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CVNT 2 > GI medicine > Flashcards

GI medicine Flashcards

1
Q

chelitis

A

inflammation of lips

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2
Q

glossitis

A

inflammation of tongue

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3
Q

gingivitis

A

inflammation of gums

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4
Q

stomatitis

A

inflammation of oral mucosa

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5
Q

gingivostomatitis

A

inflammation of gums and oral mucosa

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6
Q

dysphagia

A

difficulty swallowing

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7
Q

odynophagia

A

swallowing pain

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8
Q

regurgitation

A

passive return of food, water or saliva due to oesophageal problem

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9
Q

ptyalism/hypersalivation

A

overproduction of saliva
(due to pain or disease in the mouth)

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10
Q

pseudoptyalism

A

drooling despite normal amount of saliva production
(lip/mouth conformation or swallowing problem)

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11
Q

clinical signs of oropharyngeal disease

A
  • dysphagia
  • odynophagia
  • drooling saliva +/- blood
    • can be due to nausea
  • halitosis (bad breath)
    • dental disease
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12
Q

nursing considerations for physical exam

A
  • restraint needed
    • temperament, pain opening mouth?
  • equipment
    • lighting, swabs, forceps
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13
Q

nursing considerations for investigation

A
  • sedation/GA
  • intubation challenges
    • visualisation, obstructions, brachycephalics
  • blood tests
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14
Q

halitosis

A

bad breath

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15
Q

epulis

A

benign oropharyngeal neoplasia

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16
Q

diagnostics of oropharyngeal disease

A
  • dental radiography
    • loss of bone in neoplasia
  • check for metastasis
    • needle aspiration/biopsy
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17
Q

treatment of oropharyngeal disease

A
  • neoplasia
    • surgery, radiation, chemo
  • remove foreign body
  • wound management
  • anti-inflammatories
  • antibiotics
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18
Q

nursing considerations for oral disease

A
  • barrier nursing (infectious)
  • analgesia
  • nutrition (oral, tube feeding)
  • oral rinses
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19
Q

regurgitation as a clinical sign

A
  • hallmark of oesophageal disease
  • undigested food (saliva covered)
  • solid or liquid
  • fresh blood if ulcerated
  • neutral pH
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20
Q

vomiting as a clinical sign

A
  • gastric and upper intestinal content
  • may be caused by gastrointestinal or extra-gastrointestinal disease
  • acidic pH
  • neural reflex
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21
Q

secondary problems of regurgitation

A
  • malnutrition
  • dehydration
  • anorexia/polyphagia
  • reflux pharyngitis/rhinitis (inflamed pharynx/nasal cavity)
  • aspiration pneumonia
  • swallowing pain
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22
Q

oesophageal disease diagnostics

A
  • physical exam
  • chest x-rays (conscious, oesophageal fluoroscopy)
    • sedation/GA can cause dilation
  • haematology, biochemistry
  • oesophagoscopy
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23
Q

causes of regurgitation

A
  • oesophagitis
  • oesophageal obstruction
    • intraluminal= lumen obstruction
    • intramural= inside wall
    • extraluminal= outside oesophagus
  • megaoesophagus= dilation
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24
Q

oesophagitis causes

A
  • ingestion of:
    • caustics, hot liquids, foreign bodies, irritants
  • gastro-oesophageal reflux
  • persistent vomiting
    leads to oesophageal strictures
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25
Q

gastro-oesophageal reflux

A
  • reflux of gastric acid and enzymes into oesophagus leading to inflammation
  • during anaesthesia
  • hiatal hernia
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26
Q

oesophagitis clinical signs

A
  • pain
  • regurgitation
  • anorexia
  • hypersalivation
  • weight loss
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27
Q

feeding considerations for oesophagitis

A
  • oesophageal rest?
  • reintroducing food
    • soft, bland, frequent
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28
Q

nursing considerations for oesophagitis

A
  • monitor pain
  • ease of medicating
    • liquid antacid/coating agents
    • drugs to reduce further reflux
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29
Q

megaoesophagus

A
  • idiopathic
  • myasthenia gravis
    • generalised muscle problem
  • focal dilation (congenital)
    • vascular ring anomaly
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30
Q

