GI - SA chronic vomiting/diarrhoea Flashcards
What does haematemesis look like?
Coffee grounds - if in stomach for a long time
Blood
What is the name for blood from the small intestine?
Melaena
How do you evaluate for extra GI causes of chronic vomiting/diarrhoea?
Haematology
Serum biochemistry
Electrolytes
What signs on bloodwork can indicate malabsorption as a GI disease consequence?
Hypoalbuminaemia
+/- Hypocholesterolaemia
What tests should you do if diarrhoea is part of the presentation of GI disease?
Faecal evaluation - parasitology and giardia antigen ELISA
Colonic wash - for tritrichomonas
cTLI/fTLI (trypsin like immunoreactivity) - for exocrine pancreatic insufficiency
Where is folate absorbed?
Proximal small intestine - jejunum
Where is cobalamin (vit B12) absorbed?
In the distal SI - ilium
What does cobalamin (vit B12) need to be bound to to be absorbed?
Intrinsic factor
What causes low cobalamin in cats? How is this different to dogs?
Pancreatic disease exclusively - EPI
Dogs it is primarily pancreatic but can be gastric disease
How do you treat hypocobalaminaemia
Identify and treat cause
Subcut injections weekly until normalised
Or oral with massive doses to make sure is absorbed
How does a diet trial work?
Feed completely novel protein/carb
Or can feed hydrolysed protein
Feed EXCLUSIVELY with water for 3-10 weeks
What are the breed specific considerations of german shepherds with chronic GI disease?
High incidence of EPI
High incident of antibiotic responsive diarrhoea - give oxytetracycline to treat the diarrhoea
What endocrine diseases should you exclude when investigating GI disease?
Hypoadrenocorticism - dog
Hyperthyroidism - cat
How many dogs have evidence of chronic pancreatitis?
34%
How do dogs with chronic pancreatitis present?
Chronic intermittent inappetance
“ vomiting
“ diarrhoea
“ abdominal pain
How can you treat chronic pancreatitis?
Avoid risk factors
Weight reduction
Low fat diet
Analgesia - paracetamol
Maropitant - anti-nausea
What type of exocrine pancreatic neoplasia can dogs (and rarely cats) get? What does it cause?
Ductular and acinar adenocarcinoma
Triggers pancreatitis
What endocrine pancreatic neoplasia can dogs and cats get?
Insulinoma
Gastrinoma (rare)
When should you do diagnostic imaging when approaching GI disease?
If palpable abdominal pain/abnormality
GI haemorrhage
GI perforation concern
What are you evaluating for on diagnostic imaging when approaching GI disease?
Ultrasound - GI wall thickness, layering, ulceration, mass lesions
Any extra GI pathology - abdominal inflammatory/neoplastic disease
Urogenital disease
What is the normal appearance of a cats stomach on ultrasound?
Wagon wheel appearance
What does it mean if see food in stomach when fasting?
Abnormal - may be functional problem with motility or structural problem eg. obstruction
What structural problems can cause delayed gastric emptying?
Pyloric FB
Pyloric mass lesion - neoplasia, polyp
Chronic hypertrophic pylorogastropathy
How can you treat chronic hypertrophic pylorogastropathy?
Can be removed with surgery quite easily
What are some causes of secondary motility disorders causing delayed gastric emptying?
Primary GI disease
Local inflammation in abdomen eg. pancreatitis
Electrolyte disturbance - low K, high Ca
Drugs
What does a stomach ulcer look like on ultrasound?
Hyperechoic area - whiter
What does lymphangectasia look like on ultrasound?
Abnormal bands on intestines
In the case of a focal primary GI abnormality, when should you do surgery over endoscopy?
If its a chronic FB that is past stomach
If focal mass lesion - excise
Concern for sepsis/perforation
Chronic hypertrophic pylorogastropathy
How do you diagnostic image a diffuse primary GI abnormality?
Endoscopy - scope top or bottom end
What should you do if everything is normal on non invasive testing in GI disease cases? When should you do each test?
Diet trial - if young animal or less severe case
Endoscopy/histopathology - if more severe signs
When do you take an intestinal biopsy?
