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

GI - SA chronic vomiting/diarrhoea Flashcards

1
Q

What does haematemesis look like?

A

Coffee grounds - if in stomach for a long time
Blood

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2
Q

What is the name for blood from the small intestine?

A

Melaena

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3
Q

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

A

Haematology
Serum biochemistry
Electrolytes

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4
Q

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

A

Hypoalbuminaemia
+/- Hypocholesterolaemia

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5
Q

What tests should you do if diarrhoea is part of the presentation of GI disease?

A

Faecal evaluation - parasitology and giardia antigen ELISA
Colonic wash - for tritrichomonas
cTLI/fTLI (trypsin like immunoreactivity) - for exocrine pancreatic insufficiency

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6
Q

Where is folate absorbed?

A

Proximal small intestine - jejunum

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7
Q

Where is cobalamin (vit B12) absorbed?

A

In the distal SI - ilium

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8
Q

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

A

Intrinsic factor

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9
Q

What causes low cobalamin in cats? How is this different to dogs?

A

Pancreatic disease exclusively - EPI
Dogs it is primarily pancreatic but can be gastric disease

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10
Q

How do you treat hypocobalaminaemia

A

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

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11
Q

How does a diet trial work?

A

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

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12
Q

What are the breed specific considerations of german shepherds with chronic GI disease?

A

High incidence of EPI
High incident of antibiotic responsive diarrhoea - give oxytetracycline to treat the diarrhoea

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13
Q

What endocrine diseases should you exclude when investigating GI disease?

A

Hypoadrenocorticism - dog
Hyperthyroidism - cat

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14
Q

How many dogs have evidence of chronic pancreatitis?

A

34%

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15
Q

How do dogs with chronic pancreatitis present?

A

Chronic intermittent inappetance
“ vomiting
“ diarrhoea
“ abdominal pain

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16
Q

How can you treat chronic pancreatitis?

A

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

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17
Q

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

A

Ductular and acinar adenocarcinoma
Triggers pancreatitis

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18
Q

What endocrine pancreatic neoplasia can dogs and cats get?

A

Insulinoma
Gastrinoma (rare)

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19
Q

When should you do diagnostic imaging when approaching GI disease?

A

If palpable abdominal pain/abnormality
GI haemorrhage
GI perforation concern

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20
Q

What are you evaluating for on diagnostic imaging when approaching GI disease?

A

Ultrasound - GI wall thickness, layering, ulceration, mass lesions
Any extra GI pathology - abdominal inflammatory/neoplastic disease
Urogenital disease

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21
Q

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

A

Wagon wheel appearance

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22
Q

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

A

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

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23
Q

What structural problems can cause delayed gastric emptying?

A

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

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24
Q

How can you treat chronic hypertrophic pylorogastropathy?

A

Can be removed with surgery quite easily

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25
Q

What are some causes of secondary motility disorders causing delayed gastric emptying?

A

Primary GI disease
Local inflammation in abdomen eg. pancreatitis
Electrolyte disturbance - low K, high Ca
Drugs

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26
Q

What does a stomach ulcer look like on ultrasound?

A

Hyperechoic area - whiter

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27
Q

What does lymphangectasia look like on ultrasound?

A

Abnormal bands on intestines

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28
Q

In the case of a focal primary GI abnormality, when should you do surgery over endoscopy?

A

If its a chronic FB that is past stomach
If focal mass lesion - excise
Concern for sepsis/perforation
Chronic hypertrophic pylorogastropathy

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29
Q

How do you diagnostic image a diffuse primary GI abnormality?

A

Endoscopy - scope top or bottom end

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30
Q

What should you do if everything is normal on non invasive testing in GI disease cases? When should you do each test?

A

Diet trial - if young animal or less severe case
Endoscopy/histopathology - if more severe signs

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31
Q

When do you take an intestinal biopsy?

A

Following exclusion of:
extra GI causes
Treatable primary GI disease
Stopped steroids

If anorexic
If had abnormal GI imaging
If hypoalbuminaemic

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32
Q

What are the two different methods of taking intestinal biopsy?

A

Laparotomy
Endoscopy

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33
Q

What are the pros and cons of laparotomy for intestinal biopsy?

A

Can get multiple full thickness biopsies
Can sample multiple organs
But surgical risk of dehiscence

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34
Q

What are the pros and cons of endoscopy for intestinal biopsy?

A

Minimally invasive
but small biopsies
May not reflect jejunal disease

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35
Q

How do you prepare a patient for colonoscopy?

