GI - SA chronic vomiting/diarrhoea Flashcards by Mary Tilling

What does haematemesis look like?

Coffee grounds - if in stomach for a long time
Blood

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What is the name for blood from the small intestine?

Melaena

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How do you evaluate for extra GI causes of chronic vomiting/diarrhoea?

Haematology
Serum biochemistry
Electrolytes

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What signs on bloodwork can indicate malabsorption as a GI disease consequence?

Hypoalbuminaemia
+/- Hypocholesterolaemia

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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

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Where is folate absorbed?

Proximal small intestine - jejunum

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Where is cobalamin (vit B12) absorbed?

In the distal SI - ilium

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What does cobalamin (vit B12) need to be bound to to be absorbed?

Intrinsic factor

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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

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How do you treat hypocobalaminaemia

Identify and treat cause
Subcut injections weekly until normalised
Or oral with massive doses to make sure is absorbed

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How does a diet trial work?

Feed completely novel protein/carb
Or can feed hydrolysed protein
Feed EXCLUSIVELY with water for 3-10 weeks

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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

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What endocrine diseases should you exclude when investigating GI disease?

Hypoadrenocorticism - dog
Hyperthyroidism - cat

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How many dogs have evidence of chronic pancreatitis?

34%

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How do dogs with chronic pancreatitis present?

Chronic intermittent inappetance
“ vomiting
“ diarrhoea
“ abdominal pain

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How can you treat chronic pancreatitis?

Avoid risk factors
Weight reduction
Low fat diet
Analgesia - paracetamol
Maropitant - anti-nausea

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What type of exocrine pancreatic neoplasia can dogs (and rarely cats) get? What does it cause?

Ductular and acinar adenocarcinoma
Triggers pancreatitis

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What endocrine pancreatic neoplasia can dogs and cats get?

Insulinoma
Gastrinoma (rare)

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When should you do diagnostic imaging when approaching GI disease?

If palpable abdominal pain/abnormality
GI haemorrhage
GI perforation concern

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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

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What is the normal appearance of a cats stomach on ultrasound?

Wagon wheel appearance

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What does it mean if see food in stomach when fasting?

Abnormal - may be functional problem with motility or structural problem eg. obstruction

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What structural problems can cause delayed gastric emptying?

Pyloric FB
Pyloric mass lesion - neoplasia, polyp
Chronic hypertrophic pylorogastropathy

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How can you treat chronic hypertrophic pylorogastropathy?

Can be removed with surgery quite easily

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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