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PCP > GIT > Flashcards

GIT Flashcards

1
Q

before supplementary nutrition…

A

correct electrolyte and acid-base imbalances
stabilise
shock - reduced GIT perfusion
consider periods of at home anorexia

compromised patients - may have insulin resistance, reduced absorptive and digestive enzyme production

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2
Q

reasons patients may refuse to eat in hospital

A

stress
pain
absence of preferred food
nausea
physical incapacity

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3
Q

supplementary feeding - fat

A

calorically dense
indicated if critically ill - difficult to get nutritional volume in
contraindicated in pancreatitis

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4
Q

supplementary feeding - high protein

A

contraindicated in hepatic and renal disease and pancreatitis

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5
Q

energy requirements

A

RER = 70 x (bodyweight)^0.75

or (in animals 3-25kg)

RER = (30 x BW) + 70

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6
Q

resting energy requirements (RER)

A

calories needed for normal function in fasted patient under thermo-neutral conditions

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7
Q

calculating energy requirements

A

weigh
calculate RER
divide RER by diet content (kcal) to give daily amount
divide by total number of feeds
do not exceed 5-10ml/kg when introducing food

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8
Q

enteral feeding

A

to GIT

use gut if works

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9
Q

parenteral feeding

A

nutrients via IV

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10
Q

tube types

A

naso-oesophageal/nasogastric
oesophagostomy
gastrostomy (PEG)
enterostomy or jejunostomy

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11
Q

factors in choosing tube type

A

patient condition
injury/illness
food needed
availability of resources (including staff)
financial factors
duration of feeding required

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12
Q

naso-oesophageal/nasogastric

A

most common
through nostril
distal tract must be functional
conscious placement
3-5 days (up to 10) - short term
easy to place
no GA needed
can be used immediately and removed easily
patient can eat and drink around tube
patient may pull out
around head - bite risk
can only put liquid down - not crushed oral medication

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13
Q

Oesophagostomy

A

surgical placement into oesophagus
distal GIT must be functional
contraindicated if secondary oesophageal disorder
wider than NG so can prepare own diet
weeks/months
easy placement and any time removal
can give crushed medications
GA needed
biting risk
wound management needed for risk of infection
risk of stricture formation

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14
Q

Gastrostomy

A

into stomach through body wall
bypasses oral cavity and oesophagus
contraindicated if primary gastric disease
has to stay in for 10-14 days to allow seal to form between stomach and abdominal wall prevent leaks into abdominal cavity –> pancreatitis
can be left in for months-years
further from head so less biting
variety of diets
can give crushed medications
can’t use for 24 hours after placement
needs GA
risk of local infection
risk of pancreatitis/peritonitis

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15
Q

Jejunostomy (j-tube)

A

invasive and challenging to place
mid-long term support
bypasses upper GIT
patient can still eat by oral route if needed
jejunum has no storage capacity - trickle feeding instead of bolus
usually only referral cases

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16
Q

total parenteral nutrition (TPN)

A

IV
short term - 3-5 days
only if unable to feed enterally, increased aspiration risk or if other methods have failed
aim to meet all protein and energy needs
Partial parenteral nutrition - combined with other methods
intensive nursing needed

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17
Q

postural feeding

A

megaoesophagus
intake split into 3-4 small meals
soft wet food rolled in small balls and fed from height
sitting position

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18
Q

enamel

A

outermost layer
97% calcium and phosphorus
no circulatory system - can’t be replaced

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19
Q

dentin

A

majority of tooth
made by odontoblasts
laid down through life
nerve supply - responds to stress

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20
Q

pulp

A

living tissue
nerves, blood and connective tissue
where odontoblasts live
provides nutrition, protection and sensation - pain if damaged

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21
Q

gingiva

A

gums
both attached and free sections

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22
Q

cementum

A

anchors tooth

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23
Q

alveolar bone

A

portion of the jaw the teeth sit in
covered in periosteum

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24
Q

periodontal ligament

A

in periodontal space between tooth and alveolar bone
shock absorber
holds tooth in place

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25
Q

closed mouth exam

A

lips
oral mucosa
occulsion

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26
Q

open mouth exam

A

gingiva
cheek mucosa
palate
tongue
floor of mouth
discharge
foreign bodies
masses
swelling
inflammation
fractures
ulcers

NB: not whole tooth is visible - could be root pathology

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27
Q

GA dental exam

A

intubation
lateral recumbency
pharyngeal pack
chlorhexadine prep
mouth gag - only large dogs, not for long
radiographs to see hidden pathology

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28
Q

occlusion

A

upper incisors should overlap lower
lower canines should fit into upper diastema
upper and lower premolars should interdigitate

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29
Q

number of teeth

A

missing or supernumery
retained deciduous teeth
overcrowding - common in brachycephalics

