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VET 433a - Small Animal Stream 1 > GI pt. 1 > Flashcards

GI pt. 1 Flashcards

GI pt. 1

1
Q

3 Classifications of dysphagia

A
  1. Oropharyngeal
  2. Esophageal
  3. Gastroesophageal
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2
Q

3 subtypes of oropharyngeal dysphagia

A
  1. Oral – difficulty prehending and transporting food or water to the oropharynx
  2. Pharyngeal – Pharyngeal weakness secondary to a polyneuropathy or polymyopathy, or pharyngeal foreign body or neoplasia
  3. Cricopharyngeal – Failure of the bolus to pass through the cricopharyngeus region
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3
Q

Oropharyngeal dysphagia

A
  • exaggerated swallowing movements and food will usually drop from the mouth within seconds of swallowing
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4
Q

Esophageal Dysphagia

A

more delayed regurgitation and is usually not associated with exaggerated swallowing movements.

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5
Q

Gastroesophageal Dysphagia

A

typically associated with a sliding hiatal hernia or abnormal decreased tone in the lower esophageal sphincter causing gastroesophageal reflux

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6
Q

Odynophagia

A

painful swallowing, often associated with esophageal foreign body or esophagitis

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7
Q

T/F: the cricopharygeal muscle is a vital part of the upper esophageal sphincter

A

T

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8
Q

Retching

A

an involuntary and ineffectual attempt at vomiting

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9
Q

Gagging

A

reflexive contraction of the constrictor muscles of the pharynx resulting from stimulation of the pharyngeal mucosa.

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10
Q

Diagnosis of swallowing disorders (History)

A 
Age of onset is important
Liquids vs solids
Intermittent vs progressive
Temporal pattern w/ swallowing
Recent gen. anesthesia
Dysphonia?
Odynophagia
Medications
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11
Q

T/F: an ability to ingest liquids fine, but inability to ingest solids is indicative of some form of structural abnormality, esophagitis, or vascular ring anomaly.

A

T

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12
Q

What is one of the most valuable tools when checking a dysphagic patient?

A

actually watching the animal attempt to eat/ drink

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13
Q

Diagnostic Approach to the Dysphagic Dog

A
  • physical and neuro exam
  • observe the animal eating and drinking
  • CBC, Chem (including CK)
  • survey rads
  • Esophagram vs Videofluroscopy
  • Esophagoscopy
  • EMG and NCV
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14
Q

T/F: Dysphagia is not a diagnosis, it is a clinical sign.

A

T

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15
Q

Masticatory Muscle Myositis

A
  • often present with an inability to open the jaw (trismus), jaw pain, and swelling/ atrophy of the masticatory muscles
  • Diagnostics should include CK, 2M antibody test, and muscle biopsy
  • Treatment with aggressive immunomodulatory drugs - cyclosporine, pred
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16
Q

T/F: muscles often affected by MMM are: masseter, temporalis, pteygoid, frontalis, and digastric.

A

F: the frontalis is not affected and so a muscle biopsy taken is not indicative/ useful for establishing MMM

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17
Q

Cricopharyngeal Muscle (CPm) Dysphagia

A
  • Classified as either an Achalasia or Asynchrony, but have similar clinical presentations
  • Clinical Signs: dysphagia immediately upon swallowing, repeated swallowing attempts, dysphagia worse w/ water, nasal reflux, bloating, coughing
  • Diagnostics: Video-fluroscopy, rule out other causes
  • Treatments: Surgery (myotomy - ideal), Botox injection (temp. repair for couple months), Balloon dilation of UES (not great alone)
  • Prognosis - extremely variable
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18
Q

What are the two causes of nasal reflux

A
  • Cleft pallate

- CPm achalasia (normally, but can also be asynchrony)

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19
Q

CPm Achalasia vs Asynchrony

A

Achalasia:
- failure of UES to relax

Asynchrony:
- failure of UES relaxation to time with pharyngeal contraction

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20
Q

Megaesophagus (Congenital Form)

A
  • usually manifests in puppies at the time of weaning

- most likely due to a delay in maturation of the esophageal neuromuscular system

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21
Q

Megaesophagus (Acquired Form)

A
  • Primary (idiopathic)(roughly 52%) or Secondary (to a large number of systemic disorders such as MG (roughly 25%), Addison’s, SLE, polymyositis, etc)
  • Acquired idiopathic form is the most common in the dog (GSD, Great Dane, Irish Setter)
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22
Q

T/F: the biggest concern for an animal presenting with megaesophagus is the risk of aspiration pneumonia.

