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CVSOH BVSc4 > GI - SA acute vomiting/diarrhoea > Flashcards

GI - SA acute vomiting/diarrhoea Flashcards

1
Q

Where is the vomiting centre located?

A

In the brainstem

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2
Q

What parts of the body act on the vomiting centre?

A

Cerebral cortex
Vestibular system
GI tract
Peripheral sensory receptors
Chemical stimuli in blood

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3
Q

What are the 4 stages of vomiting?

A

Prodromal - signs of nausea
Retching
Expulsion
Relaxation

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4
Q

What are the signs of nausea?

A

Restlessness
Lip smacking
Salivating

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5
Q

What occurs during retching?

A

Duodenal retroperistalsis

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6
Q

What occurs during expulsion of vomit?

A

Pyloric contraction
Lower oesophageal sphincter relaxation
Protect the airway - breathing inhibition, closed glottis
Abdominal contraction
Diaphragm descent - squashes stomach

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7
Q

What are some bad consequences of vomiting?

A

Fluid loss - dehydration
Acid base disturbance
Aspiration pneumonia

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8
Q

What make up normal stomach electrolytes?

A

Hydrochloric acid and potassium
(HCl only produced during feeding though)

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9
Q

What makes up normal duodenum electrolytes?

A

Bicarbonate

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10
Q

What electrolytes are primarily lost during vomiting with a patent pylorus? What does this cause?

A

Primarily lose bicarbonate and potassium
Causes a metabolic acidosis

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11
Q

Why does vomiting with a patent pylorus cause a metabolic acidosis?

A

Because the only thing left is the HCl making it acidic

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12
Q

What electrolytes are primarily lost during vomiting with an obstructed pylorus? What does this cause?

A

Primarily lose hydrochloric acid and potassium (the stomach contents)
Causes a metabolic alkalosis

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13
Q

What are the main two anti-emetic drugs?

A

Maropitant
Metoclopramide

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14
Q

What action does maropitant have to act as an anti-emetic?

A

NK1 receptor antagonist

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15
Q

What are the actions of metoclopramide?

A

Anti-emetic
Pro-kinetic - stimulates gastric and duodenal motility

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16
Q

When should you not use metoclopramide?

A

If there is a GI tract blockage - increased motility doesnt help
In cats - poor efficacy, maropitant is better

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17
Q

What are the 4 disease types of diarrhoea?

A

Osmotic
Secretory
Permeability
Motility

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18
Q

What causes osmotic diarrhoea?

A

Food not being digested properly
Net water movement into gut lumen due to the unabsorbed solute

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19
Q

What causes secretory diarrhoea?

A

Intestines secrete too much GI fluid and cant absorb it back

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20
Q

What causes permeability diarrhoea?

A

Disease in the lining of the intestines
Increases the leakiness and impairs fluid absorption, villus atrophy

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21
Q

What causes motility diarrhoea?

A

Increased GI transit rate - pass through too quickly for fluid to be absorbed

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22
Q

What is motility diarrhoea usually secondary to?

A

Bacterial toxins
Intestinal distention (laxatives)
High T4

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23
Q

What can be used/done as therapy for diarrhoea?

A

Appropriate fluid intake
Buscopan - antimuscarinic
Opioids

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24
Q

What should you do to treat acute diarrhoea?

A

Usually self limiting so doesnt need treating itself, just treat symptoms eg. fluid balance

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25
Q

Do obstructions cause vomiting or diarrhoea?

A

Vomiting

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26
Q

Does stomach/small intestinal disease cause vomiting or diarrhoea?

A

Can cause both

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27
Q

Does large intestinal disease cause vomiting or diarrhoea?

A

Diarrhoea

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28
Q

What is the term for small intestinal inflammation?

A

Enteritis

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29
Q

What is the term for large intestinal inflammation?

A

Colitis

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30
Q

What is the difference between a primary and extra GI disease?

A

Primary - structural or functional disease which primarily affects the GI tract
Extra - disease elsewhere in the body which affects GI health or function

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31
Q

What should you investigate first - primary or extra GI disease?

A

Extra GI disease - because they are easy to miss if you investigate the primary GI causes first
Unless the history makes it very obvious that it is a primary GI disease eg known foreign body

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32
Q

What is the difference between acute and chronic vomiting/diarrhoea?

A

Chronic - more than 3 weeks duration
Acute - less than 3 weeks, usually less than 1 week

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33
Q

What are the causes of acute vomiting/diarrhoea out of the VITAMIND list?

A

Vascular
Inflammatory
Traumatic/toxic

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34
Q

What are some primary GI inflammatory causes of acute vomiting/diarrhoea?