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30
Q

appearance of teeth

A

defects
shape
discolouration
fractures

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31
Q

oral soft tissue exam

A

discolouration
inflammation
oedema

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32
Q

Periodontal disease

A

common
any disease affecting soft tissue or tissues holding teeth in place
may need radiographs to see full extent
signs - gingivitis, plaque build up (can mineralise to calculus), gingival recession, bone loss, mobile teeth, tooth loss

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33
Q

plaque

A

made by bacteria –> gingivitis as immune response –> tissue destruction –> plaque mineralises to calculus and prevents healing –> attachment loss –> tooth becomes mobile and falls out

34
Q

mouth directions

A

mesial - towards midline
distal - away from midline
buccal - towards buccal mucosa
lingual - towards tongue
labial - towards lips
palatal - towards palate
interproximal - between teeth
coronal - towards tip of crown of tooth
apical - towards root of tooth

35
Q

periodontal probe

A

blunt ended
measures attachment loss
assess gingival inflammation
test tooth mobility

36
Q

dental explorer

A

sharp ended
detect softened enamel
explore defects - fracture sites and tooth resorption
check for pulp exposure
don’t put in gingival sulcus

37
Q

gingivitis index

A

0 - none
1 - mild - slight change in colour, no bleeding
2 - moderate - redness, oedema, bleeding
3 - severe - ulceration, prone to spontaneous bleeding

38
Q

periodontal grading index

A

score for individual teeth
attachment loss estimated with probe and confirmed with x-ray - probe tends to overestimate depth

0 - healthy - pink, firmly attahced
1 - gingivitis due to calculus deposition, reversible by brushing, no attachment loss
2 - up to 25% detachment, deepened sulcus
3 - 25-50% attachment loss
4 - over 50% attachment loss, may see horizontal bone loss, severe inflammation

39
Q

furcation index

A

furcation = area where roots divide on multi rooted tooth - measure of amount of bone loss

0 - no bone loss
1 - less than 1/3 bone loss
2 - more than 1/3 lost but not all
3 - open furcation

40
Q

mobility index

A

measure of loss of normal support around tooth - periodontal ligament and bony support

0 - no mobility (<0.2mm)
1 - <1mm horizontal movement
2 - >1mm horizontal movement
3 - any vertical movement

41
Q

dental radiography techniques

A

parallel - plate parallel to target with beam aimed straight at it - caudal mandibular teeth only
bisecting angle - creating shadow of teeth and capturing it - used when can’t get in parallel
extra oral - plate not inside mouth - cats and small mouths, skyline view of maxillary arcade

42
Q

common dental pathology - small animal

A

vertical bone loss - radiograph, creates pocket
horizontal bone loss - can get probe under tooth
type 1 resorption - common in cats, remove full tooth
type 2 resorption - cats - tooth blends with jaw at root, remove top (not root so can’t remove whole thing)
trauma - chewing something hard
uncomplicated crown fracture - dentin exposed but not pulp
complicated crown fracture - pulp exposure - painful

43
Q

open vs closed extraction

A

open - multirooted teeth, elevation of mucoperiosteal flap and bone removal (surgical extraction)
closed - usually single root teeth, incision into gingival attachment and breakdown of periodontal ligament

44
Q

Colic - definition

A

abdominal pain - predominately GIT associated but can involve a number of systems

45
Q

colic causes

A

smooth muscle spasm
inflammation - colitis/ulceration
distension - impaction/gas accumulation
obstruction - impaction
tension on mesentery - displacement
tissue congestion/infarction/necrosis - torsion/volvulus, strangulation –> endotoxemia
combination of above

46
Q

colic - endotoxemia

A

if gut wall is compromised toxins will start to absorb toxins into blood stream
–> death

high HR
poor pulse quality
slow jugular refill
dark dry mucous membranes
slow capillary refill time

47
Q

colic - signs

A

inappetence
reduced fecal output
vocalisation
agitation
pawing
lip curling
flank watching
lying down repeatedly
stretching to urinate
rolling/trashing
sweating excessively
straining

48
Q

signs of pain - colic

A

mild - restelessness, pawing, flank watching - gas build up, inflammation, smooth muscle spasms
moderate - lying flat, groaning - impaction or simple obstruction
severe - very fractious, violenet rolling - acute colic, severe strangulation
end stage - dull, unresponsive - eg. endotoxemia

49
Q

colic - treatment priorities

A

analgesia and triage
assess severity
construct treatment plan

50
Q

colic differentials

A

false colic - non-GI source - liver disease, urinary disease, peritonitis, intra-abdominal abscess, intra-abdominal neoplasia, reproductive disorders

non abdominal - oesophageal obstruction, rhabomyalysis, laminitis, pleuropneumonia

51
Q

colic - risk factors

A

recent changes - feeding, management, stabling, exercise
dental history
parasites
viruses

52
Q

colic - CV assessment

A

increased HR - more driven by CV status than pain
pulse quality
jugular refill
mucous membranes - tacky then 5% dehydrated, dry and red then need fluid therapy (horses are big so takes lots of fluid to rehydrate)
capillary refill time

