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Year 4 small animal > GI disease > Flashcards

GI disease Flashcards

1
Q

what are the 2 phases of digestion

A

luminal
mucosal/membraneous

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2
Q

what is epi

A

inadequate secretion of pancreatic enzymes
maldigestion
steatorrhoea

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3
Q

what is biliary disease

A

failure of emulsification
lipase works but unable to solubilise lipids in micelles
maldigestion

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4
Q

what is ileus

A

inhibition of smooth muscle causing decrease in motility

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5
Q

clinical signs of intestinal disease

A

diarrhoea
vomiting
abdo pain/discomfort
weight loss
anorexia
flatulence
borborygmi
constipation
tenesmus
melaena or haematochezia

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6
Q

what defines diarrhoea

A

passing faeces with increased volume and/or frequency

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7
Q

categories of diarrhoea

A

osmotic - maldigestion, malabsorption
secretory - toxin, infection related
inflammatory - IBD
motility disorder
infectious - bacteria eg, salmonella, viral, parasites

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8
Q

investigation into intestinal disease

A

signalment
history
PE
haematology/biochemistry - cause/effect
faecal analysis

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9
Q

management of diarrhoea

A

fluids
electrolytes
control losses - vomiting/regurgitation
analgesia
anti-emetics
gut protectants

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10
Q

Acid base disturbances

A

can cause metabolic alkalosis/acidosis
SI diarrhoea - metabolic acidosis
severe vomiting - metabolic alkalosis
in all - manage underlying cause and restore renal perfusion

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11
Q

what causes jaundice

A

hyperbilirubinaemia >50umol/L

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12
Q

what is bilirubin

A

product of haemoglobin metabolism
haemoglobin > heme>biliverdin>bilirubin

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13
Q

how does bilirubin appear on excretion

A

urobilin - turns urine yellow
stercobilin - turns faeces brown

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14
Q

haemolytic anaemia causes

A

acquired - hypophosphatemia, oxidative damage
genetic defects - abyssinian/somali cats have hereditary haemolysis
non-spherocytic in beagles, phosphofructokinase in spaniels
immune mediated
mechanical injury - turbulent blood flow neoplasia

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15
Q

Types of immune mediated haemolytic anaemia

A

primary - spontaneous, common in spaniels, diagnosis of exclusion
secondary - drugs/toxins, other immune disease, infection, neoplasia

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16
Q

diagnosis of haemolysis (pre-hepatic)

A

PCV - anaemia - macrocytic, hypochromic regenerative is classic for haemolysis
blood smear - sperocytosis and auto-agglutination
visual inspection
can develop thrombocytopaenia concurrently

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17
Q

hepatic causes of anaemia

A

infectious hepatic disease
inflammation - cholangiohepatitis
neoplasia - lymphoma, mct, adenocarcinoma
drugs/toxins - paracetamol, nsaids etc
degeneration - amyloidosis, lipidosis,cirrhosis
proximal biliary disease - cholangitis,cholangiohepatitis

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18
Q

diagnosis of hepatic anaemia

A

biochemistry
- alt - elevation = hepatocellular damage
- ast - liver/muscle, can raise with venipuncture
- alp - concentrated in biliary tree, small elevations significant in cat as short half life
ggt - biliary tree (and other areas) useful in combination with alp
functional tests
- urea - low values support reduced liver function
- ammonia - high as not converted into urea
- albumin - low values support liver disease
- clotting factors - produced by liver
bile acid stim
imaging - ultrasound/ct, fna/biopsy

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19
Q

post-hepatic causes of jaundice

A

intraluminal obstuction
mural - inflammation/neoplasia
extra-mural - pancreatic disease, duodenal disease, porta-hepatic stricture

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20
Q

CE/history for jaundice

A

CE
ecchymoses/bruising
perhipheral oedema
cranial abdo pain
neuro deficits - hepatic encephalopathy
low bcs in chronic
ascites

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21
Q

associated signs for regurgitation

A

dyspnoea
cough
nasal discharge

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22
Q

associated signs for vomiting

A

hypersalivation
lip-licking

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23
Q

signs of nausea

A

hypersalivation
lethargy
anorexia
lip smacking
burping

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24
Q

causes of vomiting

A

vomiting centre - elevated csf pressure through nausea/inflammation
vestibular apparatus - motion sickness/otitis
perhipheral receptors - git, pancreas, liver, mesentary, peritoneum, urinary tract, heart
chemoreceptor trigger zone - drugs, metabolic disorders, toxins

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25
Q

foreign body vomiting

A

pathophysiology - obstruction increases pressure and dilates/compromises perfusion leading to inflammation and vomiting
diagnosis - plain/contrast radiography, ultrasound, CT and endoscopy
treat by removal

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26
Q

Intussusception

A

pathophysiology - vigorous contraction forces segment into the adjacent segment’s relaxed lumen
causes - idiopathic, parasitism, masses, fb
diagnosis - ultrasound
treatment - surgery

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27
Q

maropitant

A

anti-emetic
NK-1 action
affects the vomiting centre, peripheral receptors and CRTZ
97% effective, avoid with obstruction and reduce dose with hepatic disease

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28
Q

Ondansetron

A

Anti-emetic
5HT3 action
affects the peripheral receptors and CRTZ
avoid with obstructions

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29
Q

Metoclopramide

A

Anti-emetic
action on D2 receptors affecting the CRTZ
often used as a cri, coordinated gastric motility (prokinetic) reduce dose in hepatic/renal disease

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30
Q

Differentials for chronic intestinal vomiting

A

Inflammation
neoplasia
most common

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31
Q

Adenocarcinoma causes of vomiting

A

signs - chronic vomiting and diarrhoea, malaena, haematemesis, weight loss
CE - lymphadenopathy, abdo mass/pain?
Radiography - abdo mass, constricting lesion
ultrasound - intestinal mass, loss of layering, reduction in motility
diagnosis - biopsy, staging with blood loss/fna
treatment - surgery - 75% have mets at diagnosis

