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X Clinical Veterinary Nursing Theory > GI Medicine - Vomiting and Diarrhoea > Flashcards

GI Medicine - Vomiting and Diarrhoea Flashcards

1
Q

what does acute mean?

A

sudden onset

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2
Q

in what animals is acute vomiting and diarrhoea seen commonly?

A

dogs

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3
Q

what may acute vomiting and diarrhoea start with?

A

vomiting and progress through small to large intestinal diarrhoea

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4
Q

how does acute vomiting and diarrhoea often resolve?

A

usually self limiting

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5
Q

define emesis

A

vomiting

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6
Q

define haematoemesis

A

vomiting blood

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7
Q

define haemtochezia

A

fresh blood in/on faeces/diarrhoea (originates in large intestine)

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8
Q

define melaena

A

faecal passage of digested blood (stomach or small intestine origin)

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9
Q

define diarrhoea

A

increase in faecal water content

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10
Q

define tenesmus

A

straining to pass faeces

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11
Q

define dyschezia

A

difficulty passing faeces

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12
Q

define emetic

A

substance which stimulates vomiting

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13
Q

define anti-emetic

A

substance that inhibits vomiting

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14
Q

what is vomiting?

A

a complex, coordinated reflex reaction

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15
Q

what are the events of vomiting coordinated by?

A

the brainstem

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16
Q

does vomiting involve gastric contraction?

A

no

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17
Q

what are the 4 stages of vomiting?

A

prodromal (nausea)
retching
expulsion
relaxation

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18
Q

what occurs in the prodromal phase of vomiting?

A 
nausea 
restlessness and agitation
hypersalivation
gulping 
lip licking
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19
Q

what is inhibited during the retching phase of vomiting?

A

salivation

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20
Q

what happens during the retching phase of vomiting?

A

simultaneous, uncoordinated, spasmodic contractions of respiratory muscles
duodenal retroperistalsis
mixing of gastric contents

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21
Q

what happens during the expulsion phase of vomiting?

A

pyloric contraction and fundic relaxation to move food into upper stomach
relaxation of proximal stomach and lower oesophageal sphincter
airway is protected
abdominal contraction and descent of diaphragm

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22
Q

initially during the expulsion phase of vomiting what is the tone like in the upper oesophageal sphincter?

A

high so that it remains closed

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23
Q

how is the airway protected during the expulsion phase of vomiting?

A

inhibition of breathing

coordinated closure of the glottis and nasopharynx to protect both aspects of the airway

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24
Q

how does abdominal contraction and the descent of the diaphragm lead to vomiting in the expulsion phase of vomiting?

A

stomach is squeezed and vomitus forced up (heaves)
oesophageal retro-peristalsis
reduced upper oesophageal sphincter tone