management of megaoesophagus

A
  • postural feeding
    • raised front end
  • slurry liquidated food
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31
Q

haematochezia

A

fresh blood in faeces

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32
Q

melaena

A

digested blood in faeces

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33
Q

tenesmus

A

straining to pass faeces

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34
Q

diarrhoea

A

increased faecal water content

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35
Q

dyschezia

A

difficulty passing faeces

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36
Q

stages of vomiting

A
  1. prodromal (nausea)
  2. retching
  3. expulsion
  4. relaxation
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37
Q

prodromal phase signs

A
  • restless
  • hypersalivation
  • gulping
  • lip-licking
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38
Q

retching phase

A
  • salivation inhibited
  • simultaneous, spasmodic contractions of resp muscles
  • duodenal retroperistalsis
    • duodenal contents enter stomach
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39
Q

expulsion phase

A
  • 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
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40
Q

relaxation stage

A

muscles relax
- diaphragm, abdominal, respiratory
- glottis and nasopharynx relax
- return of breathing

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41
Q

small intestinal diarrhoea

A
  • large vol
  • watery
  • normal frequency
  • often normal colour
  • +/- melaena
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42
Q

large intestinal diarrhoea

A
  • small vol
  • increased urgency and frequency
  • tenesmus, dyschezia
  • +/- mucus
  • +/- blood
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43
Q

gastritis

A

stomach

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44
Q

enteritis

A

small intestine

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45
Q

colitis

A

large intestine

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46
Q

gastro-enteritis

A

stomach-large intestine

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47
Q

entero-colitis

A

small-large intestine

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48
Q

gastro-entero-colitis

A

stomach, small and large intestine

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49
Q

phone triage- emergencies

A
  • collapsed
  • known/suspect toxicity
  • unproductive vomiting
  • visible bloating
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50
Q

questions to ask about vomit/diarrhoea

A
  • productive/non productive?
  • frequency? (gauge fluid loss)
  • foreign material?
  • haematemesis/melaena?
  • SI or LI diarrhoea?
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51
Q

questions about patients history

A
  • pre-existing medical disease
  • medication
  • pre-existing GI disease
  • anthelmintic history (parasites)
  • recent dietary change
  • known scavenger
  • clinical demeanour
  • appetite/drinking
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52
Q

acute gastroenteritis considerations

A
  • consider infectious causes if:
    • young, unvaccinated, haemorrhagic diarrhoea, pyrexic, raw diet
  • isolation and barrier nurse
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53
Q

mild concern causes of acute vom and diarrhoea

A
  • dietary indiscretion
  • adverse drug event
  • parasites (roundworm, protoza)
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54
Q

high concern causes of acute vom and dirrhoea

A
  • intoxications
  • pathogenic enteric infections
    -parvovirus, bacterial
  • acute pancreatitis
  • surgical disease
  • acute haemorrhagic diarrhoea syndrome
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55
Q

acute vom and diarrhoea emergencies

A
  • surgical disease
  • foreign body
  • gastric dilation and volvulus (twist)
  • stricture/obstruction
  • intusussception
    • intestine goes back into another piece
  • incarceration (strangulated by mesentry)
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56
Q

acute gastroenteritis diagnostic tests

A
  • history
  • physical exam
  • bloods (haem, biochem, electrolytes)
  • faecal (parasitology, culture, parvo test)
  • PLI (pancreatitis test)
  • imaging
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57
Q

nursing considerations for diarrhoea

A
  • clean and dry bottom
  • prevent over-grooming
  • tail bandage
  • waste disposal
58
Q

dietary advice for vomiting

A
  • withhold food for 12-24hrs
  • free access to water
  • bland diet, little and often
59
Q

dietary advice for diarrhoea

A
  • continue feeding
    • reduces risk of sepsis, increases rate of recovery
  • bland diet
60
Q

treatment of acute vom and diarrhoea

A
  • antiemetics (only after obstruction is excluded)
  • antispasmodics
  • anthelmintic (worming agent)
    • pups and kits
  • NO NSAIDs
    • prostaglandins needed in GI mucosa and renal blood flow
61
Q

