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Small animal medicine > GI-lecture 1 > Flashcards

GI-lecture 1 Flashcards

1
Q

What are the main goals of GI medicine?

A

Determine if primary GI or secondary GI
Determine if severe or if treat’em street’em is good enough
Establish an etiological diagnosis

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2
Q

Why is history important with GI disease?

A
  1. signalment
  2. signs
  3. duration
  4. severity
    e. g. what did it look like to begin with–small bowel diarrhea –maldigestion, malabsorption–>large bowel diarrhea–>urgency, defecation in the house–>owner notices
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3
Q

How do you differentiate vomiting and regurgitation?

A

vomit
1. actively vomiting
2. bile
3 acidic (may have bicarb from intestine, may not be acidic)
4. digested food (depends length of time since feeding)
5. prodromal

regurgitation

  1. passive act
  2. no bile
  3. non-acidc
  4. undigested food
  5. no progromal signs
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4
Q

What features do you use to differentiate small vs large bowel diarrhea?

A
  1. frequency (high with large bowel)
  2. urge (large bowel)
  3. volume (large bowel–each bowel movement smaller, small bowel each bowel movement larger)
  4. mucous (large bowel)
  5. frank blood (large bowel)
  6. melena (upper GI)
  7. weight loss (usually small bowel–maldigestion, malabsorption. can occur with large bowel if so severe animal is not eating)
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5
Q

What are the features of a good physical exam?

A
  1. thorough! Includes rectal!!
  2. nose to tail
  3. looking not only for information on primary GI problems but also to ensure no other concurrent illnesses
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6
Q

What are general things you look at with a good physical exam?

A
  1. mentation
  2. TPR–e.g. aspiration complications
  3. mucus membranes (color, CRT)
  4. hydration–animal vomiting and diarrhea-dehydration
  5. general nutrition (weight)–chronic weight loss?
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7
Q

What are the things you look at with an oropharyngeal exam?

A
  1. teeth
  2. mucous membranes
  3. tongue–look under tongue! linear foreign body may be under base of tongue
  4. palate
  5. gag reflex
  6. sedation (tonsils, pharynx, larynx, epiglottis)
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8
Q

What are the things you want to focus on in the head and neck?

A
  1. salivary glands
  2. lymph nodes
  3. muscles of mastication
  4. esophagus
  5. thyroid gland
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9
Q

What are the things you want to focus on in abdominal palpation?

A
  1. liver (can elevate front of animal)
  2. pancreatic region (most dogs w/ pancreatitis painful, cats rarely 10%)
  3. stomach (and spleen)–GDV etc
  4. intestines (pain, thickness, consistency, positioning, mobility)
  5. colon, rectum–in cats constipation associated with vomiting, mucus pasing
  6. anal region (anal sac dz, perianal fistulas)
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10
Q

What are the things you want to focus on in rectal examination?

A
  1. fecal sample
  2. feel mucosa
  3. sublumbar lymph nodes
  4. anal glands
  5. urethra
  6. PROSTATE (if present)
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11
Q

What can be done with fecal exams?

A
  1. float (zinc sulfate etc)
  2. direct smear (clostridial spores, giardia)
  3. fecal fat, fecal occult blood
  4. giardia elisa
  5. parvovirus elisa (false positive, false negatives)
  6. electron microscopy
  7. culture (campy, salmonella, e. coli with typing)
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12
Q

What should you do on standard lab evaluation? why?

A
  1. CBC: anemia, esoinophilia, stress leukgram, NRBC, basophilic stippling
  2. SERUM CHEMISTRIES: electrolytes, protein losing dz, secondary causes
  3. URINALYISIS: protein loss, urobilinogen?
    in more chronically, severely sick animals
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13
Q

What are ancillary lab tests?

A
  1. amylase, lipase–not specific
  2. TLI (trypsin, trypsinogen)-dogs EPI, cats: EPI and pancreatitis?
  3. PLI more specific test, though still false positivies–not that good, doesn’t change what would do in cat
  4. cobalamine (decreased in SIBO, may be needed t tx of some GI dz)
  5. folate (incresed in SIBO)
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14
Q

Why do you measure cobalamine?

