GI medicine Flashcards
chelitis
inflammation of lips
glossitis
inflammation of tongue
gingivitis
inflammation of gums
stomatitis
inflammation of oral mucosa
gingivostomatitis
inflammation of gums and oral mucosa
dysphagia
difficulty swallowing
odynophagia
swallowing pain
regurgitation
passive return of food, water or saliva due to oesophageal problem
ptyalism/hypersalivation
overproduction of saliva
(due to pain or disease in the mouth)
pseudoptyalism
drooling despite normal amount of saliva production
(lip/mouth conformation or swallowing problem)
clinical signs of oropharyngeal disease
- dysphagia
- odynophagia
- drooling saliva +/- blood
- can be due to nausea
- halitosis (bad breath)
- dental disease
nursing considerations for physical exam
- restraint needed
- temperament, pain opening mouth?
- equipment
- lighting, swabs, forceps
nursing considerations for investigation
- sedation/GA
- intubation challenges
- visualisation, obstructions, brachycephalics
- blood tests
halitosis
bad breath
epulis
benign oropharyngeal neoplasia
diagnostics of oropharyngeal disease
- dental radiography
- loss of bone in neoplasia
- check for metastasis
- needle aspiration/biopsy
treatment of oropharyngeal disease
- neoplasia
- surgery, radiation, chemo
- remove foreign body
- wound management
- anti-inflammatories
- antibiotics
nursing considerations for oral disease
- barrier nursing (infectious)
- analgesia
- nutrition (oral, tube feeding)
- oral rinses
regurgitation as a clinical sign
- hallmark of oesophageal disease
- undigested food (saliva covered)
- solid or liquid
- fresh blood if ulcerated
- neutral pH
vomiting as a clinical sign
- gastric and upper intestinal content
- may be caused by gastrointestinal or extra-gastrointestinal disease
- acidic pH
- neural reflex
secondary problems of regurgitation
- malnutrition
- dehydration
- anorexia/polyphagia
- reflux pharyngitis/rhinitis (inflamed pharynx/nasal cavity)
- aspiration pneumonia
- swallowing pain
oesophageal disease diagnostics
- physical exam
- chest x-rays (conscious, oesophageal fluoroscopy)
- sedation/GA can cause dilation
- haematology, biochemistry
- oesophagoscopy
causes of regurgitation
- oesophagitis
- oesophageal obstruction
- intraluminal= lumen obstruction
- intramural= inside wall
- extraluminal= outside oesophagus
- megaoesophagus= dilation
oesophagitis causes
- ingestion of:
- caustics, hot liquids, foreign bodies, irritants
- gastro-oesophageal reflux
- persistent vomiting
leads to oesophageal strictures
gastro-oesophageal reflux
- reflux of gastric acid and enzymes into oesophagus leading to inflammation
- during anaesthesia
- hiatal hernia
oesophagitis clinical signs
- pain
- regurgitation
- anorexia
- hypersalivation
- weight loss
feeding considerations for oesophagitis
- oesophageal rest?
- reintroducing food
- soft, bland, frequent
nursing considerations for oesophagitis
- monitor pain
- ease of medicating
- liquid antacid/coating agents
- drugs to reduce further reflux
megaoesophagus
- idiopathic
- myasthenia gravis
- generalised muscle problem
- focal dilation (congenital)
- vascular ring anomaly
management of megaoesophagus
- postural feeding
- raised front end
- slurry liquidated food
haematochezia
fresh blood in faeces
melaena
digested blood in faeces
tenesmus
straining to pass faeces
diarrhoea
increased faecal water content
dyschezia
difficulty passing faeces
stages of vomiting
- prodromal (nausea)
- retching
- expulsion
- relaxation
prodromal phase signs
- restless
- hypersalivation
- gulping
- lip-licking
retching phase
- salivation inhibited
- simultaneous, spasmodic contractions of resp muscles
- duodenal retroperistalsis
- duodenal contents enter stomach
expulsion phase
- pylorus contracts
- proximal stomach and lower oesophageal sphincter relax
- inhibition of breathing (glottis and nasopharynx close)
contraction - diaphragm descends towards stomach
- stomach squeezed and vomit forced up
- reduced upper oesophageal sphincter tone
relaxation stage
muscles relax
- diaphragm, abdominal, respiratory
- glottis and nasopharynx relax
- return of breathing
small intestinal diarrhoea
- large vol
- watery
- normal frequency
- often normal colour
- +/- melaena
large intestinal diarrhoea
- small vol
- increased urgency and frequency
- tenesmus, dyschezia
- +/- mucus
- +/- blood
gastritis
stomach
enteritis
small intestine
colitis
large intestine
gastro-enteritis
stomach-large intestine
entero-colitis
small-large intestine
gastro-entero-colitis
stomach, small and large intestine
phone triage- emergencies
- collapsed
- known/suspect toxicity
- unproductive vomiting
- visible bloating
questions to ask about vomit/diarrhoea
- productive/non productive?
