GIT 1 Flashcards
Dysphagia
Difficulty with prehension, chewing, and/or swallowing of food
What are the main differences between vomiting and regurgitation? (4)
Vomiting:
* Active;
* Nausea;
* Stomach and proximal SI;
* Primary or secondary GI disease;
Regurg:
* Passive;
* No nausea;
* esophagus;
* Swallowing or esophageal problems
What are the main differences between small bowel and large bowel diarrhea?
Stool size and frequency
Mucous
Blood
Fat
Vomiting
Gas
Diarrhea
Small bowel:
Large, 2-3x/day; No mucous; Melena; Sometimes fat; Sometimes vomit; Sometimes gas; Often weight loss
Large bowel:
Small, >3x/day; Mucous; Fresh blood; No fat; Vomiting, gas, and weight loss not typical
Most common singular clinical sign, especially in cats, of GIT disease
Anorexia/hyporexia w/ associated weight loss (not very specific eh?)
What are the 3 main steps of a GIT workup in small animal?
- History (esp. dietary history; issues with dietary indiscretion or intolerance)
- Identify the primary complaint (the most specific complaint)
- Determine if its acute or chronic
True or false. Dental disease is not an important cause of GI disease
True (:o oh mai gawd)
For acute GI disease with no GI urgency markers, would a therapeutic diet trial or diagnostic tests be more indicated?
Therapeutic diet trials
For acute GI disease with GI urgency markers, would a therapeutic diet trial or diagnostic tests be more indicated?
Diagnostic tests
For chronic GI disease with no GI urgency markers, would a therapeutic diet trial or diagnostic tests be more indicated?
Therapeutic diet trial
For chronic GI disease with GI urgency markers, would a therapeutic diet trial or diagnostic tests be more indicated?
Diagnostic tests
Chronic GI disease
GI disease lasting more than 2-3 weeks
Justify why you would do a diet trial in a patient with acute diarrhea and anorexia. Describe the different components
Patient is stable and has no GI urgency markers. First I would recommend deworming as it is a simple way to rule out disease. Then I would recommend either a therapeutic diet trial to see if that helps alleviate clinical signs. Simultaneoulsy, I would provide anti-nauseant medication, and a probiotic to treat concurrent signs. May recommend SQ or IV fluids. Give patient a few days to recover, if not, or patient gets worse, recommend diagnostic workup
For an acute vomiting patient w/ no GI urgency markers, what at minimum should you do for a therapeutic trial?
NPO trial w/ GI diet
For an acute diarrhea patient w/ no GI urgency markers, what at minimum should you do for a therapeutic trial?
Probiotics + GI diet
For a chronic vomiting patient, what would your therapeutic diet trial look like at minimum?
Elimination diet
For a chronic diarrhea patient, what would your therapeutic diet trial look like at minimum?
Elimination diet; Probiotics; Fibre (if large bowel)
What GI diet would you recommend for an acute vomiting animal w/ no GI urgency markers? How would you recommend dietary transition?
Highly digestible/low residue (low fat) diet; Recommend for 1 week, and then gradual transition onto regular food
No per os or NPO trial
Therapeutic trial indicated for acute vomiting patients where you essentially limit their food and water intake, and gradually increase it - incorporating a GI diet. If they continue to vomit, then diagnostics should be considered
Generally describe the structure of an NPO trial
No food or water for the first 12 hours –> small amounts of water every 2 hours for 6h –> small meatballs of GI diet in 4-6 meals per day for 2-3 days –> if desired, reintroduce with old diet (gradual transition); if animal vomits at any point in the trial, especially at the beginning, recommend further diagnostics
Describe the therapeutic trial you would use for acute diarrhea patient w/o GI urgency markers
GI diet (highly digestible for 1 week and then transition to old diet); Probiotics; Fenbendazole or other anti-parasitic treatment for young animals
Why are antibiotics no longer indicated in cases of acute diarrhea w/o GI urgency markers?
Antibiotics like Tylosin and Metronidazole were thought to correct flora dysbiosis. In all actuallity, they are no more effective than probiotics or placebo, and may actually perpetuate dysbiosis. Furthermore, not all pets are responsive to antibiotics like metronidazole. Lastly, AMR babeeey
For chronic vomiting and diarrhea w/o urgency markers, what type of therapeutic trial would you recommend?
Elimination diet
In patients with non-urgent chronic vomiting or diarrhea, what other exam should they have done and why?
Dermatological exam. Chronic non-urgent vomiting and diarrhea suggests allergies, which may also present in the skin
Describe what an elimination diet looks like
Animal is immediately switched to a simple ingredient/novel protein/hydrolyzed/hypoallergenic diet for 6-8 weeks at minimum. Monitor for change in clinical signs.
Why are antacids like famotidine or sulcralfate not indicated for general GI disease?
Not effective at preventing vomiting (sulcralfate may exacerbate vomiting in cats) and may also induce microbial dysbiosis
What “antacid” can you use in acute vomiting cases as a preventitive?
Omeprazole
If a patient is 5% dehydrated, <25 kg, and has no GI urgency markers, are SQ or IV fluids indicated?
SQ fluids
If a patient is >5% dehydrated and/or is in shock, ae SQ or IV fluids indicated?
IV fluids
List at least four GI urgency markers in small animals
Shock alongside GI signs; Abdominal pain; Marked weight loss; Edema/hypoproteinemia; Repeated inappetance in cats; Abdominal effusion; Hypovolemia; Hypotension; Hypoperfusion; Prolonged anorexia; Intractable vomiting
What are the 3 stages of swallowing?
Oral stage (prehension) –> Pharyngeal stage (tongue actively pushes food towards the caudal pharynx and upper esophageal sphincter) –> Cricopharygeal stage (relaxation of the cricopharyngeal muscles and passage of bolus into the proximal esophagus)
List at least three clinical signs you would seen in a dysphagia disorder?
Exagerrated head movements; Exaggerated prehension; Dropping food; Coughing; Aspiration; Pneumonia; Gagging; Retching; Drooling; Regurg
List at least two differentials for dysphagia
Severe peridontal disease with abscessation; Oropharyngeal masses; Conegnital cricopharyngeal dysphagia; Neurologic diseases like botulism
Definition of delyaed gastric emptying
Outflow obstruction or defective propulsion results in vomiting of food 8-16 hours after a meal
DDx for Giardiosis
Parvovirus; Tapeworm; Roundworms
Limitations of fecal smear
You should expect a mixed bacterial population in feces; you cannot determine a diagnosis
Limitations of fecal PCR
Pathogens can be a normal part of the GIT; interpret in the light of clinical findings
What is the worst fecal-based diagnostic?
Fecal culture (There should be bacteria in poop hehe)
Hypocobalaminemia suggests what type(s) of GI disorders?
Suggests impaired absorption (e.g. IBD) or increased destruction (e.g. ARD)
Elevated folate suggests what type(s) of disorder?
Anti-biotic resistant diarrhea
Decreased folate suggests what type(s) of disorder?
Severe mucosal disease
Trypsin-like immunoreactivity (TLI) is used to diagnose which disease?
Exocrine pancreatic insufficiency (make sure fasted for 12h)
Pancreatic lipase immunoreactivity (PLI) is used to diagnose which disease?
Pancreatitis
When supplementing cobalamin for suspect IBD, what should you always do?
Recheck levels, one month after for injectable and one week later for oral
Prednisone song
0.1 mg/kg (replacement dose); 1 mg/kg (anti-inflammatory); 2 mg/kg (immunosuppressive)