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32
Q

lymphoma cause of vomiting

A

CS - chronic vomiting/diarrhoea, malaena, haematemesis, weight loss
CE - lymphadenopathy, abdo mass/pain
Radiography - abdo mass/constricting lesion
Ultrasound - thickened abdo wall, loss of intestinal layering, reduced motility
Diagnosis - biopsy/FNA
Treatment - surgery/chemotherapy
Prognosis - 4-18m better in cats

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33
Q

Physiology of vomiting

A

active reflex mediated via the emetic centre, can be stimulated by the chemoreceptor trigger zone, GI tract, cerebral cortex or vestibular system
lots of systems to consider as cause

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34
Q

acute vs chronic vomiting causes

A

acute - toxic, obstructive, inflammatory, infectious
chronic - chronic inflammation, chronic infection, metabolic/endocrine and neoplastic

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35
Q

physiology of regurgitation

A

passive expulsion of food from pharynx/oesophagus
consider anatomy, musculature and neurological systems
oesophagus - sphincters

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36
Q

what is dysphagia

A

failure to prehend/bite and move to swallow food
pain on opening/closing of the jaw
failure of neuromuscular control
obstruction

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37
Q

regurgitation

A

failure to pass the oesophagus
dilation - megaoesphagus
obstruction
neuromuscular disorder

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38
Q

gastroprotectants

A

omeprazole - PPI
Misoprostal - prostaglandin analogue - dont use with pregnancy
H2 receptor agonist - cimetidine - reduce acid secretion
sucralfate - binds damaged mucosa

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39
Q

diagnostic testing

A

imaging - obstructive/anatomical disease
radiography
ultrasound - pocus for free fluid
haematology/biochemistry
specific blood tests

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40
Q

treatment of ingested toxins in stomach

A

induce emesis withing 2-8h dog and 2-12h cat
apomorphine in dogs
xylazine/medatomidine isnt licensed but may be used in cats

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41
Q

Intestinal transit of toxins

A

use adsorbents - activated charcoal, binds toxin for excretion but does cause black faeces

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42
Q

Skin exposure of toxins

A

decontamination of the skin - washing - take care as prolonged washing can wash in some toxins, take care drying as abrasions can allow toxin

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43
Q

inhaled toxins

A

cannot decontaminate - take care if retrieving

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44
Q

metabolic toxins

A

prevention of metabolising once in the blood stream
fluid therapy best
lipid infusion for lipid soluble compunds

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45
Q

body system assessment

A

neuro - seizures, ataxia, sedation
cardiovascular - arrythmias, tachy/bradycardia, hypo/hypertension
GI - V+/D+
renal - azotaemia/inapprorpiate usg
hepatic - jaundice, alt,alp,bile acids
clotting time/anaemia

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46
Q

Ibruprofen/Nsaid toxicity

A

reduced prostaglandin production
CS - haemorrhagic V+/D+, aki
treatments - H2 blockers - cimetidine
PPI - omeprazole
Prostaglandin analogue - misoprostal

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47
Q

Aspirin toxicity

A

prostaglandin inhibition plus thromboxane inhibition (platelet function)
CS - thrombocytopathy
Treatment as NSAIDs

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48
Q

Paracetamol toxicity

A

NAPQI excess de-toxified by glutathione, stores can be exhausted
excess = hepatic cell necrosis, nephrotoxicity
CS - brown MM, jaundice, abdo pain, lethargy, vomiting, AKI, tissue hypoxia
Treatment
- N-acetyl cysteine - glutathione precursor
- H2 receptor agonists
- vit C
- liver, AKI and GI support

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49
Q

chocolate toxicity

A

methyl-xanthines increasing catecholamine release, increase cAMP and inhibits adenosine receptors
CS - hyperactivity, V+/D+, arrythmias, seizures, coma, death
Treatment - charcoal 4-6 hourly, can need intubation/urinary catheterisation

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50
Q

Xylitol toxicity

A

mimics glucose but not broken down in the same way
Stimulates insulin release and is hepatotoxic leading to prolonged hypoglycaemia (12-48h) and liver failure in 72h
CS - weakness, collapse, seizures, coma, death, jaundice
treatments - hepato-protectant - sAME, UDA, silybin. Glucose supplementation

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51
Q

Pyrethroid poisoning

A

found in ant powders/old flea products
cats susceptible
CS - ataxia, tremors, disorientation, seizures, dyspnoea, respiratory arrest, hypersalivation, vomiting
diagnosis on exposure/CS
Treatment - general principles, decontamination, intralipid very good

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52
Q

Cleaning procedures

A

damage through surface contact
CS - oral pain, dysphagia, regurgitation, vomiting
dont do gastric decontamination
Dilute with oral water etc

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53
Q

Ethylene glycol toxicity

A

metabolised into glycoaldehyde, glycolic acid and oxalic acid.
Glycoaldehyde - neurotoxic
Glycolic acid - severe acidosis
oxalic acid - calcium oxalate crystals in organs
High mortality
CS - v+, lethargy, ataxia followed by tachyarrythmias, tachypnoea, hypocalcaemia then AKI and death
Treatment - medical ethanol/vodka diluted with saline. Dialysis with referral

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54
Q

Warfarin poisoning

A

inhibits vit K production which stops clotting factors leading to coagulopathy
Diagnosis - prolonged clotting, haemothorax in large bleeds
Treatment - injectible/oral vit K, fresh frozen plasma for clotting factors