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25
what muscles relax during the relaxation phase of vomiting?
abdominal diaphragmatic respiratory
26
what happens during the relaxation phase of vomiting?
muscles relax glottis and nasopharynx open breathing returns
27
describe small intestinal diarrhoea
``` large volume watery normal frequency normal colour melaena ```
28
describe large intestinal diarrhoea
``` small volume increased urgency and frequency tenesmus dyschezia +/- mucous +/- blood ```
29
what does 'itis mean?
inflammation
30
define gastritis
inflammation of the stomach
31
define enteritis
inflammation of the small intestine
32
define colitis
inflammation of the large intestine
33
define gastro-enteritis
inflammation of the stomach and small intestine
34
define entero-coliitis
inflammation of the small and large intestine
35
define gastro-entero-colitis
inflammation of the stomach, small and large intestines
36
what questions must you ask about vomiting and diarrhoea when completing phone triage?
``` is vomiting productive or non-productive frequency - try to gauge fluid loss foreign body/material risk haematemesis/melaena diarrhoea - small or large intestinal ```
37
what questions must be asked about the patient generally when completing phone triage?
pre exisiting medical or GI disease or medication worming history (especially with puppies and kittens) recent change in diet known scavenger - dietary indiscretion or FB ingestion clinical demenour appetite drinking other systemic signs
38
when should you advise a patient receives consultation following phone triage?
``` unproductive vomiting large loss of fluid haematemesis / melaena suspect FB inappetant / hypodipsic other systemic signs neonate any other concerns ```
39
what are the 3 main categories of acute vomiting and diarrhoea?
non fatal, often trivial, may or may not require specific treatment severe and potentially life threatening surgical
40
what are the causes of vomiting and diarrhoea that is non fatal, often trivial and may or may not require specific treatment?
dietary indiscretion parasitism enteric infection adverse drug event
41
what are the causes of vomiting and diarrhoea that is severe and potentially life threatening?
``` pathogenic and enteric infections (e.g. parvovirus or bacterial) acute haemorrhagic diarrhoea syndrome acute pancreatitis intoxications surgical disease ```
42
what are the causes of vomiting and diarrhoea that are surgical?
``` intusussception GDV incarceration stricture/partial obstruction foreign body ```
43
what is the major presenting complaint seen in surgical GI dieases?
vomiting
44
what is intusussception?
telescoping of one intestine loop into another
45
in what animals is intusussception commonly seen?
young rather than old
46
what must be investigated regarding intusussception?
underlying cuase
47
what is incarceration?
loop of intestine becomes strangulated by the mysentry
48
what are the possible consequences of vomiting and/or diarrhoea?
dehydration hypovolaemia acid base disturbance aspiration pneumonia
49
when is aspiration pneumonia particularly a risk for vomiting patients?
if sedated neuromuscular disease upper airway incompetency (e.g. laryngeal paralysis)
50
what are the diagnostic tests used for acute gastroenteritis?
history and physical exam laboratory diagnostics imaging response to surgery or symptomatic treatment
51
what laboratory diagnostics may be used for acute gastroenteritis?
bloods - haematology, biochem and electrolytes faecal - infectious disease testing specific tests as required (e.g. cPLI or fPLI)
52
what will a pooled faecal sample test for?
parasitology and culture
53
what will a swab/faecal sample test for?
CPV
54
what is the cornerstone of management of acute vomiting and diarrhoea?
maintaining hydration
55
how may hydration be maintained in acute vomiting and diarrhoea patients?
IV fluids | oral rehydration solutions
56
what fluids are best used to maintain hydration in acute vominting and diarrhoea patients?
hartmanns with potassium
57
what is found within rehydration solutions?
glucose, electrolytes and glutamine
58
when will oral rehydration solutions be used to treat acute V+D patients?
if able to manage at home
59
what is usually sufficent for re-hydrating acute V+D patients if at home?
water
60
what is the dietary advice if acute vomiting is seen?
rest the gut (free access to water) for 24-36 hours before reintroducing an bland diet little and often
61
when should animals with acute vomiting be transferred back onto their normal diet following resting the gut?
