GI disease Flashcards
Classifications of GI disease
By anatomical location
Functional vs mechanical
Increased motility, decreased motility, altered digestion, altered absorption
Intestinal accidents, obstructions, chock and fistulas ……
Congenital vs acquired
Inflammatory vs Non-inflammatory
Infectious vs noninfectious
Halitosis
Bad breath
Dysphagia
Difficulty swallowing
Oral masses
Relatively common in dogs and cats
May or may not be malignant
Common masses are
Epulis
Squamous cell carcinoma
Oral melanoma
Fibrosarcoma
Oral papilloma
Stomatitis is and causes
Inflammation of the mucous membranes of the oral cavity
Causes
Trauma uremia
Periodontal disease
Autoimmune disease
Infection
Oronasal fistulas etiology
Congenital: cleft palate
Acquired: trauma, base narrow lower canine teeth, periodontal disease or iatrogenic
Clinical signs of oronasal fistulas
Clinical signs/complications depend on the cause of the fistulas
Asymptomatic
Tooth root abscess → may extend into nasal cavity and cause rhinitis and nasal d/c
Pain
Aspiration pneumonia
Congenital cleft palate causes, c/s and treatment
May include the lip, hard and soft palate
Occurs in all veterinary species
Several causes
Brachycephalic breeds, folate deficiency, teratogens
Clinical signs?
Trouble nursing
Milk coming out of nose
Treatment
Stomach tube neonates to prevent aspiration pneumonia and ensure caloric requirements are met
Surgical repair
THESE ANIMALS SHOULD NOR BE BRED!!!!!
Regurgitation is
a passive process. The food has not reached the stomach. Bile is never present, there are no pro-dromal signs. The glottis does not automatically close
This can cause aspiration pneumonia and choking
Vomiting def
an active process. There are abdominal contractions prior to and during vomiting. Bile may be present in the vomitus. Glostic closes
Regurgitation can be caused by
Esophageal motility problem
Megaesophagus
Congenital vs acquired
Diaphragmatic herniation of the stomach
Esophageal obstruction
Esophageal foreign body/ “Choke” in horses
GDV (gastric dilatation and volvulus)
Esophageal strictures
Vomiting can be caused by
Dogs, cats and pigs
Several underlying causes- may be a primary GI problem or secondary to an issue somewhere else in the body
Some animals are more prone to vomiting while other have “gut of steel”
Cats will vomit if you look at them funny, or are upset with you, or you didn’t get them the “good” treats
Horses, ruminants and some exotic pets can not vomit
Hematemesis
Vomiting up blood
Common causes of vomiting
Dietary indiscretion
Gastroenteritis
Infections
Parasites
Pancreatic disease
GI foreign body
Dietary intolerance
Renal disease
Liver disease
Side effect of many medications
Toxicities
Neoplasia
Diagnostics to determine what is wrong when vomit/regurg
Dependent on signalment, history, clinical signs and physical exam findings
May include
Labwork
Imaging
+/- contrast studies
Diet trials
Exploratory laparotomy
Biopsies
Treating vomit
Depends on underlying causes
Address the primary problem
Anti-emetics
Fluid support if indicated
Bland diets
Surgery if indicated
Specific medications
Treatment for regurg
Feeding in an upright position
Feeding “meatballs”
Surgery
Medications
Acute abdomen is
Severe abdominal pain
Fast onset
The more severe the pain the worse the prognosis, and the higher the likelihood that surgery will be indicated
May be accompanied by vomiting in small animal species
Perception of pain in the abdomen
Pain perception in the abdomen is very different than on the surface of the body
Pain is perceived with:
Distension or spasm of the GI tract- very intense pain
Traction
Torsion
Inflammation of the GI tract or peritoneum (peritonitis)
Vascular compromise
Causes of acute abdomen
Severe enteritis
GI foreign body/Impaction
GI torsion or entrapment
Performing GI ulcers
Pancreatitis
Peritonitis
Urolithiasis
Liver disease
Pyometra
Treatment for acute abdomen
Medical vs surgical management
Pain control
Circulatory support - IVF
Other medications
Dietary management
Stool softening agents
Magnesium sulfate orally
Mineral oil orally
Oral or IV fluids
Primary causes of peritonitis
Virus or bacteria gains entry through the gut or respiratory tract
It travels through the blood and localizes the peritoneum
Other membranes (pericardium, pleura and joints) may also be affected
Secondary causes of peritonitis
Perforating ulcer
Devitalized gut
Organ rupture
Egg yolk peritonitis in birds
Pancreatitis
Clinical signs of peritonitis
Abdominal pain
Reluctance to move
Abdominal distension
Fever
Anorexia
Depression
Increased HR
May be difficult to differentiate from back pain
Paralytic Ileus is caused by
Temporary cessation of peristalsis
Caused by:
Handling of the GIT
Peritonitis
Electrolyte imbalances (low K or Ca)
Paralytic Ileus c/s
Post operative patient- most common signalment observed by RVTs
Signs
No intestinal sounds on auscultation
Nausea, anorexia, vomiting
Mild abdominal discomfort
Minimal to no feces produced
Incision site may be swollen or draining
What to do if you notice paralytic Ileus
Alert DVM!