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55
Q

raisin/grape toxicity

A

substance unknown
leads to AKI
treatment - IVFT

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56
Q

Recreational drug toxicity

A

Cocaine - hyperactive/hyperthermic/V+/ataxia. General treatment
Marijuana - vomiting, ataxia, depression, coma, incontinence. treated generally, intralipid, catheterisation and anxiolytics
Opiates - depression, lethargy, V+, constipation. Treatment - general, reversal - naloxone
Ketamine - ataxia, hallucinations, aggression, cataplexy - treated with general principles and intubation

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57
Q

Lily toxicity

A

substance not known
cats very sensitive - AKI
dogs - GI signs
Treat as AKI plus decontamination in case of pollen on feet etc

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58
Q

Onion/garlic/leek/chive toxicity

A

large quantities for toxicity
sulphur containint - haemolysis/heinz body anaemia
CS - V+/D+, tachycardia, tachypnoea, pale MM
treat - general principles + transfusion

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59
Q

Tremorgenic mycotoxins - fungus

A

Penitrem A - neurotxic
CS - muscle tremors, hyperaesthesia, seizure, coma, death (rare)
Treatment - general principles, methocarbamol for tremors but is off license (diazepam does not work)
Good prognosis but look bad

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60
Q

signs for FB

A

history - scavenger, acute severe vomiting, abdominal pain/palpable obstruction
diagnosis - plain/contrast radiography, ultrasound, CT/endoscopy
Treat by removal

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61
Q

Treatment of acute gastritis

A

time, reduced toxin exposure, fluid therapy
anti-emetics
reduce acid damage - highly digestible, low fat/fibre wet/hypoallergenic

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62
Q

helicobacter chronic gastritis

A

high prevalence in companion animals
try symptomatic meds/diet first
in man treated with - amoxyclav, clarithromycin and PPIs

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63
Q

what antiemetics are available

A

maropitant
ondansetron
metoclopramide

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64
Q

what drugs reduced acid secretion

A

PPIs
H2 agonists
antacids
synthetic prostaglandins
sucralfate

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65
Q

Gastric ulceration

A

end of chronic gastritis
CS - chronic vomiting, haematemesis, malaena
Bloodwork - evidence of GI bleeding
Ultrasound - loss of wall layering, reduced motility, free fluid with perforation
endoscopy - similar to neoplasia, biopsy for definitive
Treatment - surgical for perforation, medical for chronic gastritis

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66
Q

what is a gastrinoma

A

rare neuroendocrine tumour of the pancreas secreting gastrin
leads to ulceration/erosion along the GIT

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67
Q

Indications for exploratory laparotomy

A

if diagnosis can only be made by inspection/palpation
if diagnosis needs cytological/histological or culture for diagnosis

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68
Q

Therapeutic indications for ex lap

A

haemorrhage control
correction of contamination/infection
elimination of pain cause
removal of mass
removal of visceral obstruction
removal of traumatised organs
relief of dystocia
removal of abnormal fluid accumulation
supportive care

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69
Q

common mistake during exlap

A

failure to make a large enough incision
failure to explore the entire abdominal cavity
failure to take appropriate biopsies
failure to be prepared for the likely diagnosis or diagnoses
failure to approach the intra-operative findings in a logical fashion

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70
Q

what are the 5 regions to check

A

cranial quadrant
intestinal tract
right paravertebral
left paravertebral
caudal

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71
Q

what fixes the duodenum in place

A

dueodeno-coelic ligament

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72
Q

what does the duodenal manouvere allow visualisation of

A

caudal pole of right kidney and right ovarian pedicle

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73
Q

what does the colonic manouvere allow visualisation of

A

left kidney and left ovarian pedicle

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74
Q

what layer of the linea alba is crucial to close

A

rectus sheath

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75
Q

what suture pattern is best for the linear alba

A

continuous to spread tension

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76
Q

why do you have to take care an oesophagostomy tube doesnt sit in the stomach

A

it allows acid reflux

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77
Q

clinical signs of oesophageal FB

A

retching
regurgitation
vomiting??
ptyalism
anorexia
restlessness
cervical pain

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78
Q

what drugs can be used to reduce chance of oesophageal stricture after FB removal

A

H2 antagonists
PPI
sucralfate
analgesia
feed soft food

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79
Q

indications for gastric surgery

A

placement of gastric feed tube
gastrotomy for FB
gastropexy to stop volvulus
correct GDV
pyloroplasty for outflow disease
partial gastrectomy for tumour resection

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80
Q

Enterotomy for FB removal EXAM

A

Orthogonal xrays needed for locations
proximal to obstruction is likely to be distended and distal empty
incise through unaffected bowel and milk out the proximal distension
close with single layer - simple continuous, interrupted or inverting. use non-cutting needle and drape omentalise

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81
Q

Problems occuring with linear FB

A

string/wool anchored somewhere proximal
concertinas the bowel and tries to cut through the mesenteric border - can perforate in multiple locations
must free proximal attachment before removal

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82
Q

points of care for enterectomy

A

clamps on bowel remaining must be atraumatic
others can be traumatic
ligate mesenteric vessels
cut on diagonal towards mesentery to maintain blood supply
end to end anastomosis with simple continuous
close mesentery

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83
Q

indications for large intestine surgery

A

colopexy
colotomy
colectomy
subtotal colectomy
colonic torsions
small bowel torsion

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84
Q

differences between cat and dog pancreas

A

dog pancreatic duct small/absent cat is present
dog accessory pancreatic duct is large in cats it is absent in 80%

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85
Q

where do you biopsy the pancreas

A

tip of the left limb as most avascular

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86
Q

what does the liver do

A

metabolic processes
digestion of; fat/triglycerides, protein, carbohydrate/glycogen/cholesterol/vits/mins
waste management
protein metabolism

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87
Q

acute diarrhoea causes

A

diet - food changes, allergies, intolerance, scavenging. food poisoning/toxins
drugs - antimicrobials/chemo
infections - parvovirus, corona virus, adenovirus, rotavirus. Bacteria - salmonella, campylobacter, e.coli, clostridial species
parasites - helminths, protozoa - giardia/tritrichomonas