over 2-5 days once bland diet tolerated
62
is resting the gut suitable for all patients?
no - neonates and diabetics are at risk of hypoglycaemia if they go without food
63
what is glutamine and why is it useful for acute V+D patients?
amino acid which supports enterocytes and helps them to function well
64
what is the dietary advice if the patient has diarrhoea?
feed throughout to nourish enterocytes
65
what risk is reduced by feeding through diarrhoea?
sepsis
66
what is the issue with needing to feed through diarrhoea in dogs?
most have concurrent vomiting | cosmetic issue as will produce more diarrhoea when eating
67
what is the main supportive/symptomatic management of acute V+D?
antiemetics antispasmodics antidiarrhoeals
68
what must be ruled out before anti emetics given?
obstruction
69
how do anti diarrhoeals work?
bind toxins and excess water as well as modifiying GI motility and secretions
70
what is often found in anti-diarrhoeals?
clay (kaolin)
71
how is acute vomiting and diarrhoea treated?
anthelmintics (worming) antibiotics rarely indicated pre and pro biotics
72
when will anthelmintics be given?
if puppy or kitten | if adult and not recently wormed
73
when should antibiotic use for treatment of acute V+D be considered?
if haemorrhagic diarrhoea | if pyrexic
74
what is the benefit of giving pre and pro biotics?
safer than unnecessary antibiotics
75
what drugs are always contraindicated for patients with vomiting and diarrhoea?
NSAIDs
76
what should happen if patients with acute V+D have pre-exisiting NSAID use?
consider that they could be the cause | withhold for the duration of V+D episode and restart when resolved
77
why are NSAIDs contraindicated for V+D patients?
inhibition of prostaglandins which are needed for maintenance of GI mucosal integrity and renal blood flow during hypovolaemic stress
78
what are prostaglandins required for?
maintenance of GI mucosal integrity and renal blood flow during hypovolaemic stress
79
what are prostaglandins required for?
maintenance of GI mucosal integrity and renal blood flow during hypovolaemic stress
80
when should you consider than the cause of gastroenteritis may be infectious?
``` neonates unvaccinated animal haemorrhagic diarrhoea pyrexia raw fed patient ```
81
what should happen to potentially infectious patients until any alternative diagnosis confirmed?
barrier nurse and isolate
82
what are the nursing considerations for acute V+D?
patient hygiene environmental hygiene kennel signage
83
what are the areas of patient hygiene that must be considered in V+D patients?
clean/dry bottom avoid patient over grooming/rubbing tail bandage
84
what are the areas of environment hygiene that must be considered in V+D patients?
waste disposed of appropriately appropriate washing/disinfection of contaminated items PPE
85
what are the 2 main types of gastrointestinal foreign body presentations?
no obstruction | obstruction
86
if the foreign body is smooth/small and gastric and not causing obstruction how should it be treated?
induce emesis
87
what drug is used to induce emesis in dogs?
Apomorphine
88
what drug is used to induce emesis in cats?
Xylazine
89
if the foreign body is non obstructive and intestinal how should it be treated?
natural passage with radiographic monitoring
90
if the foreign body is gastric but larger and not smooth but not causing obstruction how should it be treated?
endoscopic retrieval or surgery depending on size
91
what will happen to bones in the stomach?
will be dissolved by gastric acid in a few days
92
what can be done if the FB is a needle in the intestine?
feed high fibre diet | monitor for passage
93
how is an obstructive gastrointestinal FB treated?
surgery
94
what is gastric dilation?
acute dilation of the stomach
95
what is GDV?
acute dilation of the stomach with torsion of the stomach and twisted splenic pedicle
96
what is the effect of GDV?
impaired venous return (pressure on caudal vena cava) compromised gastric mucosa leading to shock and death
97
what is a key sign of GDV?
unproductive vomiting
98
how quickly must GDV be treated?
ASAP - is life threatening
99
what dogs are more likely to get GDV?
deep chested breeds
100
what is the cause of GDV?
``` not really known but may be: diet aerophagia delayed emptying of stomach due to pyloric blockage timing of exercise very soon after meal ```
101
how is GDV treated?
aggressive IVFT immediate decompression of stomach IV antibiotics surgical correction
102
what can a bandage be useful for during GDV treatment?