A

T

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23
Q

Megaesophagus (clinical Signs)

A
  • regurgitation
  • anorexia
  • drooling,
  • pain on swallowing (secondary to esophagitis)
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24
Q

Megaesophagus (Diagnostics)

A
  • radiography ( Also, enlargement of the cranial eso with normal distal eso indicates a vascular ring anomaly or stricture)
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25
Q

T/F: We are concerned that a dog’s presentation of megaesophagus is secondary due to MG. However, the serum AChR-Abx come back only at high normal. What do we make of this?

A
  • we are still concerned for MG so we will re-run the titers in a couple months to see if we simply caught the disease early on
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26
Q

Management of Megaesophagus

A
  • modify feeding practices (animal should be fed in a vertical position and kept there for 5-10 minutes after eating)
  • if esophageal achalasia exists, you can treat that with botulism injections too
  • gastrostomy tubes are entirely viable options as well
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27
Q

Megaesophagus (Prognosis)

A
  • idiopathic is poor due to the risk of aspiration pneumonia
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28
Q

Esophageal obstruction

A
  • can be intraluminal (foreign body), intramural (stricture), or periesophageal (inflammation, neoplasia, hilar lymphadenopathy, vascular ring anomaly [persistent right aortic arch])
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29
Q

Esophageal foreign body

A
  • can result in severe ulcerative esophagitis, esophageal perforation, or stricture formation
  • diagnose via radiograph
  • treatment via removal of foreign body
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30
Q

Intramural esophageal obstruction

A
  • often a result of stricture formation
  • treatment via
  • -> balloon catheter dilators (multiple treatments),
  • -> Sucralfate (good for stricture ass. esophagitis),
  • -> give an H2 or PPI to decrease esophageal mucosa damage
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31
Q

Peri-esophageal

A
  • obstruction via inflammation, neoplasia, hilar lymphadenopathy, and vascular ring anomalies (persistent right aortic arch)
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32
Q

Esophagitis

A
  • inflammation of the esophagus resulting from ingestion of caustic agents, chronic vomiting, foreign body obstruction, reflux esophagitis
  • results from a loss of competency of the gastroesophageal sphincter and subsequent reflux
  • can results from general anesthesia (important), pill-induced (doxy, clinamycin, NSAIDs)
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33
Q

Esophagitis (Treatment)

A
  • removing underlying causes
  • Sucralfate
  • PPIs and H2 blockers
  • Prokinetics (Cisapride and Metaclopramide)
  • Dietary Fat Restriction
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34
Q

H2-antagonists vs PPI

A
  • PPIs are significantly more potent than H2’s

- H2’s suffer from tachyphylaxis (buildup of tolerance to certain drugs)

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35
Q

Myasthenia Gravis

A
  • 40% megaesophagus only

- 45% megaesophagus + gen. weakness

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36
Q

T/F: the incidence of gastroesophageal reflux varies between 16-55% depending on the measuring device, type of surgery and larger size

A

T

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37
Q

T/F: Cisapride is contraindicated in patients with megaesophagus

A

T

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38
Q

Ondansetron

A

potent selective 5HT3 receptor antagonist

- CRTZ, Vomiting Center, and GIT/Pharynx, (no vestibular nuclei)

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39
Q

Cerenia/ Maropitant

A

Substance P inhibitor

- CRTZ, Vomiting Center, and GIT/Pharynx (no vestibular nuclei)

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40
Q

T/F: the vestibular nuclei connect directly to the vomiting center in the dog while they must pass through the CRTZ in the cat.

A

False, signals must pass through the CRTZ in the dog while they can pass directly to the vomiting center in the cat

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41
Q

Name some breeds predisposed to MMM

A
  • labradors
  • Dobermans
  • GSD
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42
Q

Breed Disposition to Cricopharyngeal Achalasia?

