GI med 2 Flashcards
what is “acute gastroenteritis” or acute gastritis? what are the typical clinical findings? what are important ddx?
sudden gastric insult causing vomiting
V+, ± hematemesis, anorexia, nausea, d+
primary GI!!: dietary indiscretion, ± infectious, ± intoxications
(secondary GI less common)
how do you dx acute gastritis
C/S, hx, PE ± MEDB
usually no GI urgency markers
how do you tx acute gastritis
therapeutic trial (NPO!)
what is “chronic gastroenteritis” or chronic gastritis? what are important ddx?
also called what?
chronic, intermittent or daily vomiting
dietary intolerance (hypersensitivity; allergy) - cause rarely ID’d
food responsive enteropathy
what is the tx for chronic gastritis
therapeutic trial
tell me about the two different types of hypoallergenic diets
hydrolyzed: enzymatic hydrolysis –> produce low molecular weight protein hydrolysates
novel protein: protein source that animal should not have had contact with
failed trial? GI urgency markers? what do??
GI diagnostics!
abd rads, abd US, endoscopy, surgical biopsies, GI blood panel, fecal float, Giardia or deworm (if baby)
do fecal cultures work for when you have an animal with GI urgency markers or an animal that fails a therapeutic trial?
nope! dont do.
true or false: like humans, H. pylori causes gastric ulcers in small animals
false!! it does NOT
true or false: Helicobacter pylori causes chronic vomiting that responds to therapeutic trials
false. it causes chronic vomiting that does NOT respond to trials
how do you diagnose H. pylori in SA?
endoscopic or surgical gastric biopsy (histopath)
urease test (bac t produce urease) - not specific
what is the tx for H. pylori in SA
Metronidazole, amoxicillin, famotidine ± pesto-bismol, ± omeprazole
why might a Basenji be chronically vomiting?
hypertrophy of funds mucosa
why might a brachycephalic be chronically vomiting?
hypertrophy of pyloric mucosa –> gastric outflow obstruction
why might a Lundehund be chronically vomiting?
protein-losing gastroenteropathy; atrophy of gastric mucosa; adenocarcinoma
what fungal agent in south of US and South America causes chronic vomiting in animals?
pythiosis
what are delayed emptying/motility disorders?
normal gastric emptying: organized interaction of smooth muscle with neural and hormonal stimuli
delayed emptying: outflow obstruction or defective propulsion
- typical presentation: vomiting food 8-16 hr after meal
what is the typical C/S and hx of delayed gastric emptying/motility disorder?
C/S: vomiting food many hours after a meal (looks barely digested)
hx:
- brachycephalic (pyloric hypertrophy)
- older, weight loss, hematemesis –> neoplasia
- cats + hairballs
what are some common causes of delayed gastric emptying/motility disorders?
- pyloric hypertrophy**
- neoplasia*
- pancreatitis*
- recent sx
- certain drugs
- idiopathic**
- IBD
how do you dx delayed emptying/motility disorders?
- breeds at risk
- endoscopy, biopsy
- U/S
how do you tx delayed emptying/motility disorders?
directed at underlying cause if present
- pyloric hypertrophy –> sx
- dietary mods –> GI diet, wet food
true or false: it is normal for cats to cough up hairballs frequently
false. if increased frequency or weight loss, could be a sign of something more serious
what is the tx for frequent hairballs in cats?
(little evidence based)
- special hair ball diet (insoluble fibre or larger kibble)
- diet mod
- grooming
- smaller meals
- gastric lubricants (paraffin)
- pro kinetics
basically trial and error. if they’re getting worse or continuing, need other diagnostics
true or false: gastric ulcers are not common in cats and dogs unless there is a predisposing factor.
true!!!!
what are the causes of gastric ulcers in animals?
- decreased blood flow (shock, anesthesia)
- hyper secretion of acid (MCT, gastrinomas)
- NSAIDs and glucocorticoids***
- exercise-induced, stress
- Addison’s**
- aspirin, ibuprofen***
true or false: COX-2 selective agents are less ulcerogenic
true
what are the clinical findings of a SA with Gi ulceration
vomiting, hematemesis, melena
pale gums, abd pain, shock
how do you dx GI ulceration in SA?
CBC: regen anemia, (lack of stress leukogram in Addisons)
Chem: elevated BUN
rads, US, endoscopy (can see gastric ulcer), surgical biopsies
why is there an elevated BUN with GI ulceration in SA?
breaking down blood (protein), sending to liver, makes BUN
how do you tx gastric ulcers in SA?
- IV fluids, resuscitation (shock)
- GI protectants
- anti-emetics (metoclopramide, maropitant)
- Abx
- opioids for pain (bupe, methadone, hydromorphone)
what GI protectants are there for Gastric ulcers?