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88
Q

Parvovirus (cpv-2)

A

very stable in environment, faecal-oral
CS- V+, D+(haemorrhagic/foetid with mucosal sloughing), dehydration, depression, anorexia, sepsis, ileus
Diagnosis - PCR - snap okay send off better. faecal analysis. haematology/biochemistry
Treatment - fluids, electrolytes, antibiotics - amoxy-clav, anti-emetics, pro-motility (metaclopramide), ant-acids
prevention - vaccination, cleaning/disinfection

89
Q

what drug can be used both pro-motility and anti-emetic

A

metaclopramide

90
Q

haemorrhagic gastroenteritis

A

idiopathic mostly
CS - vomiting +/-blood, foetid diarrhoea, depression, anorexia, clinical dehydration, high PCV, tp lost in GI
Treatment - fluids, colloids/plasma/whole blood
Anti-microbials - amoxy-clav, metronidazole

91
Q

Feline panleukopaenia

A

feline parvo - treated the same
vaccinate in early outbreaks for protection

92
Q

coronavirus

A

dog - young/highly contagious, mild villus destruction with enterocytes at tips. If severe give supportive therapy
cat - as with dog but links with FIP

93
Q

campylobacter

A

normally commensal
young/immunocompromised causes acute enterocolitis
cs- D++, V+, straining, fever, abdo pain
diagnosis - faecal stain/culture, PCR
treatment - underlying disease if present

94
Q

salmonella

A

similar to campylobacter but risk to immunocompromised owners (more so fed raw)
can get - transient diarrhoes, acute gastritis, carrier or bacteraemia
treat if sepsis/shock on culture
negative indicator - hypoglycaemia, temp over 40 degrees and degenerate left shift

95
Q

clostridial enteritis

A

normal flora - diarrhoea due to endotoxin production
dont overtreat
metronidazole first choice
very resistant in environment

96
Q

signs of ascarids

A

puppies/kittens
failure to gain weight
pot belly
v+, small bowel d+
obstruction of git
respiratory disease with migration

97
Q

signs of hookworms

A

diarrhoea
weight loss
anaemia
interdigital dermatitis, perineal irritation

98
Q

gut adsorbants

A

kaolin oral suspension good

99
Q

pro-kinetics

A

metaclopramide - upper GIT
erythromycin - gastric emptying
ranitidine - anti-cholinesterase
lidocaine - si motility and analgesic

100
Q

dehydration

A

cs - skin tent, tacky MM, sunken eyes
= fluid deficit
fluid deficitxbodyweight = litres deficit

101
Q

what is your starting fluid rate for a dehydrated patient

A

deficit/24h plus maintenance

102
Q

fluid care for animals with cancer

A

weight decreasing, measure regularly to readjust

103
Q

fluid care for DCM heart failure

A

with D+/V+
do not relieve full deficit EVER
keep slightly dehydrated to reduce strain on heart

104
Q

signs of hypovolaemia

A

increased CRT
pale MM
cold
increased HR
weak pulses
increased RR

105
Q

signs of sirs/sepsis

A

CRT decreased
reg/congested MM
pyrexia
increased HR
poor/bounding pulses
increased RR

106
Q

common pancreatic disease

A

acute pancreatitis - inflammation, sudden onset with little/no permanent change
chronic pancreatitis - continuing inflammatory disease with irreversible morphological changes - fibrosis/atrophy. can lead to permenant impairment of function

107
Q

clinical signs of pancreatitis

A

lethargy/weakness
anorexia
V+/D+
abdominal pain
cranial abdo mass
mild ascites
dehydration
fever
jaundice
anaemia

108
Q

lab findings for pancreatitis

A

haematology - anaemia, haemoconcentration, leukocytosis
biochemistry - azotaemia, increased ALP, hyperbilirubinaemia, hyper/hypo glycaemia, hypoalbuminaemia, hypertriglyercidaemia, hypercholesterolaemia
electrolytes - hypokalaemia, hypochloraemia, hyponatraemia, hypocalcaemia

109
Q

imaging for pancreatitis

A

radiography - rarely useful, can see displacement of abdominal organs
abdominal ultrasound - enlargement, localised effusion, decreased echogenicity (pancreatic necrosis), hyperechogenicity (pancreatic fibrosis in chronic), pancreatic duct dilation

110
Q

pancreatitis treatment

A

underlying cause
analgesia
antiemetics
antibiotics - in infectious
feeding - high carb, low fat
enteral feeding if anorexic

111
Q

complications of pancreatitis treatment

A

pancreatic pseudocyst - similar signs to pancreatitis, significance unclear
pancreatic abscess - bacterial infection rarely present, cranial abdominal mass, avoid surgery unless enlarging and not responding to drugs

112
Q

long term pancreatitis management

A

avoid high fat - fat restricted diet
oral pancreatic enzymes supplements
recurring episodes - prednisolone

113
Q

pancreatic neoplasia

A

adenomas - singular, benign, incidental, can obstruct duct/cause EPI
Adenocarcinoma - more common, originate in ducts or acinar tissue, necrosis can cause inflammation
CS- V+/D+, weight loss, anorexia
imaging - radiography- mass, splenic displacement. Ultrasonography - soft tissue near pancreas, sample peritoneal effusion
diagnosis - ex-lap/PM - biopsy
Treatment - prognosis grave, resection can be attempted

114
Q

gross appearance of pancreatic nodular hyperplasia

A

small nodules through exocrine portion
no capsule
usually incidental

115
Q

pancreatitis gross appearance

A

oedematous tissue
soft
swollen
fibrinous adhesions
serosanguinous free fluid
pseudocysts
haemorrhages
fat necrosis

