapy
```
118
What is feline triaditis
Inflammation of the liver, pancreas and small intestine