treatment of non-obstructive foreign bodies in stomach

A
  • induce emesis
    • apomorphine (dogs) xylazine (cats)
  • endoscopic retrieval
  • surgery
  • bones will dissolve in gastric acid
62
Q

treatment of non-obstructive foreign bodies in intestine

A

natural passage with radiographic monitoring

63
Q

gastric dilation

A
  • stomach fills with gas
  • may progress to GDV (volvulus)
64
Q

gastric dilation and volvulus

A
  • torsion of the stomach
  • splenic pedicle may twist
  • impaired venous return to heart
65
Q

telephone triage of gastric dilation and volvulus

A
  • unproductive retching
  • bloat
  • stomach pain
  • pale MM
  • lethargic/collapsed
  • deep chested, large breeds, middle aged-old
66
Q

recommendations for dogs predisposed to GDV

A
  • don’t exercise straight after eating
  • raised food bowl (reduces aerophagia)
67
Q

GD/GDV treatment

A
  • aggressive fluid therapy
  • immediate decompression (stomach tube, needle paracentesis)
  • antibiotics
  • surgery prep
68
Q

protozoal (parasite) causes of vom and diarrhoea

A
  • coccidia
  • giardia (zoonotic)
    • treated with fenbendazole)
69
Q

tritrichomonas foetus

A
  • young cats
  • diarrhoea, peri-anal oedema, asymptomatic
  • faeco-oral transmission
  • colonic wash (PCR) to diagnose
  • poorly responsive to treatment
    • environment management
70
Q

acute pancreatitis as cause of acute vom and diarrhoea

A
  • inflammation of pancreas (sudden onset)
  • idiopathic
  • predisposed by: high fat food, hyperlipaemia, impaired perfusion, trauma
  • release of pancreatic enzymes locally
    • digestion of pancreas
71
Q

clinical signs of acute pancreatitis

A
  • inappetance, lethargy
  • severe abdominal pain (prayer position)
  • vom and diarrhoea
  • bile duct obstruction (jaundice)
72
Q

acute pancreatitis diagnostics

A
  • ultrasound
  • haematology, biochem
  • pancreatic lipase immunoreactivity (PLI)
    • snap test
73
Q

nursing considerations of acute pancreatitis

A
  • monitor hydration
  • nutritional support (tube feeding)
  • water available when vomiting controlled
  • slowly introduce diet (low fat, highly digestible
74
Q

acute pancreatitis treatment

A
  • NO NSAIDs
  • antiemetics
  • antacids (omeprazole)
75
Q

chronic pancreatitis

A
  • repeated attacks of acute pancreatitis
    or
  • chronic low-grade pancreatitis
    • inappetance, lethargy, vom + diarrhoea
76
Q

chronic pancreatitis management

A

diet modification
- highly digestible (complex carbs)
- low fat
nausea/appetite management
analgesia

77
Q

borborygmi definition

A

gurgling

78
Q

flatus definition

A

passing wind

79
Q

ileus definition

A

reduced gastro-intestinal motility

80
Q

anorexia definition

A

loss of desire to eat despite being physically able to

81
Q

hyporexia definition

A

inappetance

82
Q

polyphagia definition

A

excessive appetite

83
Q

pica definition

A

appetite for non-nutritional substrates
- metal/concrete
- due to micronutrient deficiencies

84
Q

secondary complications of anorexia

A
  • weight loss
  • impaired immune function
  • increased risk of sepsis
  • poor wound healing/slow recovery
85
Q

how long until chronic diarrhoea and vom?

A

3 weeks

86
Q

clinical signs of chronic GI disease

A
  • altered appetite
  • dehydration
  • vomiting +/- blood
  • diarrhoea +/- blood
  • weight loss
  • borborygmi/flatus
  • abdominal discomfort
87
Q

causes of primary chronic GI disease

A
  • gastric ulceration
  • dietary intolerance
  • IBS
  • gastric carcinoma
  • GI lymphoma
88
Q

extra-GI causes of chronic GI disease

A
  • liver, kidney disease
  • pancreatitis
  • endocrine disease
89
Q

diagnostics for chronic GI disease

A
  • 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
90
Q

advantage of laparotomy biopsy

A

full thickness biopsies

91
Q

disadvantage of laparotomy biopsy

A

surgical risk of dehiscence (splitting of GI tract)