116
Q

diets appropriate for pancreatitis

A

Oral
Dogs - use easily digestible diet, moderate/low fat content
Cats - high protein, fat restriction unnecessary

117
Q

refeeding protocol

A

if anorexic for >3-5 days when refeeding feed only 1/3rd of RER on day 1
increase in small meals up to RER at day 3 if tolerated
decreased risk of metabolic complications

118
Q

where are the anal sacs located

A

4 and 8 oclock between internal and external sphincter muscles

119
Q

considerations of anal/rectal issues

A

infection risk - large clip, evacuate rectum, pack rectum, dont use enemas - more likely to contaminate, anti-biotics with cover for anaerobes (metronidazole)
very vascular - high chance of haemorrhage
faecal incontinence is a risk around the external anal sphincter

120
Q

cause of anal gland blockage

A

change in faecal consistency effecting emptying eg diarrhoea, diet, tapeworm, oestrus
CS - scooting
easily diagnosed on palpation
treatment - manual expression, can require flushing

121
Q

indications for anal sacculectomy

A

recurrent impaction
neoplasia
on occasion part of peri-anal fistula treatment

122
Q

how can you make anal sacculectomy easier

A

inject resin into the gland via the duct to make the border clear for resection - inflation of foley catheter in sac also works

123
Q

complications of anal sacculectomy

A

draining sinus
infection
dehiscence
tenesmus
faecal incontinence

124
Q

anal furunculosis

A

deep ulcerating tracts - needs major treatment (euthanasia is an option)
associated with increased apocrine glands in perineum
treatment - dampen the immune system - prednisolone and hypoallergenic diet - very limited use
often need surgical resection

125
Q

perianal adenoma

A

common in male dog
hairless anal ring - tail base/prepuce/ventrum
biopsy
slow growing, rare in castrated and resolve with castration
0.5-3cm can ulcerate

126
Q

anal adenocarcinoma

A

malignant lesion of perianal sebaceous gland
very infiltrative/adherent and rapidly growing
aggressive surgical removal required
poor prognosis

127
Q

anal sac adenocarcinoma

A

female >10
hard pea sized lumps in sac walls
secretes PTH like substance and causes hypercalcaemia (leads to PUPD, depression, weakness, weight loss)
diagnosis - palpation, biochemical findings, radiography/CT
Treat hypercalcaemia
excise mass, metastectomy and chemotherapy

128
Q

rectal prolapse

A

endoparasites/enteris associated
incomplete = mucosa only
complete = all wall layer
oedematous, excoriated and bleeding tissues possible
straining in history
Lavage, lubricate and reduce
amputate is traumatised
colopexy if recurrent

129
Q

rectal stricture

A

secondary to proctatitis/anal sacculitis, FBs or surgical complication
Dx - digital rectal exam, radiography/colonoscopy
biopsy to differentiate from neoplasia
give corticosteroids

130
Q

rectal polyps

A

benign, male/female, mean age 7
CS - blood/mucus in faeces, may prolapse
treatment - surgical removal

131
Q

rectal adenocarcinoma

A

infiltrative/ulcerative/proliferative invading rectal wall
CS - tenesmus, dyschezia, weight loss, lethargy as they advance
Dx- palpation, radiography, ultrasound, endoscopy
Tx - colorectal resection/anastomosis
can become incontinent - discuss

132
Q

atresia ani

A

uncommon - associated with recto-vaginal/rectal-urethral fistulae, can have secondary megacolon
CS - tenesmus, perineal bulging
Dx - radiography
Tx - surgical creation of an anus

133
Q

reasons for underweight patients

A

underlying condition increasing requirement - neoplasia, GI dysfunction, inflammation
different nutrient requirements - pancreatitis/portosystemic shunts
disease stage - high/low protein depending

134
Q

RER calculation

A

70(BWkg)x power 0.75
or (30xBW) +70 (for 2-45kg)

135
Q

diet requirements

A

calorie dense - not chicken
palatable
as normal as possible - if raw…cook it!
complete

136
Q

tactics to encourage eating

A

warming
hand feeding
bowl type
texture
covered area
owner visits

137
Q

interventions for hyporexia/anorexia

A

monitor closely for 1-2 days
2-4 day intervention required - feeding tube if undergoing procedure
>5 days must intervene

138
Q

nasooesophageal tube placement

A

feed in ventromedially
drop intubeze in nose first
crunching = bad
sterile lube
x-ray for placement
cant go home

139
Q

PEG tube

A

placed using endoscope
placed via surgical incision through wall
wait 24h for adhesion

140
Q

what should you not use as a post op diet

A

chicken/rice

141
Q

causes of malnutrition

A

diet - inappropriate eg wrong age, not enough for age/activity level
not wanting to eat - pain, stress, nausea, pyrexia, appetite suppressants
physically cannot eat - dental disease, oral/pharyngeal masses, mandibular/maxillary abnormalities, congenital defects, neuromuscular disorders

142
Q

masticatory muscle myositis

A

immune mediated inflammatory condition
acute - inflamed masticatory muscles, struggles to open jae
chronic - fibrosis/atrophy, cannot open mouth, anorexia/weight loss
Dx - circulating autoantibodies against 2m fibres. haematology/biochemistry
treatment - best in acute phase - immunosupressive prednisolone. chronic - poor prognosis

143
Q

cricopharyngeal achalasia

A

uncommon - dysphagia/regurgitation
Dx - fluoroscopy - cricopharyngeal muscles dont relax
Tx - surgery

144
Q

malutilisation

A

calories not absorbed correctly
protein losing nephropathies, diabetes mellitus, liver disease
increased nutrient demand - neoplasia, hyperthyroidism, infection, parasites
usually systemically unwell