- frequency? (gauge fluid loss)
- foreign material?
- haematemesis/melaena?
- SI or LI diarrhoea?
questions about patients history
- pre-existing medical disease
- medication
- pre-existing GI disease
- anthelmintic history (parasites)
- recent dietary change
- known scavenger
- clinical demeanour
- appetite/drinking
acute gastroenteritis considerations
- consider infectious causes if:
- young, unvaccinated, haemorrhagic diarrhoea, pyrexic, raw diet
- isolation and barrier nurse
mild concern causes of acute vom and diarrhoea
- dietary indiscretion
- adverse drug event
- parasites (roundworm, protoza)
high concern causes of acute vom and dirrhoea
- intoxications
- pathogenic enteric infections
-parvovirus, bacterial - acute pancreatitis
- surgical disease
- acute haemorrhagic diarrhoea syndrome
acute vom and diarrhoea emergencies
- surgical disease
- foreign body
- gastric dilation and volvulus (twist)
- stricture/obstruction
- intusussception
- intestine goes back into another piece
- incarceration (strangulated by mesentry)
acute gastroenteritis diagnostic tests
- history
- physical exam
- bloods (haem, biochem, electrolytes)
- faecal (parasitology, culture, parvo test)
- PLI (pancreatitis test)
- imaging
nursing considerations for diarrhoea
- clean and dry bottom
- prevent over-grooming
- tail bandage
- waste disposal
dietary advice for vomiting
- withhold food for 12-24hrs
- free access to water
- bland diet, little and often
dietary advice for diarrhoea
- continue feeding
- reduces risk of sepsis, increases rate of recovery
- bland diet
treatment of acute vom and diarrhoea
- antiemetics (only after obstruction is excluded)
- antispasmodics
- anthelmintic (worming agent)
- pups and kits
- NO NSAIDs
- prostaglandins needed in GI mucosa and renal blood flow
treatment of non-obstructive foreign bodies in stomach
- induce emesis
- apomorphine (dogs) xylazine (cats)
- endoscopic retrieval
- surgery
- bones will dissolve in gastric acid
treatment of non-obstructive foreign bodies in intestine
natural passage with radiographic monitoring
gastric dilation
- stomach fills with gas
- may progress to GDV (volvulus)
gastric dilation and volvulus
- torsion of the stomach
- splenic pedicle may twist
- impaired venous return to heart
telephone triage of gastric dilation and volvulus
- unproductive retching
- bloat
- stomach pain
- pale MM
- lethargic/collapsed
- deep chested, large breeds, middle aged-old
recommendations for dogs predisposed to GDV
- don’t exercise straight after eating
- raised food bowl (reduces aerophagia)
GD/GDV treatment
- aggressive fluid therapy
- immediate decompression (stomach tube, needle paracentesis)
- antibiotics
- surgery prep
protozoal (parasite) causes of vom and diarrhoea
- coccidia
- giardia (zoonotic)
- treated with fenbendazole)
tritrichomonas foetus
- young cats
- diarrhoea, peri-anal oedema, asymptomatic
- faeco-oral transmission
- colonic wash (PCR) to diagnose
- poorly responsive to treatment
- environment management
acute pancreatitis as cause of acute vom and diarrhoea
- inflammation of pancreas (sudden onset)
- idiopathic
- predisposed by: high fat food, hyperlipaemia, impaired perfusion, trauma
- release of pancreatic enzymes locally
- digestion of pancreas
clinical signs of acute pancreatitis
- inappetance, lethargy
- severe abdominal pain (prayer position)
- vom and diarrhoea
- bile duct obstruction (jaundice)
acute pancreatitis diagnostics
- ultrasound
- haematology, biochem
- pancreatic lipase immunoreactivity (PLI)
- snap test
nursing considerations of acute pancreatitis
- monitor hydration
- nutritional support (tube feeding)
- water available when vomiting controlled
- slowly introduce diet (low fat, highly digestible
acute pancreatitis treatment
- NO NSAIDs
- antiemetics
- antacids (omeprazole)
chronic pancreatitis
- repeated attacks of acute pancreatitis
or - chronic low-grade pancreatitis
- inappetance, lethargy, vom + diarrhoea
chronic pancreatitis management
diet modification
- highly digestible (complex carbs)
- low fat
nausea/appetite management
analgesia
borborygmi definition
gurgling
flatus definition
passing wind
ileus definition
reduced gastro-intestinal motility
anorexia definition
loss of desire to eat despite being physically able to
hyporexia definition
inappetance
polyphagia definition
excessive appetite
pica definition
appetite for non-nutritional substrates
- metal/concrete
- due to micronutrient deficiencies
secondary complications of anorexia
- weight loss
- impaired immune function
- increased risk of sepsis
- poor wound healing/slow recovery
how long until chronic diarrhoea and vom?