placed between cheek teeth so that the dog can bite on something while having stomach tubed conscious
103
how is the stomach decompressed in GDV patients?
stomach tube if possible | needle paracentesis if not
104
how long should the stomach tube for GDV treatment be?
from tip of nose to last rib
105
what diameter should stomach tubes be?
same as would be required for ET tube
106
what surgery is performed on GD or GDV patients?
gastropexy | +/- derotation if GDV
107
what is gastropexy?
stomach is tied to the abdominal wall in a normal position to prevent reccurance
108
what are the main parasitic causes of acute (or chronic) V+D?
roundworms hookworms whipworms cestodes (do not cause GI signs)
109
do roundworms typically cause clinical GI signs?
rarely but may do in puppies/kittens
110
what is caused by hookworms?
GI bleeding
111
what is caused by whipworms?
inflammation and diarrhoea
112
what are the protozoal causes of acute or chronic V+D?
coccidia giardia Tritrichomonas foetus
113
when is coccidia problematic?
only in puppies and kittens | coinfections
114
what GI signs are caused by Giardia?
large and small intestine diarrhoea
115
in what animals is Giardia seen?
young dogs and cats
116
what is the risk associated with Giardia?
can be zoonotic
117
how is Giardia diagnosed?
3 pooled faecal sample (SNAP test)
118
in what animals is Tritrichomonas foetus infection seen?
young cats (less than 18 months)
119
what can be caused by Tritrichomonas foetus?
intractable diarrhoea peri-anal oedema faecal incontinence
120
how is Tritrichomonas foetus transmitted?
faeco-oral
121
how is Tritrichomonas foetus diagnosed?
colonic wash and PCR from sample
122
how is colonic wash performed?
10mls sterile saline into colon and then collected through a urinary catheter (usually foley)
123
how is Tritrichomonas foetus treated?
environmental management to reduce transmission | as maturity reached they have an adequate immune response
124
what causes acute pancreatitis?
``` idiopathic dietary indiscretion hyperlipaemia impaired perfusion trauma to pancreas handling of pancreas in surgery ```
125
what happens during acute pancreatitis?
local release of pancreatic enzymes | pancreatic autodigestion leading to severe local inflammation and pain
126
what can be caused by pancreatitis?
systemic inflammation and death
127
what are the systemic signs of acute pancreatitis?
``` mild to fatal inappetance lethargy severe abdominal pain V+D jaundice ```
128
why is jaundice caused in acute pancreatitis patients?
due to bile duct obstruction if pancreas swells
129
what position may dogs adopt when they have acute pancreatitis?
prayer position
130
how is acute pancreatitis diagnosed?
history and physical exam imaging (x ray and ultrasound) lab evaluation
131
what is involved in the laboratory examination for acute pancreatitis?
haematology biochemistry pancreatic lipase immunoreactivity (PLI)
132
what tests are available for pancreatic lipase immunoreactivity?
``` benchside or external lab species specific (cPLI or fPLI) ```
133
how is acute pancreatitis treated?
IVFT nutritional support through feeding (oral or tube) analgesia (NSAIDs contraindicated as V+D)
134
what is the prognosis of acute pancreatitis?
variable to guarded | death and recurrence are possible
135
what attitude to feeding pancreatitis patients has overtaken the fasting idea?
should be fed well throughout as it improves prognosis
136
when should acute pancreatitis patients be offered water?
frequent, small amounts once vomiting is controlled
137
how should food be introduced to acute pancreatitis patients once vomiting is controlled?
slowly (little and often)
138
what soft of diet should be fed to acute pancreatitis patients?
highly digestible complex carbohydrate low fat
139
what does chronic pancreatitis result from?
repeated attacks of acute pancreatitis | chronic low grade pancreatitis
140
what are the signs of chronic pancreatitis?
chronic, recurrent, grumbling GI signs inappetance and lethargy V+D
141
how is chronic pancreatitis managed?
at home modified diet manage nausea/appetite analgesia (not NSAIDs)
142
define anorexia
a loss of desire to eat despite being physically able to
143
what may anorexia be due to?
a variety of GI and systemic disorders
144
define hyporexia
reduced appetite
145
define polyphagia
excessive appetitie
146
define pica
appetite for non-nutritional substrates (e.g. licking concrete or metal)
147
what is pica usually due to?
micro-nutrient deficiencies (e.g. iron or B12
148
what secondary complications does prolonged anorexia lead to?