Following exclusion of:
extra GI causes
Treatable primary GI disease
Stopped steroids
If anorexic
If had abnormal GI imaging
If hypoalbuminaemic
What are the two different methods of taking intestinal biopsy?
Laparotomy
Endoscopy
What are the pros and cons of laparotomy for intestinal biopsy?
Can get multiple full thickness biopsies
Can sample multiple organs
But surgical risk of dehiscence
What are the pros and cons of endoscopy for intestinal biopsy?
Minimally invasive
but small biopsies
May not reflect jejunal disease
How do you prepare a patient for colonoscopy?
Fast for 24-36 hours
Oral lavage with poly ethylene glycol electrolyte solutions - tube day before
Multiple ‘high’ enemas
For diffuse GI disease, where should you sample from as it is most representative?
Ilium - most representative
What are the types of diffuse neoplasia affecting the GI tract?
Small cell lymphoma
Large cell lymphoma
What are the types of focal neoplasia affecting the GI tract?
Adenocarcinoma
Leiomyoma
Gastrointestinal stromal tumour
What are the different types of inflammatory infiltrate in the GI tract? Which are the most common?
Most common:
Lymphoplasmacytic
Eosinophilic
Less common:
Neutrophilic
Histiocytic
(if see these look for pathogens)
Why should you always biopsy last?
Because other causes can be fully treated with medical therapy without endoscopy:
Extra-GI disease
Parasitic disease
Some drugs
Dietary intolerances
What does it mean if exclude other causes of GI disease and find a lymphoplasmacytic and/or eosinophilic inflammatory infiltrate?
Diagnose idiopathic inflammatory bowel disease
How do you treat idiopathic inflammatory bowel disease?
Exclusion diet
Immunosuppression - steroids
What can idiopathic inflammatory bowel disease progress to in cats?
Small cell lymphoma
What is the name of the chronic GI disease when just the stomach is affected?
Chronic gastritis
What are the features of chronic gastritis?
Intermittent chronic vomiting
Periodic early morning vomit with bile (bilious vomiting)
+/- gastric bleeding
How do you treat chronic gastritis?
Remove aetiological agent
Acid blockers - PPIs
Multiple small feedings
Low fat diet
Exclusion diet
Antibiotics if nothing else works
What are some primary anomalous causes of vomiting/diarrhoea?
Gastric ulceration
Gastric dilation/volvulus
intestinal obstruction
Intussusception
Irritable bowel syndrome
What are some extra-GI causes of vomiting/diarrhoea?
Hepatic disease
Renal disease
Hyperthyroidism
Hyperadrenocorticism
What is chronic hypertrophic pylorogastropathy?
Idiopathic mucosal hypertrophy causing thickened gastric pyloric wall causing chronic vomiting and outflow obstruction
How do you treat chronic hypertrophic pylorogastropathy? What is the prognosis?
Surgery - good outcome if successful
What animals are predisposed to chronic hypertrophic pylorogastropathy?
Small oriental breed dogs
eg. pekingese
Lhasa apso
shih tzu
What animals tend to get intussusception?
Young animals
Usually after pre-existing episode of GI signs eg. parasitism
Rare in older animals, usually due to neoplasia
How do you treat intussusception?
Resection at surgery
What is the signalment for irritable bowel syndrome?
Anxious small breed dogs
How do you diagnose irritable bowel syndrome?
Difficult - investigations for LI diarrhoea unremarkable
Rule out other causes of intermittent large intestinal diarrhoea
What causes idiopathic inflammatory bowel disease?
Loss of mucosal tolerance to commensal flora causing immune mediated inflammatory response in GI tract
What variant of idiopathic inflammatory bowel disease is more severe?
Eosinophilic variant more severe - may present with GI haemorrhage or perforation
What causes lymphangiectasia?
Intestinal lymphatic dysfunction causing dilation and rupture which leaks lymph into the intestinal lumen
Causes protein losing enteropathy and lymph loss
What breed of dog is predisposed to lymphangiectasia?
Norwegian lundehund
What are the signs of lymphangiectasia?
Poor body condition/weight loss
Abdominal/pleural effusion
Polyphagia
How do you diagnose lymphangiectasia?