145
Q

what is hyporexia

A

not eating well enough for normal maintainence

146
Q

things to look for with appetite loss

A

drooling/pyrexia/pain
consider haematology/biochemistry/urinalysis
anti emetic trial for nausea
common causes - renal/hepatic disease, inflammatory/infectious causes, neoplasia

147
Q

things to look for with reluctance to eat

A

changes around feeding - bowl location/other animals etc
home changes
common causes - nausea, pain, stressful events, change of diet

148
Q

mechanical inability to eat

A

check can open/close mouth normally
pain in neck/mouth/limbs
video eating to bring in
may need sedation to assess
common causes - dental disease, gingivostomatitis, oral/pharyngeal/oesophageal massess

149
Q

Hepatic lipidosis risk

A

particularly anorexia in obese animals with fat mobilisation
CS - hepatomegaly, jaundice, lethargy, V+/D+, ileus, hypersalivation, pallor, neck ventroflexion(cat), coagulopathies
Dx - biochem (alp,alt,ast), haematology (nonregenerative anaemia etc) can have low coag as low vit K. Hepatomegaly
Tx - ivft, supplementation of K+, phosphate, b12. feed slowly. antiemetics

150
Q

Refeeding syndrome

A

fed too much after prolonged anorexia with electrolyte depletion. hypokalaemia - co transport with glucose and depleted levels
/hypophosphataemia
CS - seen in 5d of refeeding - cervical ventroflexion, muscle weakness, acute RBC lysis, respiratory failure
Tx - slow refeeding, check electolyte levels and supplement
prevent - slow refeeding protocol

151
Q

septic peritonitis causes

A

bacteraemia
GI perforation
penetrating injury
iatrogenic (swabs)
ascending UTI

152
Q

aseptic peritonitis causes

A

Inflammatory
Splenic abscess
Hepatitis
Nephritis
Cholangitis
Pancreatic enzymes
Bile
haemoabdomen
uroabdomen
stomach acid

153
Q

diagnosis of peritonitis

A

POCUS for free fluid (shapes with angles)
tap - septic/not
diagnostic peritoneal lavage

154
Q

treatment of peritonitis

A

source control
antibiotics- if septic YES do not wait at all and survival chance rapidly declines - metroidazole/amoxicillin. aseptic - NO

155
Q

what is an acute abdomen

A

acute onset abdominal pain
often present collapsed/V+/shock

156
Q

areas that can cause acute abdomen

A

spine - pain in all abdominal area
ventral - splenic rupture/torsion, SI - rupture/torsion/entrapment, gravity dependent - peritonitis/haemo/uroabdomen, space occupying
dorsal - kidney, radiation from stomach, spinal, spleen
cranial - liver, pancreas, spleen, stomach
caudal - colon, prostate, bladder, uterus

157
Q

diagnosis for acute abdomen

A

radiography - obstructive disease
labwork - haem/biochem, BP, lactate, electrolytes, acid/base

158
Q

metabolic acidosis findings

A

low pH
lactic acid related
breath off CO2 so normal-low
reduced bicarbonate
give hartmanns as alkalising

159
Q

metabolic alkalosis findings

A

pathognomic for pyloric obstruction as acid not entering duodenum
high pH
normal/high CO2 as breath slows
high bicarbonate as not being used by acid
give saline as dissociates into NaOH and HCL - resting pH 5.5

160
Q

clinical signs of ascites

A

abdominal distension
discomfort
dyspnoea
lethargy
can report - weight gain, difficulty rising

161
Q

diagnosis of ascites

A

history
clinical exam
ballottement - fluid wave
ultrasound

162
Q

protein poor transudate ascites

A

pathophysiology - altered fluid dynamics, hypoalbuminaemia, decreased plasma colloid oncotic pressure
DDx - protein losing nephropathy/enteropathy, hepatic failure
Dx - biochemistry, unrinalysis, ultrasound

163
Q

protein rich transudate ascites

A

Pathophysiology - increased hydrostatic pressure in blood/lymphatics, protein leaks from capillaries, TP most important, over time inflammation and increased TNCC
DDx - cardiovascular disease, chronic liver disease, neoplasia, thrombosis
Dx - ultrasound, radiography, biochemistry

164
Q

septic exudate ascites

A

DDx - penetrating wound, surgical complication, rupture of infected leison, bacteraemia
Dx - abdominocentesis, appearance, cytology, C&S, lactate/glucose
CS - sick and painful, normally require surgery

165
Q

non-septic exudate ascites

A

DDx - neoplasia, uroperitoneum, bile peritonitis, FIP
Dx - abdomincentesis, fluid appearance, cytology, fluid analysis (high urea, creatinine/potassium if uroperitoneum)
biochemistry, ultrasound

166
Q

Lymphatic effusion

A

rare - obstruction/destruction of lymphatics
DDx- cardiac disease, hepatic disease, neoplasia, steatitis (fat inflammation)
Dx - appearance (milky), cytology (many small lymphocytes, fluid analysis, ultrasound, biochemistry

167
Q

haemorrhagic effusion

A

DDx - surgical/non-surgical trauam, haemostatic defects, neoplasia
Dx - pcv/tp, platelet presence, cytology, ultrasound

168
Q

what is dyschezia

A

difficult/painful defecation

169
Q

what is tenesmus

A

excessive straining to pass stools

170
Q

causes of dyschezia

A

colonic impaction
perineal hernia/rectal diverticulum
rectal stricture
anal neoplasia
severe prosatomegaly
obstipation (chronic constipation)

171
Q

causes of tenesmus

A

top - colitis
bone ingestion
rectal/anal tumours
post op (perineal surgery)
prostatomegaly

172
Q

colitis signs

A

colon not absorbing water/ overproduction of mucous
CS - tenesmus, soft stools, mucus in stool, fresh blood, generally well
Treat - metranidazole/sulphursalazine, high fibre feed