- PPI (omeprazole, pantoprazole)
- misoprostol (PGE2 analog)
- sucralfate
what is bilious vomiting syndrome? ie. what is the pathogenesis?
dogs
chronic intermittent vomiting of bile secondary to reflux into stomach
reasons not understood
what are the C/S of bilious vomiting syndrome?
vomiting early morning of bile
how do you dx bilious vomiting syndrome?
C/S, rule out other causes
how do you tx bilious vomiting syndrome?
meal late at night, antacids
if no response, consider additional workup to rule out other conditions
what is hemorrhagic gastroenterocolitis (HGE)? AKA acute hemorrhagic diarrhea syndrome
it’s a syndrome, the cause is usually unknown… could be:
- acute hypersensitivity reaction
- C. perfringens
mixture of V+, small and large bowel D+, hematochezia
what is the typical clinical presentation of hemorrhagic gastroenterocolitis? C/S, test results, clinical findings, etc
V+, SI and LI D+, hematochezia, acute abdomen, shock/hypovolemia
acute dehydration, hemoconcentration, protein loss (PCV and TS similar in value!!!)
how do you dx and tx hemorrhagic gastroenterocolitis?
dx: C/S, hx
tx: treat shock, NPO is v+, gastro diet, probiotics
px good, improvement within hours
true or false: canine parvovirus (CPV-2) is:
a) highly contagious
b) aerosol transmission
c) vaccination prevents
d) more common in summer
a) true
b) false. fecal-oral
c) false. vax protects, reduces severity
d) true
what cell tropism does canine parvovirus love?
rapidly-dividing cells (intestines, BM)
what are the C/S of canine parvovirus?
- 4-7 days after infection
- typical situation: puppy recently adopted!!! weaning-6mo
- acute v+, d+, hematochezia, hematemesis, depression, febrile or hypothermia, abd pain (intussusception)
how do you dx Parvo in dogs?
CBC: leukopenia, anemia
chem: panhypoproteinemia
fecal antigen ELISA (can take up to 10-12 days after infection to become positive ….. retest!!)
vaccination can cause false positive on ELISA
how do you tx canine Parvo? (also feline Parvo/feline panleukopenia)
supportive (nutritional ASAP)
plasma or albumin transfusions (plasma = no proven benefit?)
pain meds (opioids)
monitor
feline panleukopenia is caused by…?
parvovirus
mortality 50-90%
similar tx as canine Parvo
canine and feline coronavirus causes what C/S?
usually self-limiting d+, although in cats can mutate to FIP
feline panleukopenia (parvovirus) causes ____ before birth
cerebella hypoplasia
what are the C/S and risk factors for Giardia?
C/S: small or large bowel d+ or recurring d+, vomiting
risks: young, immune compromise, shelters, kennels, pet stores
how do you diagnose Giardia?
3 zinc sulfate floats, or ELISA or PCR
how do you tx Giardia?
fenbendazole
(metronidazole less effective)
true or false: Giardia is zoonotic
true
food hypersensitivities (allergies) typically cause what type of disease?
chronic SI disease with often with derm signs
how do you dx and tx food hypersensitivities ?
hypoallergenic diet trial 6-8 weeks
what breed has gluten-sensitive enteropathy?
Irish Setters
What is ARD? what is it’s other name? what is the pathogenesis?
antibiotic-responsive diarrhea
SIBO: small intestinal bacterial overgrowth
dysbiosis, causing malabsorption syndrome and diarrhea
who gets primary ARD?
young GSD, local IgA deficiency
what causes secondary ARD?
- abnormal GIT, motility disorder
- chronic enteropathies
- acute enteropathies
- meds, diet
what are the C/S of ARD/SIBO?
small bowel diarrhea ± vomiting, weight loss, borborygmi, flatus, decreased appetite
how do you diagnose ARD/SIBO?
eliminate other causes, esp EPI
folate (elevated), cobalamin (low)
how do you tx ARD/SIBO?
- metronidazole, tylosin 4-6 wks
- diet change
- cobalamin SC if needed
what is EPI? what are the causes/pathogenesis?
exocrine pancreatic insufficiency
insufficient synthesis and secretion of pancreatic enzymes
primary (dogs, autosomal recessive): GSD, Eurasians, rough-coated collies
secondary (cats): old age, chronic pancreatitis, more rare!
what are the C/S of EPI?
steatorrhea (not always), voluminous loose stools, weight loss, increased appetite
how do you diagnose EPI
low TLI (sensitive + specific!!)
how do you tx EPI
- pancreatic enzyme supplementation with food!
- cobalamin supplementation as needed
- high-quality diet