A

Parvovirus
Parasites
Bacterial enteritis

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35
Q

What are some extra GI inflammatory causes of acute vomiting/diarrhoea?

A

Acute pancreatitis
Infection eg. pyometra, hepatitis, peritonitis
Hypoadrenocorticism

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36
Q

What can cause chronic vomiting/diarrhoea out of the VITAMIND list?

A

Inflammatory, neoplastic
Metabolic

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37
Q

What are some primary GI inflammatory causes of chronic vomiting/diarrhoea?

A

Chronic inflammatory enteropathies
eg. food responsive disease, antibiotic responsive disease, inflammatory bowel disease

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38
Q

What are some extra GI inflammatory causes of chronic vomiting/diarrhoea?

A

Chronic pancreatitis

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39
Q

What are some metabolic causes of chronic vomiting/diarrhoea?

A

Exocrine pancreatic insufficiency
Endocrine disease
Renal disease
Hepatic disease

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40
Q

What is the difference between small and large intestinal diarrhoea?

A

SI - large volume, normal frequency, no urgency
LI - small volume, increased frequency, with urgency, straining and difficulty, may have more mucus

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41
Q

What are some other signs of small intestinal disease other than diarrhoea?

A

Weight loss
Inappetence or pica, polyphagia, coprophagia
Gas production

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42
Q

What will a puddle of diarrhoea from small intestinal disease look like?

A

Large brown liquid puddle

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43
Q

What will a puddle of diarrhoea from small intestinal disease look like?

A

Smaller bloody, mucousy puddle

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44
Q

When should acute vomiting/diarrhoea be investigated?

A

If dehydrated/hypovolaemic
If there was an abnormality/alarm bell from history or clinical exam

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45
Q

What should you do to manage acute vomiting/diarrhoea?

A

Fluids
Bland food little and often
Not very good to fast them
Anti-emetic (if obstruction excluded)
Appetite stimulant
Analgesia (NOT NSAIDs)
Probiotics

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46
Q

What is the difference between prebiotics and probiotics?

A

Prebiotics - feed and promote the health of the bacteria in the gut
Probiotics - the microorganisms themselves

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47
Q

Should you give antimicrobials if vomiting/diarrhoea?

A

NO - unless know that it is bacterial enterocolitis which is rare

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48
Q

What should you do if you suspect a GI foreign body?

A

Abdominal radiographs
Emesis if small/soft
Surgical resection - if obstructed/perforated
Wait and see - if small/not obstructed/needle

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49
Q

When should you do faecal analysis?

A

If have done all the tests eg. haem, biochem, imaging and still not found an answer

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50
Q

What can you test for on faecal analysis?

A

Parvovirus
Parasitology
Giardia
Tritrichomonas

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51
Q

What are the 3 diseases that it might be if vomiting/diarrhoea cause is not found after haem, biochem, imaging or faecal testing?

A

Acute pancreatitis
Hypoadrenocorticism
Hyperthyroidism

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52
Q

What is the job of the exocrine tissue in the pancreas?

A

Produce digestive enzymes for proteins, carbs and fats
Produce NaHCO3/bicarbonate to neutralise gastric acid

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53
Q

What is the job of the endocrine tissue in the pancreas?

A

Produce insulin and glucagon

54
Q

What are the digestive enzymes in the pancreas stored in?

A

Zymogen granules (away from the activators that are stored in lysosomes)

55
Q

What happens in pancreatic pathology?

A

Abnormal fusion of zymogen granules and lysosomes causing pancreatic autodigestion

56
Q

What can trigger pancreatitis?

A

Dietary indiscretion - high fat items
Obesity
Blunt abdominal trauma
Hypoperfusion
Drugs
Idiopathic

57
Q

What breed is predisposed to pancreatitis?

A

Miniature schnausers

58
Q

Where is the pancreas located?

A

Left limb - adjacent to duodenum
Right limb - adjacent to transverse colon
Adjacent to common bile duct
Near stomach

59
Q

What are the presenting clinical signs of pancreatitis?

A

Vomiting
Diarrhoea
Inappetance
Abdominal pain (prayer position)
Pyrexia
Jaundice

60
Q

How does pancreatitis cause vomiting?

A

Duodenum proximity causes inflammation and ilius
Stomach proximity causes peritonitis/inflammation, vagal nerve stimulation

61
Q

How does pancreatitis cause jaundice?

A

Pancreas swelling can block bile duct

62
Q

What is the difference between acute and chronic pancreatitis?

A

Sudden onset vs waxing/waning
potentially fully reversible vs progressive

63
Q

What can chronic pancreatitis result in if it gets to end stage?