IV fluids, K+ supplementation
Nasogastric tube +/- suction to relieve fluid build up
Adequate pain control
Intestinal stasis in rabbits is caused by
Monogastric, hindgut fermenters - what other domestic species does this describe?
Fibrous diet is required to promote gut motility
Obstruction can occur if gut motility is disrupted
Inappropriate diet (high carbohydrate, low fiber)
Dehydration
Stress
Pain
Acute gastritis and gastroenteritis is caused by
Inflammation of the stomach
SI also often involved
Several underlying causes
Dietary indiscretion
Sudden diet changes
Infections - bacteria, viruses, parasitic
Toxins
Ingestion of foreign materia
Acute gastritis and gastroenteritis clinical signs
Anorexia
Nausea and vomiting
+/-
Diarrhea
Abdominal pain
Dehydration
Acute gastritis and gastroenteritis treatment
Bland diet
Small frequent meals
Anti-emetics
Other…
Gastric ulcers are and risk factors
Superficial to deep
The submucosa is exposed to stomach acids
Risk factors
Treatment with NSAIDs
Finely ground feed - Pigs
Stress
Exercise
Gastric ulcers c/s
Subclinical → death
Bruxism
Ptyalism
Decreased appetite
Melena
Hematemesis
Abdominal discomfort
Septicemia
Treatment of gastric ulcers
Antacids
Gastroprotectants
Discontinue medications contributing to ulcer formation
NSAIDs, steroids
Aggressive surgical therapy required with ulcer perforation - prognosis guarded
Intestinal obstructions can be caused by
Foreign material
Mass
Neoplasia, abscess, granuloma
Gastrointestinal accidents - a sudden change in structure of the intestine
Intussusception
Mesenteric torsion
Incarcerations
Gastric Dilation of Volvulus (GDV)
c/s of intestinal accidents and treatments
Clinical signs
Peracute - acute and very painful
Vascular compromise causes damage to gut wall
Shock
Death
Treatment
Surgery or euthanasia
Treatment for foreign bodies
Medical management or surgery
Diarrhea is
Digestion and absorption of nutrients occurs primarily in the small intestine
Bile and pancreatic enzymes enter the gut lumen at the proximal duodenum
The mucosa of the small intestine is lined with microscopic villi that increase the surface area of the gut to aid in absorption of nutrients
Absorption of fluids occurs in the large intestine and to a lesser extent the small intestine
All species are affected
Diarrhea is a clinical sign, not a diagnosis
Several underlying etiologies
Needs to be addressed quickly in neonates
Peracute to chronic
Etiology of diarrhea
Infectious
Bacterial, viral, protozoal, parasitic
Dietary indiscretion
Immune mediated
Inflammatory
Neoplasia
Toxin/Irritant
Side effect of many medications
Secondary to a medical condition occurring somewhere else in the body
Addison’s disease, exocrine pancreatic insufficiency, liver disease, heart failure…..