A

Fast for 24-36 hours
Oral lavage with poly ethylene glycol electrolyte solutions - tube day before
Multiple ‘high’ enemas

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36
Q

For diffuse GI disease, where should you sample from as it is most representative?

A

Ilium - most representative

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37
Q

What are the types of diffuse neoplasia affecting the GI tract?

A

Small cell lymphoma
Large cell lymphoma

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38
Q

What are the types of focal neoplasia affecting the GI tract?

A

Adenocarcinoma
Leiomyoma
Gastrointestinal stromal tumour

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39
Q

What are the different types of inflammatory infiltrate in the GI tract? Which are the most common?

A

Most common:
Lymphoplasmacytic
Eosinophilic

Less common:
Neutrophilic
Histiocytic
(if see these look for pathogens)

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40
Q

Why should you always biopsy last?

A

Because other causes can be fully treated with medical therapy without endoscopy:
Extra-GI disease
Parasitic disease
Some drugs
Dietary intolerances

41
Q

What does it mean if exclude other causes of GI disease and find a lymphoplasmacytic and/or eosinophilic inflammatory infiltrate?

A

Diagnose idiopathic inflammatory bowel disease

42
Q

How do you treat idiopathic inflammatory bowel disease?

A

Exclusion diet
Immunosuppression - steroids

43
Q

What can idiopathic inflammatory bowel disease progress to in cats?

A

Small cell lymphoma

44
Q

What is the name of the chronic GI disease when just the stomach is affected?

A

Chronic gastritis

45
Q

What are the features of chronic gastritis?

A

Intermittent chronic vomiting
Periodic early morning vomit with bile (bilious vomiting)
+/- gastric bleeding

46
Q

How do you treat chronic gastritis?

A

Remove aetiological agent
Acid blockers - PPIs
Multiple small feedings
Low fat diet
Exclusion diet
Antibiotics if nothing else works

47
Q

What are some primary anomalous causes of vomiting/diarrhoea?

A

Gastric ulceration
Gastric dilation/volvulus
intestinal obstruction
Intussusception
Irritable bowel syndrome

48
Q

What are some extra-GI causes of vomiting/diarrhoea?

A

Hepatic disease
Renal disease
Hyperthyroidism
Hyperadrenocorticism

49
Q

What is chronic hypertrophic pylorogastropathy?

A

Idiopathic mucosal hypertrophy causing thickened gastric pyloric wall causing chronic vomiting and outflow obstruction

50
Q

How do you treat chronic hypertrophic pylorogastropathy? What is the prognosis?

A

Surgery - good outcome if successful

51
Q

What animals are predisposed to chronic hypertrophic pylorogastropathy?

A

Small oriental breed dogs
eg. pekingese
Lhasa apso
shih tzu

52
Q

What animals tend to get intussusception?

A

Young animals
Usually after pre-existing episode of GI signs eg. parasitism
Rare in older animals, usually due to neoplasia

53
Q

How do you treat intussusception?

A

Resection at surgery

54
Q

What is the signalment for irritable bowel syndrome?

A

Anxious small breed dogs

55
Q

How do you diagnose irritable bowel syndrome?

A

Difficult - investigations for LI diarrhoea unremarkable
Rule out other causes of intermittent large intestinal diarrhoea

56
Q

What causes idiopathic inflammatory bowel disease?

A

Loss of mucosal tolerance to commensal flora causing immune mediated inflammatory response in GI tract

57
Q

What variant of idiopathic inflammatory bowel disease is more severe?

A

Eosinophilic variant more severe - may present with GI haemorrhage or perforation

58
Q

What causes lymphangiectasia?

A

Intestinal lymphatic dysfunction causing dilation and rupture which leaks lymph into the intestinal lumen
Causes protein losing enteropathy and lymph loss

59
Q

What breed of dog is predisposed to lymphangiectasia?

A

Norwegian lundehund

60
Q

What are the signs of lymphangiectasia?

A

Poor body condition/weight loss
Abdominal/pleural effusion
Polyphagia

61
Q

How do you diagnose lymphangiectasia?

A

Hypoalbuminaemia
Hypocholesterolaemia
Intestinal ultrasound - hyperechoic mucosal striations
Endoscopic appearance

62
Q

What is a new disease which causes chronic vomiting/diarrhoea, weight loss and gastrointestinal masses in cats?

A

Feline gastrointestinal eosinophilic sclerosing fibroplasia

63
Q

How do you treat Feline gastrointestinal eosinophilic sclerosing fibroplasia?