3 weeks
clinical signs of chronic GI disease
- altered appetite
- dehydration
- vomiting +/- blood
- diarrhoea +/- blood
- weight loss
- borborygmi/flatus
- abdominal discomfort
causes of primary chronic GI disease
- gastric ulceration
- dietary intolerance
- IBS
- gastric carcinoma
- GI lymphoma
extra-GI causes of chronic GI disease
- liver, kidney disease
- pancreatitis
- endocrine disease
diagnostics for chronic GI disease
- history/clinical exam
lab tests: - haem, biochem
- basal cortisol/total thyroxine
- pancreatic tests
- faecal analysis
- vit B9/12
imaging- radiographs/ultrasound
gastroscopy/laparotomy for biopsies
advantage of laparotomy biopsy
full thickness biopsies
disadvantage of laparotomy biopsy
surgical risk of dehiscence (splitting of GI tract)
advantage of endoscopic biopsy
minimally invasive
disadvantages of endoscopic biopsy
- small biopsy (internal wall of GI tract only)
- may not reflect jejunal disease
chronic enteropathies definition
chronic disease of the small intestine
- inflammatory bowel disease
protein-losing enteropathy
- chronic enteropathy with diffuse SI disease
- malabsorption and weight loss
- loss of albumin and globulin
- oedema/ascites
protein-losing enteropathy causes
- severe IBD
- lymphangiectasia
- alimentary lymphoma
diagnosed by: endoscopy
chronic vom and diarrhoea treatment
- treat underlying cause
- exclusion of parasitism (fenbendazole course)
- vit B12
- steroids
- anti-emetics
- appetite stimulants
chronic enteropathies diet
- highly digestible
- low fat (fat associated with delayed gastric emptying)
- supplementary diet
- little and often (3-4 times a day)
- avoid any intolerances
appetite stimulant drug
mirtazepine
cobalamin B12
- facilitates enzymatic reactions
- low B12 can cause inappetence
- sub-cut once a week for 4-6 weeks
or - daily oral dose for 4-6 weeks
exocrine pancreatic insufficiency- EPI
- failure of normal exocrine (enzyme) pancreatic secretion
- maldigestion/malabsorption
- caused by pancreatic acinar atrophy
- recurrent pancreatitis
exocrine pancreatic insufficiency- EPI diagnosis
- trypsin-like immunoreactivity serum test
- TLI
EPI treatment
- expensive/lifelong
- oral pancreatic extract with every meal
EPI diet
- 2-3 times a day
- enzyme with every meal
- highly digestible
- high protein
- non-complex carbohydrates
- vit B12 supplementation
colitis definition
chronic inflammation of LI
colitis treatment
sulphasalazine
- contradicted in SI disease
- monitor schirmer tear test as side effect of drug= keratoconjunctivitis sicca (dry eye)
irritable bowel syndrome
- LI pattern of diarrhoea
- small breed dogs
- diagnosis by exclusion of other causes
irritable bowel syndrome treatment
- long term dietary modification
- coarse bran= colonic motility
- anti-spasmodics
- anti-cholinergics
GI bleeding causes
- coagulopathy- clotting problems
- swallowed blood (nasal, oral, pulmonary)
- gastric/SI bleeding
- LI bleeding
- GI ulceration
GI ulceration causes
- drugs (NSAIDs, steroids)
- foreign body (trauma)
- neoplasia (gastric carcinoma)
- hypoadrenocorticism
- kidney/liver disease
gastric ulceration treatment
- treat underlying cause
- acid blockers
- proton pump inhibitors (omeprazole)
- coating agents (sucralfate)
- analgesia
- misoprostol (for NSAID overdose)
- surgery if perforated
constipation definition
- impaction of the colon/rectum with faeces
- may include hair/bones
prolonged constipation leads to…
- irreversible changes to colonic wall
- motility affected
- obstipation- excessive accumulation of faeces that cannot be passed
constipation clinical signs
- lack of defecation
- hard, pebble like stool
- discomfort
normal functions of the liver
- synthesis of proteins, glucose and cholesterol, clotting factors
- detoxification of bilirubin, bile acids, ammonia
clinical signs of hepatic dysfunction
- inappetence, lethargy
- vom + diarrhoea
- jaundice
- ascites
- persistent drug activity
jaundice (icterus)
- yellow discolouration, tissue deposition of bile pigment in high levels
- due to hyperbilirubinaemia