A
  • mini dashchunds, toy breeds
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43
Q

Breed Disposition to Cricopharyngeal Asynchrony?

A
  • Golden Retrievers
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44
Q

Cisapride

A
  • increased LES tone
  • stimulates gastric emptying
  • stimulates distal esophageal motility (cats)

useful in GERD and esophagitis
contra in dogs with megaesophagus

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45
Q

Which two anesthetic drugs do not decrease LES tone?

A
  • ketamine

- propofol

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46
Q

Which two anesthetic drugs do not decrease GI motility

A
  • alfaxalone

- benzodiazepines

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47
Q

Approach to vomiting patient

A
  • keep head down to prevent aspiration

- induce quickly (no opioids or inhalants)

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48
Q

Approach to regurgitating patient

A
  • keep head up to prevent regurge
  • induce quickly
  • have suction ready
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49
Q

Anesthetizing patients with GERD (risk factors)

A
  • increasing age
  • surgery type
  • longer fasting time
  • drugs used
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50
Q

Anesthetizing patients with GERD (non-risk factors)

A
  • position of the patient

- type of inhalant used

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51
Q

Top complications of anesthetizing GI patients

A
  • Esophagitis

- Aspiration pneumonia

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52
Q

GI Vomiting Causes

A

GI:

  • Dietary Indiscretion
  • GI foreign body
  • GI neoplasia
  • infectious gastro-enteropathy
  • IBD (inflammatory bowel disease)
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53
Q

Extra-GI Vomiting Causes

A

Extra-GI:

  • Hyperthyroidism
  • Hepatic Dysfunction
  • Renal Failure (uremic acids)
  • Addison’s
  • pancreatitis
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54
Q

Top causes of chronic small bowel disease –> vomiting in the cat?

A
  • IBD (49%)
  • Lymphoma (46%)
  • Mast Cell Disease (3%)
  • Adenocarcnimoa (1%)
55
Q

Two pathways for the vomiting reflex

A
  1. CRTZ (bloodborne) - humoral pathway
    - renal failure, liver disease, digoxin toxicity, endotoxemia, apomorphine
  2. Vomiting Center (neural reflex) -
    - GI infection, inflammation, toxicity, malignancy
56
Q

4 components of the vomiting reflex

A
  1. visceral receptors in the gi tract
  2. sympathetic and vagal affarent neurons (synapse in vomiting center)
  3. CRTZ
  4. Vomiting Center
57
Q

Regurgitation vs Vomiting

A 
Regurge:
- no prodromal nausea
- passive
- seconds-hrs
Vomiting:
- active, abd contractions
- prodromal nausea 
- minutes-hours
58
Q

T/F: cats to do not have very good dopiminergic receptors which makes apomorphine (agonist of D2) and metoclopramide (D2 antagonist) not very effective

A

True, these work very well in the dog, but are almost completely useless in the cat

59
Q

Management of the acutely vomiting dog/ cat

A
  • crystalloid fluids
  • antiemetics
  • dietary management
  • broad spectrum angelmenthics
    Don’t - NPO, gastric acid suppressants, antibiotics, corticosteroids
60
Q

What is the value of the chemistry profile in the vomiting patient?

A
  • rule out metabolic diseases/ extra-gi causes such as renal, hepatic, addison’s, diabetes, hypercalcemia, etc.
61
Q

Chronic gastritis

A
  • can have many different problems including IBD, foreign body, toxin ingestion, infections, etc.
62
Q

Esophageal acalasia (treatment)

A
  • sildenafil

- botulism injections

63
Q

Shortcomings of PPI vs H2

A
  • H2 suffers from drug tolerance

- PPIs are significantly more potent

64
Q

Helicobacter spp.