weight loss impaired immune function increased risk of sepsis poor wound healing and slow recovery
149
define borborygmi
gurgling
150
define flatus
passing wind
151
define ileus
reduced GI motility
152
when is V+D defined as chronic?
when it is greater than 3 weeks in duration
153
what are the main signs and findings of chronic GI disease?
``` altered appetite (quantity and substrate) dehydration vomiting (+/- blood) diarrhoea (+/- digested or fresh blood) weight and condition loss borborygmi/flatus abdominal discomfort ```
154
what are the uncommon signs of chronic GI disease?
ascites | oedema
155
what are the main causes of chronic V+D?
primary GI disease | secondary to extra-GI disease
156
what are the main primary GI diseases that cause chronic V+D?
gastric ulceration dietary intolerance/sensitivity inflammatory neoplastic
157
what are the main causes of chronic V+D that are secondary to extra-GI diseases?
liver disease kidney disease chronic pancreatitis endocrine disease (hyperthyroid in cats and hypoadrenocorticism in dogs)
158
how is the cause of chronic V+D diagnosed?
``` history and clinical exam lab diagnostics to eliminate extra-GI causes absorption tests imaging gastroscopy / laparotomy and biopsy ```
159
what lab diagnostics will be used to rule out GI disease?
``` haematology serum biochem basal cortisol total thyroxine pancreatic tests (f/cPLI and f/cTLI) faecal analysis ```
160
what are absorption tests used for?
to check amount of vitamin B9 (folate) and B12 (cobalamin) being absorbed from different areas of the GI tract
161
when is contrast radiography performed?
when lab results and imaging have not achieved a definite diagnosis and endoscopy is not available
162
what are the issues with contrast studies?
messy time consuming difficult to interpret often done poorly
163
what is used for GI contrast studies?
barium
164
what are BIPS?
barium impregnated polyethylene spheres
165
what is shown by BIPS?
spheres vary in size so can give an indication of the size of the obstruction
166
what is the role of ultrasound in diagnosing the cause of chronic V+D?
identify masses, intussusceptions and measure GI wall thickness evaluate lymph nodes for free fluid
167
what are the 2 main ways to perform intestinal biopsy?
laparotomy | endoscopy
168
what is the advantage of laparotomy for intestinal biopsy?
enables multiple full thickness biopsies (more detail)
169
what is the disadvantage of laparotomy for intestinal biopsy?
surgical risk of dehiscence is high (2-12%)
170
what is the advantage of endoscopy for intestinal biopsy?
minimally invasive
171
what is the disadvantage of endoscopy for intestinal biopsy?
small biopsies only | may not reflect jejunal disease (as scope cannot reach)
172
what are chronic enteropathies?
chronic disease of the small intestine
173
what is the most common form of chronic enteropathy?
inflammatory bowel disease (IBD) complex
174
what diseases make up the IBD complex?
food responsive diarrhoea (FRD) antibiotic responsive disease (ARD) true idiopathic inflammatory bowel disease (iIBD)
175
what is food responsive diarrhoea (FRD) caused by?
intolerance / hypersensitivity
176
what is antibiotic responsive disease (ARD) caused by?
abnormality in the gut flora of the GI tract that interacts poorly with the immune system
177
what breed is antibiotic responsive IBD seen in?
GSD
178
what is true idiopathic inflammatory bowel disease (iIBD) caused by?
inflammation caused by the immune system within the gut wall launching an auto immune response
179
what is protein losing enteropathy a form of?
chronic enteropathy
180
what is protein losing enteropathy?
severe (diffuse) SI disease resulting in severe malabsorption and loss of albumin and globulin
181
what are the signs of protein losing enteropathy (PLE)?
severe weight loss oedema ascites risk of thromboembolytic events
182
what are the causes of PLE?
IBD lymphangiectasia - dilation of lymph vessels alimentary lympho(sarco)ma
183
how is PLE diagnosed?
endoscopy
184
how is chronic V+D treated?
treat underlying cause
185
what are the commonly used therapies for chronic V+D?
``` exclusion of parasitism dietary modification vitamin B12 steroids anti-emetics appetite stimulants ```
186
how should food intolerance/hypersensitivity be managed?
avoidance of allergen | novel or hydrolysed diets
187
what are hydrolysed diets?
all food broken down into constituents so that body doesn't recognise where they originate and so will no launch allergic response
188
what are the general feeding principles for all GI disease?