92
Q

advantage of endoscopic biopsy

A

minimally invasive

93
Q

disadvantages of endoscopic biopsy

A
  • small biopsy (internal wall of GI tract only)
  • may not reflect jejunal disease
94
Q

chronic enteropathies definition

A

chronic disease of the small intestine
- inflammatory bowel disease

95
Q

protein-losing enteropathy

A
  • chronic enteropathy with diffuse SI disease
  • malabsorption and weight loss
  • loss of albumin and globulin
  • oedema/ascites
96
Q

protein-losing enteropathy causes

A
  • severe IBD
  • lymphangiectasia
  • alimentary lymphoma
    diagnosed by: endoscopy
97
Q

chronic vom and diarrhoea treatment

A
  • treat underlying cause
  • exclusion of parasitism (fenbendazole course)
  • vit B12
  • steroids
  • anti-emetics
  • appetite stimulants
98
Q

chronic enteropathies diet

A
  • highly digestible
  • low fat (fat associated with delayed gastric emptying)
  • supplementary diet
  • little and often (3-4 times a day)
  • avoid any intolerances
99
Q

appetite stimulant drug

A

mirtazepine

100
Q

cobalamin B12

A
  • 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
101
Q

exocrine pancreatic insufficiency- EPI

A
  • failure of normal exocrine (enzyme) pancreatic secretion
  • maldigestion/malabsorption
  • caused by pancreatic acinar atrophy
  • recurrent pancreatitis
102
Q

exocrine pancreatic insufficiency- EPI diagnosis

A
  • trypsin-like immunoreactivity serum test
  • TLI
103
Q

EPI treatment

A
  • expensive/lifelong
  • oral pancreatic extract with every meal
104
Q

EPI diet

A
  • 2-3 times a day
  • enzyme with every meal
  • highly digestible
  • high protein
  • non-complex carbohydrates
  • vit B12 supplementation
105
Q

colitis definition

A

chronic inflammation of LI

106
Q

colitis treatment

A

sulphasalazine
- contradicted in SI disease
- monitor schirmer tear test as side effect of drug= keratoconjunctivitis sicca (dry eye)

107
Q

irritable bowel syndrome

A
  • LI pattern of diarrhoea
  • small breed dogs
  • diagnosis by exclusion of other causes
108
Q

irritable bowel syndrome treatment

A
  • long term dietary modification
    • coarse bran= colonic motility
  • anti-spasmodics
  • anti-cholinergics
109
Q

GI bleeding causes

A
  • coagulopathy- clotting problems
  • swallowed blood (nasal, oral, pulmonary)
  • gastric/SI bleeding
  • LI bleeding
  • GI ulceration
110
Q

GI ulceration causes

A
  • drugs (NSAIDs, steroids)
  • foreign body (trauma)
  • neoplasia (gastric carcinoma)
  • hypoadrenocorticism
  • kidney/liver disease
111
Q

gastric ulceration treatment

A
  • treat underlying cause
  • acid blockers
    • proton pump inhibitors (omeprazole)
  • coating agents (sucralfate)
  • analgesia
  • misoprostol (for NSAID overdose)
  • surgery if perforated
112
Q

constipation definition

A
  • impaction of the colon/rectum with faeces
  • may include hair/bones
113
Q

prolonged constipation leads to…

A
  • irreversible changes to colonic wall
  • motility affected
  • obstipation- excessive accumulation of faeces that cannot be passed
114
Q

constipation clinical signs

A
  • lack of defecation
  • hard, pebble like stool
  • discomfort
115
Q

normal functions of the liver

A
  • synthesis of proteins, glucose and cholesterol, clotting factors
  • detoxification of bilirubin, bile acids, ammonia
116
Q

clinical signs of hepatic dysfunction

A
  • inappetence, lethargy
  • vom + diarrhoea
  • jaundice
  • ascites
  • persistent drug activity
117
Q

jaundice (icterus)

A
  • yellow discolouration, tissue deposition of bile pigment in high levels
  • due to hyperbilirubinaemia
  • marker of possible hepatic disease
118
Q

causes of jaundice (pre-hepatic, hepatic, post)