A
  • present in ~50% of healthy dogs and cats
  • causes a lymphofolicular gastritis
  • treat with triple therapy ( clarithromycin, metranidazole, PPI)
65
Q

Metoclopramide

A
  • D2 antagonist (anti-emetic), minor 5HT3 (anti-emetic) and 5HT4 (prokinetic)
  • antiemetic (not in cats)
  • prokinectic drug (less effective than cisapride and does not touch the oclon)
  • best given as CRI
66
Q

Ondansetron

A
  • 5HT3 antagonist
  • can be given IV, SQ, orally
  • v potent antiemetic in dogs and cats
67
Q

alpha-2 Adrenergic Antagonist

A
  • Chlorpromazine, Prochorperazine, Yohimbine

- anti-emetics, increase GI motility

68
Q

Diphenhydramine

A
  • H1 histaminergic blocker

- useless in cats d/t lack of histaminergic receptors

69
Q

Cerenia (maropitant)

A
  • NK1 receptor antagonist, prevents Substance P binding
  • highly effective antiemetic in cats and dogs
  • can help reduce visceral pain
70
Q

GI protectant - Sucralfate

A
  • electrostatic binding to the mucosal proteins exposed during ulceration
71
Q

H2-blocker

A
  • Fomotidine, Ranitidine (never give Cimetidine)
72
Q

PPI

A
  • more potent than H2’s, must give 30-45min before meal

- Omeprazole, Esomeprozole

73
Q

Misoprostal

A
  • PGE1 analogue
  • not commonly used in vet med
  • increased mucosal blood flow, epithelial cell turnover, mucus secretion, decreased gastric acid secretion
  • no advantage over H2 blockers for treating ulcers
74
Q

How to assess intestinal viability?

A
  • color
  • consistency
  • motility
  • bleeding/ perfusion
75
Q

What is the primary holding layer in the GI

A
  • submucosa
76
Q

Gastric Closure

A
  • 2 layer closure:
  • -> mucosa/submucosa
  • -> muscularis/ serosa (inverted pattern)
77
Q

Small/ Large intestine closure

A
  • single layer appositional, must include submucosa

- inverting will decrease lumen size

78
Q

Methods for dealing with lumen disparity

A
  1. Place suture at wider interval on larger side
  2. Transect the side with the smaller diameter obliquely
  3. Spatulate Smaller sides
  4. Suture anastomosis and close mesenteric rent
79
Q

Adverse factors affecting wound healing in the Large Intestine

A
  • dehisce at a higher rate than the small intestine
  • wound strength returns more slowly than small intestine
  • poorer blood supply in mid-rectum
  • large anaerobic load present
  • Tension: reduces blood supply, oxygen tension
80
Q

Indications for colo-rectal resection

A
  • colonic neoplasia
  • feline megacolin
  • rectal neoplasia
  • colonic foreign bodies - can usually be removed without surgery
81
Q

Diagnostic approach to rectal masses

A 
For lesions close to anocutaneous jxn:
- FNA, core biopsy, incisional biopsy
- might require mucosal eversion
For more proximal lesions:
- proctoscopy or colonoscopy
Lymph node aspiration
Colotomy for colorectal jxn tumors not recommended
82
Q

Common indications for anal sac surgery

A
  • Anal sac adenocarcinoma

- anal sacculitis/ infection/ impaction

83
Q

Common complications for anal sac surgery

A
  • infection
  • fecal incontinence
  • recurrence of disease (particularly neoplasia)
84
Q

Small vs Large Bowel Diarrhea

  • frq
  • V
  • blood
  • mucous
  • tenesmus
  • urgency
  • vomiting
  • weight loss
A

Small: n frequency, n volume, melena, no mucous, no tenesmus, no urgency, yes vomiting, yes weight loss

Large: incr frequency, dec volume, hematochezia, yes mucous, yes tenesmus, yes urgency, vomiting less common, no weight loss

85
Q

CIBDAI (IBD activity index)

A
  • reserved for chronic gi disease
  • -> attitude/ activity
  • -> appetite
  • -> vomiting
  • -> stool consistency
  • -> stool frq
  • -> weight loss
86
Q

Most common causes of Acute Diarrhea

A
  • dietary indiscretion
  • foreign body
  • infectious
  • antibiotics
  • chemotherapy
87
Q

Most common causes of Chronic Diarrhea

A
  • food responsive enteropathy (#1 most common)
  • antibiotic-responsive enteropathy (dogs)
  • steroid-responsive enteropathy (IBD)
  • infectious
  • neoplasia
88
Q

T/F: a majority of acute diarrhea cases are self resolving and require no significant treatment other than possible supportive

A

T

89
Q

T/F: Diagnosis of Food-RE and Antibiotic-RE are only based off of signalment and history while Steroid-RE requires biopsy