A

Exocrine pancreatic insufficiency
Diabetes mellitus

64
Q

What can you see on biochem/haem to indicate pancreatitis?

A

Inflammatory leukogram - neutrophilia, left shift
Acute phase protein response - hyperalbuminaemia and hyperglobulinaemia

65
Q

What is the test of choice for pancreatitis?

A

Pancreatic lipase immunoreactivity

66
Q

What are the two types of pancreatic lipase immunoreactivity tests?

A

Spec cPL/fPL - quantitative, monoclonal antibodies sent to lab
SNAP test - qualitative, lots of false positives

67
Q

How do you interpret a SNAP pancreatic lipase immunoreactivity test?

A

Test spot lighter than reference - negative
Test spot same as or darker than reference - may be positive, send off for spec

68
Q

What does pancreatitis look like on ultrasound?

A

More abnormal on acute than chronic
Abnormal size/echogenicity
Free fluid

69
Q

What does pancreatitis look like on radiograph?

A

Loss of detail in right cranial quadrant - local peritonitis
Poor sensitivity

70
Q

How do you manage acute pancreatitis?

A

Supportive
Fluids
Nutrition - keep feeding little and often
Control nausea, vomiting, pain

71
Q

What is the prognosis of acute pancreatitis?

A

Guarded - recurrence and death possible
Can develop exocrine pancreatic insufficiency

72
Q

How is canine parvovirus spread?

A

Faeco-oral spread - low infective dose

73
Q

What disinfectants can you use to inactivate canine parvovirus?

A

Formalin
Hypochlorite

74
Q

What is an issue with canine parvovirus vaccination?

A

Maternally derived antibody causes an immunity gap where this wanes but not responsive to vaccination yet

75
Q

What is the usual signalment of canine parvovirus?

A

Variable but usually unvaccinated puppy around 3-6 months old

76
Q

What are the main clinical signs of canine parvovirus?

A

Haemorrhagic diarrhoea - intestinal crypt necrosis
Dehydrated
Neutropenia - bone marrow necrosis
+/- vomiting

77
Q

How do you diagnose canine parvovirus?

A

Faecal parvovirus antigen ELISA (in house) - test any dog with haemorrhagic diarrhoea
PCR - lab test cheek swab

78
Q

How do you treat canine parvovirus?

A

Aggressive fluid therapy
Nasoesophageal tube trickle feeding once stopped vomiting
May need glucose supplementation
Antiemetic
Antibiotic - amoxyclav

79
Q

How can you administer aggressive fluid therapy for canine parvovirus dogs?

A

IV
Intraosseus

80
Q

When should you give antibiotics in canine parvovirus cases? What antibiotic do you give?

A

IF severe Haemorrhagic diarrhoea
And/or neutropenic
Amoxycillin clavulanate

81
Q

How do you prevent canine parvovirus?

A

Vaccination
Barrier nursing
Disinfection with hypochlorite

82
Q

What is the prognosis of canine parvovirus?

A

Variable
>50% fatality if no care provided

83
Q

What are the different names for feline parvovirus?

A

Feline panleukopenia
Feline infectious enteritis

84
Q

How does feline parvovirus relate to canine parvovirus?

A

Closely related virus
Same clinical syndrome
Can transmit from dogs to cats and vice versa

85
Q

What can feline parvovirus cause in kittens?

A

Cerebellar hypoplasia

86
Q

What signalment are particularly at risk of getting bacterial enterocolitis?

A

Raw fed diet
Young
Unsanitary/crowded environment

87
Q

What pathogens cause bacterial enterocolitis and how is this an issue?

A

E. coli
Clostridium perfringens
Campylobacter
Salmonella
Can all be isolated from healthy dog faeces too - often overdiagnosed

88
Q

What are the clinical signs of bacterial enterocolitis?

A

Haemorrhagic vomiting and/or diarrhoea
Pyrexia
Sepsis
Enterotoxaemia

89
Q

How do you test for bacterial enterocolitis?

A

Faecal culture - only if have the right clinical signs and are at risk animals

90
Q

What campylobacter species is related to disease in dogs?

A

C. jejuni

91
Q

What campylobacter species is related to disease in cats?

A

C. coli

92
Q

What campylobacter species is a commensal in dogs?

A

C. upsaliensis

93
Q

What disease does campylobacter have the potential of developing?

A

Potential to attach/invade and cause ulcerative enterocolitis

94
Q

What antimicrobial is the first line therapy for campylobacter GI infection?

A

Erythromycin

95
Q

What can antibiotics do in cases of salmonella?

A

May encourage carrier state

96
Q

When should you treat salmonella?

