GI med 1 Flashcards
what are the general steps to obtaining a diagnosis/treatment plan for a GI issue? ie the steps for a GI workup
- get a good hx (incl diet hx)
- what is the primary complaint?
- acute vs chronic?
- PE
- differential list
- consider therapeutic trial vs diagnostic tests
what is the most important part of the GI workup?
good history!
dietary indiscretion is usually ____ and dietary intolerance is usually ___.
acute, chronic
what are some causes of dietary indiscretion?
- recent and sudden diet change
- feeding of table scraps
- free roaming behaviour
- excessive ingestion of hair
- feeing a low-quality poorly digestible diet
usually acute!
what are some causes of dietary intolerance?
- “allergy”
- inability to digest
- difficult digestion
usually chronic, usually no urgency markers
if the patient’s main complaint is dysphagia, then what is most likely the inciting cause?
oral cavity/laryngeal/upper esophageal disease
what is vomiting indicative of?
primary or secondary GI disease
what is regurgitation indicative of?
swallowing of esophageal problems
tell me the difference between SI and LI bowel diarrhea
1. stools
2. mucus
3. blood
4. fat
5. vomiting
6. gas
7. weight loss
SI / LI
- large, no tenesmus, 2-3x/day / small, tenesmus, >3x/day
- no / yes
- melena / fresh
- sometimes / no
- sometimes / not usual
- sometimes / not usual
- often / not usual
true or false: acute signs are sometimes self-limiting
true
true or false: dysphagia and regurgitation disorders are usually separate from other GI disorders and are also more urgent
true
what is the difference b/t primary and secondary GI disease?
primary: causes within the GI system
secondary: causes outside GI diseases affecting GI
what are some ddx for regurgitation?
- esophagitis
- hiatal hernia
- ring anomalies
- neoplasia
- FBs
- megaesophagus
- GERD
- MG
true or false: dental disease is an important cause of GI disease
false!!! it is NOT
true or false: GI ulcers are not common in cats and dogs unless predisposing factor
true
when should you consider a therapeutic trial?
for vomiting, diarrhea, ± anorexia if no GI urgency markers
what are the GI urgency markers? what do they mean?
means you need to do diagnostics!
- unstable pt
- marked or rapid weight loss
- concerning PE findings: ex painful abdomen
- hypoproteinemia
- abdominal effusion
- hypovolemia, hypotension, hypoperfusion
- anorexia if prolonged (>1-2d)
- intractable vomiting
- older age
you have GI symptoms with no GI urgency markers and decide to do a therapeutic trial. your patient has acute vomiting. what are your next steps?
- NPO trial
- GI diet
- ± probiotics
- ± anti-emetic
- ± deworm (fenbendazole, for young animals)
you have GI symptoms with no GI urgency markers and decide to do a therapeutic trial. your patient has acute diarrhea. what are your next steps?
- probiotics
- GI diet
- ± deworm (fenbendazole, for young animals)
you have GI symptoms with no GI urgency markers and decide to do a therapeutic trial. your patient has chronic vomiting. what are your next steps?
- elimination diet
- ± deworm (fenbendazole, for young animals)
- ± probiotics
you have GI symptoms with no GI urgency markers and decide to do a therapeutic trial. your patient has chronic diarrhea. what are your next steps?
- elimination diet
- probiotics
- ± deworm (fenbendazole, for young animals)
- fibre if large bowel
- ± Abx (tylosin)
a GI diet is usually used for ____ conditions, and an elimination diet is usually used for ____ conditions.
acute, chronic
what is a GI diet? how long should you “prescribe” a GI diet in an acutely GI patient?
highly digestible or low fat diets, ~100% digestion and absorption in proximal GI
1 week, then transition to regular diet slowly
what is an elimination diet? how do you “prescribe” this diet to a chronic GI patient?
diet that aims to eliminate offending dietary component (diet change to more simple ingredients and no treats, or novel protein diet/hydrolyzed protein diet)
make sure pet only eats prescribed diet, min 6-8 weeks
should we be using Abx for acute diarrhea?
no not really… there’s no evidence that it works.
GI diet + probiotics work!
how do you do an NPO trial for an acutely vomiting patient with no GI urgency markers?