highly digestible restricted fat - prevent GOR and delayed gastric emptying supplementary fibre - reduce LI diarrhoea (fermantable or non-fermentable) little and often (3-4 times per day)
189
what must be considered with inappetant patients?
reasons for inappetance that are related and unrelated to GI disease
190
what are the reasons unrelated to GI disease that a patient may be inappetant?
pain | stress
191
what are the reasons related to GI disease that a patient may be inappetant?
``` dehydration hypokalaemia hypocobalaminaemic nausea delayed gastric emptying making them feel full due to impaired motility ```
192
what must not be introduced to patients in hospital?
new prescription diets
193
how can food intake in hospital be encouraged?
warm, wet and smelly food | ask owner about individual preferances
194
what individual eating preferences may patients have?
``` prefurred foods environment to eat in solitary or accompanied eating hand feeding owner encouragement . facilitation ```
195
what are the main aspects of medical therapy for inappetance?
control nausea stimulate appetite ensure patient is not receiving any drugs that may be supressing appetite
196
what drugs are used to control nausea?
maropitant | metaclopromide
197
what drug is used to stimulate appetite?
mirtazapine
198
what drugs may suppress patient appetite?
opioids - reduce motility | NSAID - contraindicated anyway as cause GI irritation
199
what nutritional support is available if patient is struggling to eat?
feeding tubes (N/O, oesophageal, percutaneous endoscopic gastrotomy)
200
what can feeding tubes be used for?
microenteral nutrition liquid or blended feeding medication admin
201
what is microenteral nutrition?
glucose, AA and electrolytes given to support enterocytes as only receive nutrition from intestinal lumen
202
why does cobalamin need to be supplemented?
B12 is needed for metabolism in almost all cells | will lead to inappetance and poor enterocyte health
203
how may cobalamin be supplemented?
SQ | oral
204
how is cobalamin administered SC?
weekly until normalised (4-6 weeks) | recheck serum levels 4-6 weeks after end of course to ensure levels are staying high
205
how is cobalamin administered orally?
daily in mage doses | remeasure serum levels after 4-6 weeks
206
what is exocrine pancreas insufficiency?
failure of normal exocrine (enzyme) pancreatic secretion
207
what does EPI lead to?
maldigestion and malabsorption
208
what may EPI be caused by?
pancreatic acinar atrophy (PAA) | recurrent pancreatitis
209
what is pancreatic acinar atrophy?
progressive atrophy of pancreas in dogs
210
what breeds in PAA most commonly seen in?
GSD
211
at what age does PAA usually begin?
young adult
212
why may recurrent pancreatitis cause EPI?
scar tissue forms after each bout and so functional aspects are lost
213
what are the key signs of EPI?
ravenous appetite diarrhoea typically fatty/greasy faeces severe weight loss
214
why are EPI sufferers faeces usually greasy?
lipaze is not produced from the pancreas
215
how is EPI diagnosed?
trypsin like immunoreactivity (TLI) serum test (species specific)
216
what are the issues with EPI treatment?
expensive | lifelong
217
how is EPI treated?
oral pancreatic extract (either capsules or fresh (frozen) pancreas
218
how often should EPI patients be fed per day?
2-3 meals per day
219
what must be given with each meal for an EPI patient?
enzymes
220
what diet should be fed to EPI patients?
``` highly digestible high protein (quality) not low fat non-complex carbohydrates vitamin supplementation (cobalamin) ```
221
what is colitis?
colonic inflammation
222
what is used to treat colitis?
Sulphasalazine (Salazopryn)
223
what is Sulphasalazine (Salazopryn) contraindicated for?
SI disease
224
how does Sulphasalazine (Salazopryn) work?
sulfonamide bound to 5-ASA link is cleaved by bacteria in colon leads to local release of 5-ASA which acts as a local anti inflammatory
225
what drug type is Sulphasalazine (Salazopryn)?
NSAID
226
what is a major side effect of Sulphasalazine (Salazopryn)?
keratoconjunctivitis sicca (KCS) - dry eye
227
what must be measured before and during Sulphasalazine (Salazopryn) administration?
schirmer tear test (STT) to confirm normal
228
what is irritable bowel syndrome?
large intestinal pattern diarrhoea +/- occasional vomiting
229
in what dogs is IBS usually seen?
anxious / nervous small / toy breed dogs (potential for underlying physical or emotional disorder)
230
how is IBS diagnosed?
exclusion of all other causes of signs
231