Hypoalbuminaemia
Hypocholesterolaemia
Intestinal ultrasound - hyperechoic mucosal striations
Endoscopic appearance
What is a new disease which causes chronic vomiting/diarrhoea, weight loss and gastrointestinal masses in cats?
Feline gastrointestinal eosinophilic sclerosing fibroplasia
How do you treat Feline gastrointestinal eosinophilic sclerosing fibroplasia?
Surgical excision of masses
Antibiotics
Prednisolone
What is the prognosis for Feline gastrointestinal eosinophilic sclerosing fibroplasia?
Uncertain to poor - very varied
What causes granulomatous colitis?
Genetic mutation increasing susceptibility to E coli invasion into macrophages
What signalment is affected by granulomatous colitis?
Boxers
French bulldogs
What are the signs of granulomatous colitis?
Weight loss
Severe large intestinal diarrhoea
Granulomatous (macrophage rich) inflammation on biopsy
How do you treat granulomatous colitis?
Enrofloxacin for 6-8 weeks
What type of lymphoma has a poor prognosis?
Large cell lymphoma
What is the prognosis for gastric carcinomas?
Euthanase at diagnosis
What do colonic carcinomas often cause?
Strictures
What are leiomyo(sarco)mas?
Neoplastic transformation of GI smooth muscle
What are gastrointestinal stromal tumours?
Neoplastic transformation of interstitial cells of cajal
What is the treatment and prognosis for leiomyomas and leiomyosarcomas and GI stromal tumours?
Excellent after surgical excision for leiomyomas
Good for leiomyosarcomas and GI stromal tumours
What can cause haematemesis?
Coagulopathy
GI pathology - upper GI haemorrhage
Nasopharyngeal bleeding - swallowed
What neoplasia can cause gastric ulcers?
Mast cell tumours
What are the possible complications of gastric ulcers?
Iron deficiency - from blood loss
Septic peritonitis - from perforation
What is a protein losing enteropathy?
Severe diffuse SI disease causing loss of albumin and globulin
What are 4 causes of hypoalbuminaemia?
Liver disease
Intestinal disease - PLE
Kidney disease - PLN (protein losing nephropathy)
Exudative disease/blood loss
How do you test for protein losing enteropathy?
Test B12/folate levels
What does hypoalbuminaemia cause?
Effusions - pure transudate
Thrombi formation
What is the ideal diet for inflammatory bowel disease?
Diet trial
HA/hydrolysed diet
What is the ideal diet for lymphangiectasia?
Low fat but high calorie diet
What is the ideal diet for lymphoma?
Just keep eating
What is the treatment for lymphoplasmacytic colitis?
Sulphsalazine - 5-ASA drug (similar to aspirin)
Local anti-inflammatory in LI
What is the side effect of Sulphsalazine/5-ASA drugs?
Keratoconjunctivitis secca - dry eye
What do rectal polyps cause?
Haematochezia - haemorrhage from rectum with normal faeces
What are rectal polyps?
Benign adenomatous growth in rectum - very soft
What should you do if you find a rectal polyp?
Remove by traction (may regrow) or submucosal resection
Because may transform into carcinoma
What is the name of the condition caused by prolonged constipation causing irreversible changes?
Obstipation
What are some causes of constipation?
Hair/bone in diet
Dehydration
Electrolyte derangements
Drugs
Stress
Pain/ortho/neuro problems - cant posture
Obstruction
How do you treat constipation?
Treat underlying cause
Fluid therapy/correct electrolytes
Oral laxatives
Enemas
Surgery - remove obstruction
What drugs can you give to treat constipation?
Microlax enema
Oral laxatives - miralax
Lactulose
What is megacolon?
Loss of neuromuscular function of the colon
Weakened colonic contractions and faecal overload
What causes megacolon?
Idiopathic
Chronic underlying disease
How do you treat megacolon?
Same as constipation - correct underlying cause, fluids, enemas, laxatives
Last resort surgery - sub total colectomy (only in cats)
What signalment tend to get megacolon?
Cats
What are the consequences of pancreatic insufficiency?
Fatty, foul smelling diarrhoea
Polyphagia
Weight loss
Malabsorption
Micronutrient deficiencies - B12