- NPO for 12 hours (if v+, consider diagnostics)
- small amounts of water every 2hr for 6hr (if v+, consider diagnostics)
- small amounts (meatballs, teaspoons) of GI diet in 4-6 meals/day for 2-3 days (if v+, consider diagnostics)
- if desired, reintroduce old diet slowly
what anti-emetic is great for acute vomiting?
maropitant
for failed therapeutic trials, what should you do?
acute:
- rads, US
- cbc/chem/UA
- GI panel, endocrine testing
chronic:
- full lab work, GI panel, endocrine testing, GI biopsies, rads/US
- referral
describe briefly the normal swallowing stages
- oral stage: food in mouth, goes to oropharynx
- pharyngeal stage: tongue pushes bolus to caudal pharynx, pharyngeal constriction of bolus to upper esophageal sphincter (UES)
- cricopharyngeal stage: relaxation of cricopharngeal muscles, bolus goes into esophagus
what are the C/S of dysphagia?
- exaggerated head movement
- exaggerated prehension
- dropping food
- coughing, aspy pneu pneu
- gagging, retching
- drooling
- regurgitation
what are the ddx for dysphagia?
- severe periodontal dz
- oral/pharyngeal masses
- congenital (cricopharyngeal dysphagia)
- neuro disease
the lower esophageal sphincter (LES) at the level of the diaphragm is made of ____ muscle in dogs and ___ in cats.
dogs: longitudinal striated
cats: smooth
gastroesophageal reflux can lead to ____.
esophagitis
what causes gastroesophageal reflux?
secondary to transient or permanent changes in barrier between esophagus and stomach (LES incompetence, hiatal hernia, motility disorders, FBs, vomiting, GERD, tetracycline + clindamycin in cats)
what are the contributing factors to gastroesophageal reflux?
- anesthetic agents
- prolonged fasting (>24h)
- intra-abdominal sx procedures, abd pain, GDV, gastric dilation
what are the C/S of esophagitis?
- humans = heartburn
- anorexia
- ptyalism
- regurgitation
- retching, gagging
- coughing
- aspy pneu pneu
- repeated swallowing motions
- discomfort
- lethargy
- weight loss
- cats: vocalize loudly after eating
many animals are subclinical!!!
how do you dx esophagitis?
hx, C/S, thoracic rads
± endoscopy, contrast radiograph (Barium)
how do you treat esophagitis?
omeprazole!!!
proton pump inhibitors (PPI)
how do you diagnose esophageal FBs?
hx, rads, endoscopy
how do you tx esophageal FBs?
removal by endoscopy, pushing it into the stomach for acid to break down
what is a common sequela of esophagitis
esophageal strictures
how do you treat esophageal strictures?
balloon dilation
what is a hiatal hernia?
repeated protrusion of abdominal contents through the esophageal hiatus of the diaphragm into the thorax
mostly congenital
hiatal hernias cause ____ LES tone, leading to ____, ______, and ______.
reduced
regurg, esophagitis, aspiration
how do you treat hiatal hernias?
medically:
- acid suppression (PPI = omeprazole)
- diet (low fat)
- pro kinetics
- LES tone mod (cisapride)
surgically:
- reduction (hiatal plication)
what is a persistent right aortic arch?
embryonic right aortic arch (rather than left 4th aortic arch) becomes functional adult aorta
causes circular entrapment of esophagus by aorta on right, ligamentum arteriosum on the left
what are the typical C/S of PRAA?
regurg when fed solid food, malnourished, underdeveloped, aspy pnue pneu
young animals (dogs)
how do you diagnose PRAA
rads
- tracheal deviation to L in V/D, notch in ventral or dorsal border of esophagus in lateral, proximal megaesophagus
contrast radiography (barium), fluoroscopy
how do you treat PRAA?
surgery
what is the most common cause of regurgitation in dogs?
megaesophagus
what are some causes of secondary megaesophagus?
PRAA, chronic esophagitis, myasthenia gravis, Addison’s, hypothyroidism
how do you treat megaesohpagus?
acute: broad spectrum Abx (aspy pneu pneu), raised feedings, nutritiona support
chronic: feeding in elevated position, prevent weight loss, timing of feeding, encourage esophageal emptying (maintain elevation for a while after eating), promotability drugs (unproven), treat primary condition