A

T

90
Q

T/F: Gravitational centrifugation is 7x more sensitive than gravity flotation for when detecting protozoa such as Giardia

A

T

91
Q

Diagnostic approach to diarrhea in dogs and cats (3 questions)

A
  1. Acute or Chronic
  2. GI or extra-GI
  3. Small or Large bowel
92
Q

Giardia

A
  • most common sign is asymptomatic animal
  • associated w/ small bowel disease
  • most strains are non-zoonotic
  • often self-limiting
93
Q

Giardia (Direct wet-prep)

A
  • looking for motile trophozoites; falling leaf motion
  • high change for false neg
  • feces must be <1 hr old
  • drop of saline + small volume of fresh diarrhegic feces
94
Q

Giardia (Firect Fluoresent Immunoassay)

A
  • this is a dual assay and will highlight both giardia and cryptosporidium (crypto is significantly smaller)
95
Q

Giardia (treatment)

A
  • metronidazole (only 67% effective)
  • fenbendazole (>80% effective)
  • Ronidazole (macrolide can cause neurotox in cats)
  • Drontal plus (3 dif. drugs)
  • Secnidazole
96
Q

T/F: Treatment of T. foetus in cats is best controlled with either metronidazole or fenbendazole

A

F; treatment is best with Ronidazole however there is slight concern for neurotoxicity

97
Q

Abx for C. perfringens

A
  • Ampicillin, Metro, Tylosin
98
Q

Abx for Campylobacter

A
  • Erthyromycin, enrofloxacin
99
Q

Abx for C. Difficile

A
  • Metronidazole
100
Q

Treatment of Abx-RE

A
  • Tylan is superior

- Metronidazole can cause nausea, vomiting, neurotox

101
Q

T/F: Giardia detection via ELISA can only be used for initial diagnosis and not any further follow-ups to see if the infection has cleared

A

T; Giardia cysts can be present in the feces for months post-resolution and so ELISA is not an accurate measurement technique

102
Q

What are some major differences between T. foetus and Giardia?

A
  • T. foetus is mainly cats while Giardia is mainly dogs
  • T. foetus is large bowel diarrhea while Giardia is small bowel
  • T. foetus has no cyst stage so fecal flotation not possible
103
Q

Indications for fecal culture/ PCR

A
  1. acute onset hematamesis or bloody diarrhea w/ systemic signs of sepsis
  2. zoonotic ramificiations
  3. hemorrhagic diarrhea in an immunocompromised patient
104
Q

Food Responsive Enteropathy

A
  • ;most common form of chronic enteropathy
  • younger dogs and cats
  • large bowel signs predominate
  • disease activity index is low
105
Q

Food-RE (Dietary Management)

A
  • limited ingredient
  • hydrolyzed
  • fat-restricted (<20% by per calorie)
  • highly digestible
  • fiber modification
106
Q

T/F: Dietary therapy for Food-RE is both diagnostic and therapeutic

A

T

107
Q

Food-RE (Prognosis)

A
  • younger dogs w/ less severe disease and predominance of large intestinal signs are more likely to respond rapidly to elimination diets alone
108
Q

Food-RE (Neg Prognostic factors)

A
  • high clinical activity index
  • low B12
  • low albumin
109
Q

Food-RE (Indications for feeding hypoallergenic Diet)

A
  • complicated diet history
  • diagnosis and management of Cutaneous Adverse Food reaction
  • allergic to multiple allergens
110
Q

Antibiotic -RE

A
  • not the same as SIBO
  • a dysbiosis exists but not necessarily an overgrowth
  • young, middle aged large and giant breed (GSD)
  • mild lymphocytic-plasmacytic duodenitis w/ no architecture changes
111
Q

Antibiotic-RE (Treatment)

A
  • Tylan (macrolide)(unknown moa)
112
Q

Steroid-RE (pathogenesis)

A
  • overly aggressive T-cell response to a subset of commensal enteric bacteria develops in a genetically susceptible host
  • -> luminal antigens
  • -> genetic suscuptibility
  • -> env. triggers
113
Q