173
Q

constipation

A

uncommon - normally actually tenesmus/dyschezia

174
Q

Feline idiopathic megacolon EXAM

A

Presentation - recurrent constipation, colon dilation, hypomotility of the colon
Causes - mostly idiopathic can be pelvic/sacral spinal deformity
Leads to permanent loss of colonic structure/function
>1.5x length of 7th lumbar vertebra = mega on radiography
can feel
Treatment - laxatives (lactulose), enemas (soapy water), high fibre feed
surgery - subtotal colonectomy - try to maintain ileocaecal junction
pre-op antibiotics, NO preop enema
slow to heal with risk of dehiscence

175
Q

basic dietary requirements

A

protein - growth/repair
fat - energy and fat soluble vitamin(ADEK) carrier
carbohydrate - energy
water - fluid balance
vitamins/minerals for everything

176
Q

how is best to increase energy in feed

A

increase fat content - 8.5kcal/g

177
Q

how does neutering affect weight gain

A

adjusts fat storage
energy levels drop

178
Q

safe weightloss targets

A

1%/week in cats
1-2%/week in dogs
use interim targets if requiring >15% body weight loss

179
Q

what is in a weight loss diet

A

low fat, low carb, high fibre, high protein in dog
high fibre - slows digestion but increases faeces volume
low fat, low carb, high protein in cats - hepatic lipidosis prone if too restricted

180
Q

causes of weight gain

A

non pathological - exercise, growth, pregnancy
pathological - neoplasia, hyperplasia, inflammation, cysts/abscesses, organomegaly, fluid retention

181
Q

causes of increased appetite

A

systemic disease - normal calorific demand - hyperadrenocorticism
systemic disease - high caloric demand - acromegaly, insulinoma
iatrogenic - glucocorticoids/phenobarbitone.mirtazapine
behavioral/psychological/neurological

182
Q

acromegaly

A

increased growth hormone
Cats - associated with functional pituitary adenoma, mostly middle age/older males
dogs - unneutered females, elevated progesterone
CS - cutaneous thickening, macroglossia, increased dental spacing, prognathism, diabetes mellitus signs but weight gain not loss
Dx - clinical signs, elevated GH and IGF-1
Treatment - surgery - dogs (OVH+mamary strip) cats(hypophysectomy). Radiotherapy, drugs (dopaminergic/somatostain analogues)

183
Q

insulinomas

A

functional neuroendocrine tumours - produce excessive insulin leading to low blood glucose
clinical signs - increased appetite, weight gain, weakness, ataxia, collapse, seizures
Dx - hypoglycaemia resolving with glucose administration (exclude other causes) ultrasound for mass/mets a lot spread before identified. CT best
Tx - surgery - excisional reduces clinical signs with mets, nodulectomy/partial pancreatectomy. Medical - diet (small frequent meals), prednisolon, octreotide (inhibits insulin production), diazoxide (decreases insulin release). Chemotherapy - streptoxotocin

184
Q

staging of insulinomas

A

1 - only pancreatic
2 - regional lymph node
3 - distant mets

185
Q

hypothyroidism types

A

primary - idiopathic gland atrophy/immune mediated lymphocytic thyroiditis
secondary - space occupying mass, has neuro signs
congenital - abnormal thyroid development, dyshormonogenesis or abnormal TSH production
iatrogenic - excessive hyperthyroid treatment in cats

186
Q

hypothyroid signs/signalment

A

dogs - middle aged/older, large breed
cats - following treatment for hyperthyroid
CS - dull, lethargic, exercise intolerent, hypothermia, dry coat, increased shedding - symmetrical alopecia of trunk/thighs/tail/neck, slow regrowth, tragic expression, hypotension, bradycardia, repro issues, perhipheral neuropathies
diagnosis - routine bloods suggestive. definitive - conpatible signs + low total t4/free T4 AND normal-high TSH
Treatment - levothyroxine + monitoring

187
Q

what test is used for hypothyrodism confirmation

A

TSH with free or total T4

188
Q

aims of hernia surgery

A

return content to normal location
close neck of sac
obliterate redundant tissue

189
Q

why should monofilament be used to close hernia

A

avoid sinus formation

190
Q

what care do you need to take with hernia closure

A

tensionless closure
omentum -
eliminate dead space
drains if necessary

191
Q

umbilical hernias

A

normally congenital
lined by peritoneal sac
soft/painless
can have V+/abdo pain with strangulation
normally contain fat/omentum and normally reducible or can fix at neutering
dont breed
surgery - elliptical incision, undermine stump/remove fat, close in straight line

192
Q

causes of incisional herniation

A

incorrect technique from surgeon
incorrect material/suture pattern
entrapped fat
infection
steroid therapy
poor post op care
CS - oedema, inflammation, serosanguinous fluid, soft painless swelling, palpable defect, exposed viscera
Treatment - repair asap, can eviscerate so open and repair entire wound make sure external rectus abdominis (strongest holding layer)

193
Q

inguinal hernia

A

inguinal ring abnormality/trauma
association with obesity/pregnancy
neutering recommended
small breed <2 male/middle aged female
non-painful unless incarcerated contents

194
Q

scrotal hernia

A

common with large inguinal rings/open castrations (guinea pigs)

195
Q

diaphragmatic hernia

A

common following RTA, can be congenital
tear allows abdo contents into thorax
CS - pale/cyanotic, tachy/dyspnoeic, tachycardic, occasionally arrhythmic, hydrothorax. Chronic can have GI signs - exercise intolerance, dyspnoea, V+, weight loss
Dx - radiography - loss of diaphragmic line. ultrasonography
Treatment - oxygen, IVFT, warming, higher mortality if surgery under 24h post accident. but acute gastric distension (operate asap. prophylactic antibiotics