Secretory diarrhea
Abnormal amounts of fluid are secreted into the gut
Some bacteria (E.coli) and viruses will produce toxins that cause the cells of the gut to secrete water and electrolytes into the lumen
Malabsorrptive diarrhea
The ability of the gut to digest ingesta is impaired
Absorption of fluids and nutrients is reduced
May cause osmotic diarrhea
This may be due to villous atrophy, damage to the cells of the villi and villous fusion
Inflammatory diarrhea
Vascular and lymphatic drainage into the lumen
Damage to the villi and crypts
Loss of water, electrolytes and bicarbonate
There may be more than one process going on
Small bowel diarrhea
Large volume
Infrequent
Weight loss
Melena
Large bowel diarrhea
Small volume
High frequency
Frank blood (hematochezia) or mucous
Urgency
Straining
Treatment of diarrhea
Treat dehydration and ongoing losses
Electrolyte replacement
Correct acid base disorders
Antibiotics, parasiticides
Anti-inflammatories
Bland diet
Probiotics
Toxin absorbers
Environmental management
Identify and correct the underlying cause
Prevention
Constipation
when an animal is having difficulty having a bowel movement
Obstipation
when an animal is not able to pass feces
Causes of constipation
Dehydration- often secondary to chronic renal failure in cats
Due to reduced peristalsis
Decreased feed intake
Electrolyte imbalances
Drugs: opioids
Foreign material
Lack of fiber in diet- bulks up feces which stimulates motility
Pelvic abnormalities- may be due to previous trauma
Neoplasia
Megacolon in cats
Treatment of constipation
Rehydration
Laxatives
Warm water, sodium triphosphate (fleet) enemas
Dietary management
Also increase water intake
Prokinetic agents
Surgical management
Hepatic physiology
The liver performs several important functions
Production of proteins
Coagulation
Digestion
Metabolism and storage of nutrients
Metabolism of drugs and toxins
Extramedullary hematopoiesis
Metabolism of hemoglobin
Properties of the liver
Has the ability to regenerate
Large reserve capacity
At least 60-80% must be non-functional before clinical signs are evident
Once clinical signs are present, underlying cause needs to be identified and dealt with quickly
It is susceptible to injury
Classification of liver path
Underlying etiology
Severity
Time frame
Type of pathology present
What can cause liver disease
Infectious
Bacteria, fungus, viruses, parasites
Toxins
Drug induced
Phenobarbital, steroids, oral diazepam in cats
Nutritional deficiencies
Neoplasia
Ischemia
Genetic
Copper storage disease
Inflammatory
Idiopathic
Secondary to other conditions
Biliary obstruction, fatty liver syndrome, Cushing’s disease
Others
Severity of LD
Subclinical
Minor damages can occur due to many causes. The animal does not show clinical signs but there may be elevations of liver enzymes on blood work
Mild clinical → fatal disease
Hepatitis pathology
Inflammation secondary to infectious (often viral)
Hepatic lipidosis pathology
Anorexic cats and pregnant to lactating animals
Hepatic necrosis pathology
Secondary to toxins or infection (ex.viruses)
Neoplasia
Common site for metastasis
Clinical signs for hepatic disease
Many are non-specific
Anorexia
Lethargy
Vomiting
Diarrhea
Weight loss
Fever
Decreased production
Jaundice
Abdominal pain
Hepatic encephalopathy
Photosensitization
Petechia or abnormal clotting
Ascites
Diagnostics for hepatic disease
Blood work
Liver enzymes, bile acids, compounds produce by the liver
Ultrasound examination
FNA
Biopsy
Ultrasound guided or surgical
Treatment for hepatic disease
The goal is to minimize fibrosis and to maximize regeneration
Based in underlying cause
Antibiotics, antifungals, anti-inflammatories, removal of toxin, discontinue medications
Hepatic encephalopathy- mineral oil, lactulose, neomycin/metronidazole
Pancreatitis is
Inflammation of the pancreas due to early activation of pancreatic digestive enzymes in dogs
Infectious component more likely in cats
Acute and chronic forms
Acute flare ups can be quite severe
Most prevalent in obese animals
Middle aged to older animals
Breed predisposition- yorkie, min schnauzer
Dogs and cats are affected
Pancreatitis causes
Dogs- often associated with high fat meal
Genetics- trypsinogen may be more prone to self activation
Direct trauma
Infection
Part of feline triaditis
Infectious component much more common due to GI translocation
Clinical signs of pancreatitis and treatment
Clinical signs
Lethargy
Cranial abdominal pain
Play/Pray stance
Anorexia
Vomiting +/- diarrhea
Treatment
IV fluids
Antiemetics
Diet change
Low fat diet- dogs
Hypoallergenic diet- cats
Pain control