IBD - Clinical Criteria

A
  1. persistence of gi signs >3 weeks duration
  2. failure to respond to symptomatic signs treatment
  3. failure to document other causes of gastroenteritis
  4. hist diagnosis of benign intestinal inflammation w/ villus blunting/ fusion or changes in crypt
114
Q

Steroid-RE (Diagnostic Approach)

A
  • requires biopsy for diagnosis
  • elimination diet trial +tylosin trial
  • measure B12 + Folate
  • US –> thickening of muscularis layer
  • endoscopy –> biopsy
115
Q

2 Limitations of endoscopic biopsy for IBD

A
  1. length of endoscopy tube

2. depth of the sample

116
Q

Management of IBD (2 types)

A
  • lymphocyte-plasma cell IBD –> treat with diet, abx, immune suppress
  • Granulomatous or neutrophilic IBD –> ass. with infection, do not immunosuppress
117
Q

B12 Deficiency causes

A
  • dec ileal absorption
  • dysbiosis
  • dec. intake
  • dec. gastric acidity
118
Q

Management of non-specific colitis

A
  • Fenbendazole
  • Elimination Diet
  • Tylosin
  • +/- Pred
119
Q

Granulomatous Colitis

A
  • plasma cells, lymphocytes, PAS-positive macrophages
  • Treatment: fluoroquinolones for 6-8wks
  • Cause: Boxer macrophages lack a certain enzyme capable of breaking down E. coli from the intestine
120
Q

PLE (Major Causes)

A 
GI Inflammation
--> IBD
--> Histoplasmosis
--> intestinal pythiosis
Gi Ulceration
--> intestinal lymphoma
--> ulcerative enteritis/ gastritis
--> intussusception
Primary Intestinal Lymphangiectasia
121
Q

Primary Intestinal Lymphangiectasia

A
  • small bowel diarrhea
  • panhypoprotenemia and lymphopenia
  • hypocholesterolemia and hypocalcemia
  • malabsorption of fat and fat soluble vitamins
122
Q

Explain the relationship between decreased Calcium and Magnesium

A

…ask butt for help…

123
Q

Primary Intestinal Lymphangiectasia (management)

A
  • fat restricted diet (<20%)

- elimination diets for concurrent IBD

124
Q

Indications for Abx therapy w/ GI disease

A
  1. hemorrhagic diarrhea w/ signs of sepsis
  2. prevent bacterial translocation
  3. severely immunocompromised patient
  4. management of abx-responsive diarrhea (ARD)
  5. Management of a specific bacterial enteropathogen
125
Q

EPI (Clinical Signs)

A
  • Polyphagia
  • Weight Loss
  • Small Bowel Diarrhea
  • Poor body condition
126
Q

What is the diagnostic test of choice for EPI

A

TLI - Trypsin-like Immunoreactivity

–> picks up both trypsin and trypsinogen

127
Q

EPI (Treatment)

A
  • Pancreatic enzyme supplementation
  • Diet: highly digestible diet (avoid high fiber)
  • Vit. B12 supplementation
  • abx: only if refractory or abx-re develops
  • fat soluble vitamins
  • acid suppressants (not used)
128
Q

EPI (prognosis)

A
  • good w/ proper treatment

- better prognosis w/ B12 supplementation

129
Q

EPI (reasons for poor response)

A
  • lack of owner compliance
  • plant based enzymes
  • B12 not given
  • not on high digestible diet
  • dysbiosis not addressed
  • occult concurrent GI disease
130
Q

T/F: EPI =
Dogs = Polyphagia + weight loss + small bowel diarrhea
Cats = mainly weight loss

A

T

131
Q

4 functions of Sucralfate

A
  1. binds to proteins electrostatically
  2. stimulates PG production
  3. adsorption of bile salts
  4. inactivation of pepsins
132
Q

Common Names?

  • Metoclopramide
  • Ondansetron
  • Maropitant Citrate
  • Sucralfate
  • Omeprazole
A
  • Reglan
  • Zofran
  • Cerenia
  • Carafate
  • Prilosec
133
Q

What are 4 causes of a discordant BUN:Cr

A
  1. emaciation/ starvation
  2. gi hemorrhage
  3. dehydration
  4. high protein diet

VET 433a - Small Animal Stream 1 (10 decks)

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