A
  • 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
119
Q

ascites in liver disease

A
  • abdominal effusion
  • fluid accumulation in abdomen
    due to:
  • hypoalbuminaemia
  • portal hypertension
  • sodium and water retention
120
Q

failure of detoxication

A
  • hepatic dysfunction or abnormal blood supply
  • failure of ammonia-> urea
    • hyperammonaemia, hepatic encephalopathy
121
Q

hepatic encephalopathy exacerbating factors

A
  • high protein meal (bacterial fermentation and enterocyte glutamine metabolism increases ammonia
  • gastrointestinal haemorrhage
  • vom + diarrhoea
  • diuretics
122
Q

diagnostic tests in liver disease

A

lab tests:
- liver enzymes
- bilirubin
- bile acids
- glucose
- blood clotting parameters
imaging
liver cytology/biopsy

123
Q

acute liver disease causes

A

toxins and infections
- xylitol, mushrooms, blue green algae, alfatoxins (mould)
- phenobarbitone, paracetamol, axathioprine, doxycycline, lomustine
- leptospirosis (stagnant water)
- ascending biliary infection
- adenovirus

124
Q

acute liver disease nursing considerations

A
  • isolation/barrier nursing
  • venepuncture risks- coagulopathy
  • management of hypoglycaemia
125
Q

acute liver disease treatment

A
  • management of hepatic encephalopathy (lactulose, seizure control, hydration, electrolyte balance)
  • lactulose prevents absorption of ammonia into the blood
  • anti-emetics
  • antioxidants
  • antibiotics
126
Q

liver disease diet

A
  • restricted animal protein
  • ideally plant proteins (soy)
127
Q

chronic inflammatory liver disease causes

A

sterile
- chronic hepatitis (dogs) (idiopathic, copper build up)
- lymphocytic cholangitis (cats)
infectious
- cholangitis
- leptospirosis (dogs)
- feline infectious peritonitis

128
Q

general treatments for inflammatory liver disease

A
  • diet mod
  • liver support (anti-oxidants)
  • anti-inflammatory (steroids)
  • choleretics (increases bile secretion)
  • hepatic encephalopathy therapies
  • spironolactone (diuretic to reduce ascites)
129
Q

de-coppering therapy for chronic inflammatory liver disease

A
  • chelating agent (binds copper)
    • penicillamine, zinc (not together)
  • restrict copper intake
    • hepatic diet, avoid red meat, eggs
130
Q

antitoxidants for liver disease

A

silymarin/silibinin/sylibin
- help repair liver cells

131
Q

gall bladder mucocoeles

A
  • gallbladder is thickened, walls secrete excess mucus
  • kiwi fruit appearance on ultrasound
132
Q

clinical signs of gallbladder mucocoeles

A
  • asymptomatic
  • bile flow obstruction
  • gall bladder rupture
    treatment: surgery, medically
133
Q

feline hepatic lipidosis

A
  • anorexia causes mobilisation of fatty acid
  • triglycerides deposited in hepatocytes
  • secondary to obesity, high fat diet, systemic illness, diabetes
134
Q

feline hepatic lipidosis clinical signs

A
  • encephalopathy- due to ammonia
  • coagulopathy
135
Q

feline hepatic lipidosis treatment

A
  • treat underlying cause
  • nutritional support (tube feeding)
  • antioxidants to repair liver cells
  • L-carnitine can mobilise fats
136
Q

congenital portosystemic shunts

A
  • 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
137
Q

treatment of portosystemic shunts

A
  • 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
138
Q

hepatic neoplasia

A
  • primary liver tumours or metastases
    diagnosis:
  • imaging (ultrasound, CT)
  • biopsies/FNA (needle aspiration)
    -check clotting factors first
139
Q

hepatic neoplasia clinical signs

A
  • asymptomatic
  • obstruction of blood vessels
  • obstruction of bile duct
  • haemoabdomen if rupture
140
Q

hepatic neoplasia treatment

A
  • surgery to remove lobe of liver
  • chemo for lymphoma (covers whole liver)
  • no specific treatment for carcinoma

CVNT 2 (33 decks)

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