196
Q

perineal hernias

A

uncommon, bulging perineum. associated with faecal tenesmus/dysuria
cause - weakening of pelvic diaphragm, hormonal influence, tenesmus, congential, colitis/prostatomegaly
pelvic/peritoneal fat herniation through pelvic diaphragm
reducible swelling, can asses on rectal palpation
ultrasouns/contrast urethrography will highlight
Tx - herniorrhaphy - close gap in diaphragm

197
Q

hiatal hernias

A

brachycephalic - congenital defect
CS - regurgitation, hypersalivation, visceral discomfort, thin
Dx - radiography, flouroscopy (best) endoscopy
Tx - antacid, sucralfate, prokinetics, antibiotics. surgery - ventral midline coeliotomy, reduce hernia at oesophageal hiatus, pexy oesophagus to diaphragm and stomach to body wall

198
Q

peritoneopericardial diaphragmatic hernia - uncommon

A

congenital communication between diaphragm and pericardium
CS - GI signs - V+/D+/anorexia, weight loss, wheezing, dyspnoea
radiography - enlarged cardiac silhouette, dorsal displacement of trachea, gas in pericardium. ultrasound. contrast radiography
Surgery - ventral midline coeliotomy, reduce viscera, suture diaphragm

199
Q

what determines if blood in the abdomen

A

PCV of abdominal fluid compared to that of blood - will be lower
if ~ same as blood - acute haemoabdomen
fluid higher pcv than blood - semi-acute haemoabdomen
pcv of fluid lower than blood - chronic haemoabdomen (cancer/haemangiosarcoma)

200
Q

neoplastic haemoabdomen

A

acute/chronic
how bad - BP/lactate
fluids/transfusion - auto-transfusion, pRBC (with plasma best). whole blood best
Treatment - surgery, chemo, euthanasia

201
Q

traumatic haemoabdomen

A

rta
acute
whole blood/pRBC/plasma
transaxemic acid - antifibronilytic maintains clotting
dont operate!

202
Q

coagulopathic haemoabdomen

A

iatrogenic - warfarin poisoning
bp/lactate
fluids/transfusion - fresh frozen plasma then pRBC, auto transfusion good but need plasma

203
Q

uroabdomen

A

assessment - urinary catheter, 3 way tap and saline/air syringes - make bubbles instilling the two which can be seen on scan
tap free fluid - urea (free moving), creatinine (relevant if >2x blood value), potassium(relevant is >1.4x blood)
Hyperkalaemia worry - bradycardia, atrial standstill(no P wave), elecrolytes on blood gas - control source and give hartmanns

204
Q

aerophagia

A

swallowed air

205
Q

what can gas distension of the stomach cause

A

GDV
momentum for 180-360 degree twist, most turn clockwise
causes caudal vena cava compression, gastric vessel compression/necrosis
splenic engorgement/twists

206
Q

pathophysiology of GDV

A

associated with eating too fast, especially after eating
associated with deep chest eg setter/GSD, doberman, dachshunds
not fully understood

207
Q

obstructive shock treatment

A

tube - oro/nasogastric tube, trochar if tube placement not appropriate
oxygen therapy (hyperoxygenation good)
fluid therapy

208
Q

GDV surgery

A

anaesthetic precautions - cardiovascularly compromised so avoid alpha 2, use methadone for pain, coinduce with midazolam and propofol
continuous monitoring of BP
ventilation perfusion mismatch with diaphragmatic compression
care with re-perfusion injury acidosis/hyperkalaemia
techniques - incisional (easiest ) incise pyloric serosa and deep into abdominal wall and stitch together
decompress fully before rotating
care of gastric arteries
any signs of twisting remove spleen, do not untwist

209
Q

GDV post op care

A

regular checks
lidocaine
monitoring electrolytes
ecg for 24-48h
oxygen

210
Q

major differentials for chronic enteropathy

A

food responsive
dysbiosis
antibiotic responsive
steroid responsive
non-responsive
PLE
EPI
neoplasia

211
Q

most common chronic enteropathy

A

food responsive

212
Q

food responsive enteropathy

A

adverse reaction to food
V+/D+/pruritis possible
food trial excluding antigen - should see results in under 3 weeks (different to skin disease). diet reintroduction should relapse
Dx - food trial, food specific serum immunoglobulin (commercially available, not accurate). endoscopic sensitivity testing - direct application to mucosa, IgE mediated hypersensitivity, biopsies from reactive sites

213
Q

dysbiosis

A

major complication of ce - bacterial overgrowth common decreased gastric acid, increased SI substrates (epi/malabsorption), partial obstructions, anatomic disorders, hypothyroidism. primary condition in susceptible breeds (GSD iga deficiency)
CS - small bowel D+, weight loss, failure to thrive, V+, borborygmi, appetite changes
Dx - history/determine underlying cause, faecal microbiome analysis. serum folate/B12, coalbumin levels. Breath hydrogen testing (difficult), circulating bile acids
Treatment - oxytetracycline/tylosin/metronidazole (4-6 weeks)
ancillary approaches preferred - diet, pre/probiotics, coalbumin supplements

214
Q

steroid responsive enteropathy

A

perisistent GI signs with cellular infiltrate
cs - chronic diarrhoea, more common >12 months, weight loss, abdo discomfort, V+(cats)
diagnosis - imaging, biopsies,
work out which cellular infiltrate and treat appropriately

215
Q

lymphoplasmacytic gastroenteritis

A

mucosal changes

216
Q

eosinophilic enteritis

A

severe signs - GI haemorrhage, bowel perforation, focal mass lesions
difficult to control

217
Q

feline triaditis complex

A

CE/IBD. pancreatitis/cholangiohepatitis
diagnosis - biopsy, blood tests, radiography, ultrasound
treat depending on CS - manipulate diet, anti-parasitics (fenbendazole), vitamins, immunosuppression

218
Q

PLE

A

low albumin and low globulin

Year 4 small animal (18 decks)

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