A

Only if clinically unwell - subclinical carriage is common in healthy animals (30% of dogs)

97
Q

How do you subtype clostridium perfringens?

A

Subtype based on various toxins

98
Q

What symptoms do dogs with clostridium perfringens tend to have?

A

Large intestinal diarrhoea
But can have small or mixed as well

99
Q

How do you diagnose and treat clostridium perfringens?

A

Faecal culture - but huge limitations
Only treat if systemically ill
Ampicillin or metronidazole

100
Q

What causes Acute Haemorrhagic Diarrhoea Syndrome (AHDS)?

A

Thought to be clostridium perfringens NetF toxin targeting pore in enterocytes

101
Q

What are the clinical signs of Acute Haemorrhagic Diarrhoea Syndrome (AHDS)?

A

Acute haemorrhagic diarrhoea
Marked haemoconcentration (less fluid in blood)
+/- vomiting
Hypovolaemia

102
Q

What does Acute Haemorrhagic Diarrhoea Syndrome (AHDS) diarrhoea look like?

A

Strawberry jam

103
Q

How do you diagnose Acute Haemorrhagic Diarrhoea Syndrome (AHDS)?

A

Consistent clinical sings
Marked elevation in PCV without protein increase

104
Q

How do you treat Acute Haemorrhagic Diarrhoea Syndrome (AHDS)?

A

Intravenous crystalloid fluid therapy - boluses and continuous rate infusion
Amoxyclav if pyrexic/sepsis

105
Q

When does disease from clostridium difficile tend to occur?

A

Disease likely secondary to toxin production

106
Q

How do you diagnose clostridium difficile?

A

Faecal culture or ELISA antigen test

107
Q

How do you treat clostridium difficile?

A

Metronidazole

108
Q

When should you consider a bacterial pathogen is causing gastrointestinal disease?

A

ACUTE haemorrhagic vomiting/diarrhoea
With pyrexia
Sepsis
Inflammatory leukogram

109
Q

What signalment do roundworms cause GI signs in?

A

Puppies/kittens

110
Q

What are the names of the roundworms?

A

Toxocara canis
Toxocara cati
Toxascaris leonina

111
Q

How do puppies/kittens contract roundworms?

A

Transplacental
Transmammary - drink in milk

112
Q

What are the clinical signs of roundworms?

A

Vomiting/diarrhoea
Bloated abdomen
Obstruction if high amounts

113
Q

How do you diagnose roundworms?

A

See adults in faeces
Faecal parasitology - eggs

114
Q

What is a big risk of roundworms?

A

Zoonotic - causes larva migrans in humans

115
Q

What are the names of the hookworms?

A

Ancylostoma
Uncinaria

116
Q

What do ancylostoma hookworms cause?

A

GI blood loss
Anaemia
Iron deficiency

117
Q

How do uncinaria hookworms invade?

A

Enter through the digital skin of the paws

118
Q

What do uncinaria hookworms cause?

A

Pedal pruritus
Diarrhoea

119
Q

How do you treat ancylostoma hookworms?

A

Pyrantel

120
Q

What is the whipworm called?

A

Trichuris

121
Q

What do whipworms cause?

A

Large intestinal diarrhoea - live in caecal and colonic mucosa, bury tail causing inflammation
GI blood loss
Abdominal pain

122
Q

What do tapeworms cause?

A

DONT tend to cause GI signs

123
Q

What are the main protozoa affecting the GI tract?

A

Giardia
Tritrichomonas
Cryptosporidium

124
Q

What species does giardia affect?

A

More common in dogs than cats
Zoonotic - humans

125
Q

What does giardia cause?

A

Acute or chronic diarrhoea
Malabsorption, weight loss

126
Q

How do you diagnose giardia?

A

Faecal analysis - fresh smear
Antigen ELISA
Zinc sulfate floatation - oocysts

127
Q

What doe giardia look like on fresh smear?

A

Pear shaped
Motile
Move like a falling leaf (different to tritrichomonas)

128
Q

How do you treat giardia?

A

Fenbendazole orally once daily for 3 days
Clean environment, treat all dogs in household

129
Q

What does tritrichomonas foetus cause?

A

Chronic recurrent large intestinal diarrhoea
Can be asymptomatic
Peri-anal oedema
Faecal incontinence

130
Q

What signalment does tritrichomonas affect?

A

Kittens and young cats - immunity at maturity

131
Q

How do you test for tritrichomonas?

A

Colonic wash - PCR

132
Q

How do you treat tritrichomonas?

A

Ronidazole once a day for 2 weeks
Isolate

CVSOH BVSc4 (86 decks)

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