A

small intestine bacterial overgrowth it is decreased. May need to give cobalamine in dog with GI dz in tx?

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15
Q

Why is fPLI in cats not useful?

A

there is a wide variation in sick and nonsick animals. very hard to interpret. Does not tell you animal is sick because the pancreas is sick. Could have elevated PLI due to foreign body. Could make you miss other diagnoses.

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16
Q

What are two types of radiography that can be done?

A
  1. plain radiographs

2. contrast studies

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17
Q

What are types of contrast studies?

A
  1. barium swallow–worry about with surgery–foreign body, holds bacteria, difficult to get all out-sticks to stuff
  2. positive contrast gastrogram
  3. double contrast gastrogram
  4. barium series
  5. BIPS
  6. barium enema
18
Q

Why may dogs have a lot of air in stomach with esophageal issues?

A

breathe faster, swallow a lot of air, get a lot of air in esophagus, stomach

19
Q

What can you use ultrasonography for?

A
  1. visualize extraintestinal organs
  2. assess mural thickness
  3. assess lymph nodes size
  4. find fluid, foreign bodies–if fluid in abdomen, likely surgical, can also tap
20
Q

Why is it good to U/S bowel loops?

A

see if focal or generalized disease, see what layers affected e.g. a thickened muscularis may be infiltrative dz or inflammation

21
Q

What are the pros and cons of exploratory surgery?

A

pros

  1. entire GI tract accessible
  2. better biopsies
  3. can do other biopsies concurrently

cons

  1. more invasive
  2. more difficult to evaluate lumen????
22
Q

What should you do with exploratory surgey if everything is normal?

A

Take BIOPSIES!

  1. liver and bile culture
  2. stomach and intestine (duodenum, jejenum, ileum) NOT COLON
  3. pancreas? spleen?
  4. lymph node biopsy
23
Q

Why is it important to biopsy multiple regions of GIT?

A

because there are diseases that are only in one region and not another. DON’T just biopsy the apparently dz location

24
Q

Why don’t you biopsy colon?

A

the complication rate is much higher with biopsy of colon (even normal colon). Go rectally instead

25
Q

What is the reason for an exploratory?

A

not JUST for a foreign body. Explain that it is an exploratory RATHER than a foreign body hunt!

26
Q

Why do you have to be careful biopsying the spleen?

A

difficult to stop bleeding

27
Q

What are the pros and cons of endoscopy?

A

pro

  1. can detect morphologic dz
  2. less invasive than exploratory
  3. can visualize lumen

con
1. limited area that can be reached

28
Q

What is PAS stain specific for?

A

specific for mucous

29
Q

What are salivary mucocele?

A

accumulation of salivary fluid in subQ tissue

30
Q

What are causes of salivar mucoceles?

A
  1. trauma e.g. chew on sticks or bones
  2. neoplasia
  3. sialolith
  4. sialoadenitis
31
Q

What salivary glands are typically affected

A

sublingual

32
Q

What are the parts of the sublingual gland?

A

monostomatic and polystomatic

33
Q

What are common locations of salivary mucoceles?

A
  1. cranial cervical
  2. tongue (ranula)
  3. pharyngeal
34
Q

How do dogs with pharyngeal mucocele present?

A

dyspnea? dysphagia?

35
Q

How common are salivary mucoceles in glands other than sublingual?

A

rare, worry about neoplasia

36
Q

What are methods of treatment of mucoceles?

A

Removal of entire gland
Maybe could put a drain in until duct heals
Maybe could drain down completely and see if duct heals
only 10-15% will cure without surgery

37
Q

How are mucoceles treated?

A

remove affected glands: mandibular/sublingual complex

drains in the mucocele

38
Q

What will happen if only take out the mandibular gland and not sublingual?

A

will reoccur

39
Q

What are structures you want to avoid with mucocele surgery

A
  1. facial nerve, lingual nerve, hypoglossal nerve

2. carotid artery, jugular vein

40
Q

How should you treat a mucocele ranula?

A

marsupialize the ranula–make an incision and sew inside lining to outside so it does not close

41
Q

Why do you put drains in the cervical portion of a mucocele?

A

to drain the area so fluid does not accumulate over time

Small animal medicine (12 decks)

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