what are some of the reasons that an animal may be vomiting blood that is not of GI origin?
coagulopathy | swallowed blood from respiratory tract (oral, nasal or pulmonary)
232
what is seen with gastric or small intestinal bleeding?
haematemesis | melaena
233
what is seen with large intestinal bleeding?
haematochezia
234
what may partially digested blood in vomit look like?
coffee grounds
235
what are the causes of GI ulceration?
``` drugs (NSAIDS, opioids) foreign body (direct trauma) neoplasia hypoadrenocorticism kidney or liver disease other rare causes ```
236
how are gastric ulcers treated?
``` evaluate for and remove/treat underlying cause acid blockers coating agents analgesia Misoprostol surgery if perforated ```
237
what are the main acid blockers used to treat gastric ulcers?
proton pump inhibitors - omeprazole histamine receptor agonists antacids
238
what is the role of misoprostol?
given after NSAID overdose as it is a prostaglandin analogue and so will help to overcome defecit
239
what is constipation?
impaction of the colon or rectum with faecal material including hair/bones etc
240
what is the consistency of faeces during constipation?
excessively dry or hard
241
what does prolonged constipation lead to?
irreversible changes to the colon wall which reduces motility an leads to obstipation
242
define obstipation
the inability to pass the accumulation of dry hard feces. This can cause impaction of the entire length of the colon and lead to permanent damage
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what are the signs of constipation?
``` infrequent defecation dyschezia tenesmus pain associated with defecation (successful or not) vomiting anorexia lethargy ```
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what are the causes of constipation?
``` dietary dehydration of electrolyte derangement drug related (reduced motility) environmental pain/orthopedic problems making posturing for defecation difficult spinal / neuromuscular disease pelvic canal obstruction perineal/perianal disease ```
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what are the environmental causes of constipation?
stress dirty or absent toileting opportunities lack of exercise
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how is constipation treated?
identify and correct the underlying cause fluid therapy (with electrolyte correction if needed) oral laxatives enemas motility modification surgery (case dependent)
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how is the cause of constipation identified?
full history clinical, neurological, rectal and peri-anal exam abdominal and pelvic x-rays lab tests
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what can be used to clear the colon in a constipated patient?
microlax enema oral laxatives enema
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what are the main oral laxatives available?
lactulose lax-a-past katalax
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how is an enema performed?
warm water +/- lubricant digital manipulation and manual evacuation
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what type of enema must not be used in patients with constipation?
phosphate containing
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how can constipation be prevented?
``` ensure adequate water intake control any underlying disease add fibre into diet ensure litter tray is in a good location, is clean and is large enough provide analgesia if needed increase exercise increase gut motility laxatives ```
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why should fibre be added to the diet in constipated patients?
stimulates colonic motility
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what drugs are used for motility modification?
Cisapride
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what is megacolon?
loss of neuromuscular function of the colon producing weakened colonic contractions and faecal overload
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what species is megacolon most often seen in?
cats
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what causes megacolon?
idiopathic - neuromuscular dysfunction | chronic underlying disease
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how is megacolon treated?
as for constipation - last resort is sub-total colectomy
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what is the major side effect of a subtotal colectomy?
can lead to chronic diarrhoea

X Clinical Veterinary Nursing Theory (70 decks)

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