- marker of possible hepatic disease
causes of jaundice (pre-hepatic, hepatic, post)
- failure of routine clearance of bilirubin
pre-hepatic= haemolysis (haem pigment is broken down into bilirubin)
hepatic= failure of hepatic uptake, conjugation or transport of bilirubin
post= failure of excretion of bile
ascites in liver disease
- abdominal effusion
- fluid accumulation in abdomen
due to: - hypoalbuminaemia
- portal hypertension
- sodium and water retention
failure of detoxication
- hepatic dysfunction or abnormal blood supply
- failure of ammonia-> urea
- hyperammonaemia, hepatic encephalopathy
hepatic encephalopathy exacerbating factors
- high protein meal (bacterial fermentation and enterocyte glutamine metabolism increases ammonia
- gastrointestinal haemorrhage
- vom + diarrhoea
- diuretics
diagnostic tests in liver disease
lab tests:
- liver enzymes
- bilirubin
- bile acids
- glucose
- blood clotting parameters
imaging
liver cytology/biopsy
acute liver disease causes
toxins and infections
- xylitol, mushrooms, blue green algae, alfatoxins (mould)
- phenobarbitone, paracetamol, axathioprine, doxycycline, lomustine
- leptospirosis (stagnant water)
- ascending biliary infection
- adenovirus
acute liver disease nursing considerations
- isolation/barrier nursing
- venepuncture risks- coagulopathy
- management of hypoglycaemia
acute liver disease treatment
- management of hepatic encephalopathy (lactulose, seizure control, hydration, electrolyte balance)
- lactulose prevents absorption of ammonia into the blood
- anti-emetics
- antioxidants
- antibiotics
liver disease diet
- restricted animal protein
- ideally plant proteins (soy)
chronic inflammatory liver disease causes
sterile
- chronic hepatitis (dogs) (idiopathic, copper build up)
- lymphocytic cholangitis (cats)
infectious
- cholangitis
- leptospirosis (dogs)
- feline infectious peritonitis
general treatments for inflammatory liver disease
- diet mod
- liver support (anti-oxidants)
- anti-inflammatory (steroids)
- choleretics (increases bile secretion)
- hepatic encephalopathy therapies
- spironolactone (diuretic to reduce ascites)
de-coppering therapy for chronic inflammatory liver disease
- chelating agent (binds copper)
- penicillamine, zinc (not together)
- restrict copper intake
- hepatic diet, avoid red meat, eggs
antitoxidants for liver disease
silymarin/silibinin/sylibin
- help repair liver cells
gall bladder mucocoeles
- gallbladder is thickened, walls secrete excess mucus
- kiwi fruit appearance on ultrasound
clinical signs of gallbladder mucocoeles
- asymptomatic
- bile flow obstruction
- gall bladder rupture
treatment: surgery, medically
feline hepatic lipidosis
- anorexia causes mobilisation of fatty acid
- triglycerides deposited in hepatocytes
- secondary to obesity, high fat diet, systemic illness, diabetes
feline hepatic lipidosis clinical signs
- encephalopathy- due to ammonia
- coagulopathy
feline hepatic lipidosis treatment
- treat underlying cause
- nutritional support (tube feeding)
- antioxidants to repair liver cells
- L-carnitine can mobilise fats
congenital portosystemic shunts
- portal vein usually carries nutrients to the liver, portosystemic shunt bipasses the liver into caudal vena cava so it doesn’t receive the nutrients
- blood doesn’t get filtered leading to accumulation of toxins
treatment of portosystemic shunts
- hydration
- potassium monitoring
- plant based protein diet (animal protein restricted)
- lactulose (traps ammonia in colon)
- anti-seizure therapy
- antibiotics to modify gut flora to reduce ammonia synthesis
- surgery to close shunt
hepatic neoplasia
- primary liver tumours or metastases
diagnosis: - imaging (ultrasound, CT)
- biopsies/FNA (needle aspiration)
-check clotting factors first
hepatic neoplasia clinical signs
- asymptomatic
- obstruction of blood vessels
- obstruction of bile duct
- haemoabdomen if rupture
hepatic neoplasia treatment
- surgery to remove lobe of liver
- chemo for lymphoma (covers whole liver)
- no specific treatment for carcinoma