A

Surgical excision of masses
Antibiotics
Prednisolone

63
Q

What is the prognosis for Feline gastrointestinal eosinophilic sclerosing fibroplasia?

A

Uncertain to poor - very varied

64
Q

What causes granulomatous colitis?

A

Genetic mutation increasing susceptibility to E coli invasion into macrophages

65
Q

What signalment is affected by granulomatous colitis?

A

Boxers
French bulldogs

66
Q

What are the signs of granulomatous colitis?

A

Weight loss
Severe large intestinal diarrhoea
Granulomatous (macrophage rich) inflammation on biopsy

67
Q

How do you treat granulomatous colitis?

A

Enrofloxacin for 6-8 weeks

68
Q

What type of lymphoma has a poor prognosis?

A

Large cell lymphoma

69
Q

What is the prognosis for gastric carcinomas?

A

Euthanase at diagnosis

70
Q

What do colonic carcinomas often cause?

A

Strictures

71
Q

What are leiomyo(sarco)mas?

A

Neoplastic transformation of GI smooth muscle

72
Q

What are gastrointestinal stromal tumours?

A

Neoplastic transformation of interstitial cells of cajal

73
Q

What is the treatment and prognosis for leiomyomas and leiomyosarcomas and GI stromal tumours?

A

Excellent after surgical excision for leiomyomas
Good for leiomyosarcomas and GI stromal tumours

74
Q

What can cause haematemesis?

A

Coagulopathy
GI pathology - upper GI haemorrhage
Nasopharyngeal bleeding - swallowed

75
Q

What neoplasia can cause gastric ulcers?

A

Mast cell tumours

76
Q

What are the possible complications of gastric ulcers?

A

Iron deficiency - from blood loss
Septic peritonitis - from perforation

77
Q

What is a protein losing enteropathy?

A

Severe diffuse SI disease causing loss of albumin and globulin

78
Q

What are 4 causes of hypoalbuminaemia?

A

Liver disease
Intestinal disease - PLE
Kidney disease - PLN (protein losing nephropathy)
Exudative disease/blood loss

79
Q

How do you test for protein losing enteropathy?

A

Test B12/folate levels

80
Q

What does hypoalbuminaemia cause?

A

Effusions - pure transudate
Thrombi formation

81
Q

What is the ideal diet for inflammatory bowel disease?

A

Diet trial
HA/hydrolysed diet

82
Q

What is the ideal diet for lymphangiectasia?

A

Low fat but high calorie diet

83
Q

What is the ideal diet for lymphoma?

A

Just keep eating

84
Q

What is the treatment for lymphoplasmacytic colitis?

A

Sulphsalazine - 5-ASA drug (similar to aspirin)
Local anti-inflammatory in LI

85
Q

What is the side effect of Sulphsalazine/5-ASA drugs?

A

Keratoconjunctivitis secca - dry eye

86
Q

What do rectal polyps cause?

A

Haematochezia - haemorrhage from rectum with normal faeces

87
Q

What are rectal polyps?

A

Benign adenomatous growth in rectum - very soft

88
Q

What should you do if you find a rectal polyp?

A

Remove by traction (may regrow) or submucosal resection
Because may transform into carcinoma

89
Q

What is the name of the condition caused by prolonged constipation causing irreversible changes?

A

Obstipation

90
Q

What are some causes of constipation?

A

Hair/bone in diet
Dehydration
Electrolyte derangements
Drugs
Stress
Pain/ortho/neuro problems - cant posture
Obstruction

91
Q

How do you treat constipation?

A

Treat underlying cause
Fluid therapy/correct electrolytes
Oral laxatives
Enemas
Surgery - remove obstruction

92
Q

What drugs can you give to treat constipation?

A

Microlax enema
Oral laxatives - miralax
Lactulose

93
Q

What is megacolon?

A

Loss of neuromuscular function of the colon
Weakened colonic contractions and faecal overload

94
Q

What causes megacolon?

A

Idiopathic
Chronic underlying disease

95
Q

How do you treat megacolon?

A

Same as constipation - correct underlying cause, fluids, enemas, laxatives
Last resort surgery - sub total colectomy (only in cats)

96
Q

What signalment tend to get megacolon?

A

Cats

97
Q

What are the consequences of pancreatic insufficiency?

A

Fatty, foul smelling diarrhoea
Polyphagia
Weight loss
Malabsorption
Micronutrient deficiencies - B12

CVSOH BVSc4 (86 decks)

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