53
Q

boborygmi

A

sound of fluid and gas in intestines

54
Q

motility - colic

A

hyper motility - increased smooth muscle activity - spasm colic
local hypomotility - localised stasis of GIT
general absence of sound - GIT ileus - common in most colics

55
Q

analgesia - colic

A

xylazine (alpha-2) - first choice - short acting. But has CV effects so take into account
NSAIDs - don’t use right away, GI effects
opioid - butorphanol (torbugesic)

56
Q

further diagnostics - colic

A

nasogastric intubation - fluid/ingesta from stomach - >2l is abnormal - relfux usually needs referral

trans-rectal exam - impaction, distension, displacement, masses - risk of rectal tears

abdominocentesis - asses changes in peritoneal fluid - serosanguinous colour or increased protein (leakage of blood components), increased lactate (anaerobic tissue metabolism), ingesta (GIT rupture), high WBC (peritonitis)

abdominal ultrasound - kidneys, small intestines, spleen, intestinal wall thickness, distension of small intestine, peritoneal fluid (structures not palpable by trans-rectal palpation)

57
Q

colic - treatment

A

NSAIDs
Alpha-2s
Opioids
Spasmolytics (anticholinergics) - buscopan - rapid onset smooth muscle relaxant
fluid therapy - stomach tube - contraindicated if NG reflux or if suspected small intestinal lesion
purgatives - liquid paraffin coats impaction, epsom salts breaks impaction down

58
Q

causes of weight loss

A

reduced intake - not wanting to eat, not being able to, not being allowed, not being fed enough
poor absorption - inadequate presentation of food, GI disease, neoplasia, parasites
decreased utilisation - disorder of nutrient metabolism (liver), cushings (not really weight loss, just look ropey)
excessive loss - protein losing enteropathy
increased requirement - exercise, bacterial infection, chronic viral infection, neoplasia

59
Q

Hypoalbuminemia

A

low albumin - protein lowing enteropathy or nephropathy
reduced production - liver disease (Severe), malnutrition
chronic inflammation - negative acute phase proteins

60
Q

Anemia

A

common finding in weight loss
decreased RBC production and lifespan

61
Q

abdominocentesis

A

assess changes in peritoneal fluid
low sensitivity
good specificity for inflammation/bacteria, and neoplasia

peritoneal inflammation/bacteria - increased protein and lactate and serosanguinous colour change
neoplasia - tumours mat exfoliate cells, low grade peritoneal inflammation

62
Q

gastroscopy

A

assess gastric ulceration - associated with weight loss through desire to eat rather than absorption

63
Q

oral glucose absorption test (OGAT)

A

assesses absorptive capacity of small intestine
12 hour fast, baseline oxalate-fluoride
give glucose
take bloods every hour for 5-6 hours

normal - double after 2 hours then absorbed by end
partial malabsorption - 15-65% increase at 2 hours, slower to peak
total malabsorption - serum glucose not above 15% of baseline

64
Q

fecal blood test

A

frank blood in feces - bleeding in rectum/colon

65
Q

biopsies

A

trans-endoscopic duodenal biopsy - pinch biopsy - mucosal tissue
rectal biopsy - mucosa and submucosa
surgical - full thickness

can show inflammation
can be definitive for intestinal lymphoma or infiltrative intestinal disease

66
Q

upper GI conditions - cattle

A

mouth, teeth, throat

choke - eg. feeding potatoes - can lead to free gas bloat - pass stomach tube down and see if it hits anything
frothy gas bloat - gas trapped in pockets in rumen - eg. eating clover
bloat from vagal nerve pressure - eg. hardware disease, lymph node enlargement, pneumonia, tumour - leads to free gas bloat, can release in some bits because no obstruction but can’t do it actively

67
Q

hardware disease - cattle

A

metal wedged in reticulum - varying penetration into pericardium
collect with a magnet

68
Q

acidosis - cattle

A

subclinical - pH < 5.5
acute clinical - pH < 5 - very sick
subacute ruminal acidosis (SARA) - effect on production but not enough that you’d notice except from over time - usually nutritional issues

assess - ruminocentesis - rumen pH and microbial activity

69
Q

ketosis - cattle

A

post partum
energy deficit
fatty liver - cows have poor hepatic function for mobilising body fat
pear drop small
indistinct signs - production down, bit depressed
diagnosis - elevated ketones in milk, urine or blood

70
Q

cattle energy requirements

A

assumed 700kg -

dry -
- maintenance - 80MJ
- pregnancy - 20MJ
- milk production - 0MJ

peak lactation -
- maintenance - 80MJ
- pregnancy - 0 MJ
- milk production - 300MJ

maintenance = 10% bodyweight + 10

71
Q

GIT displacements/torsion - cattle

A

left displaced abomasum - ketosis (loss of GI tone –> enlarged abomasum filled with gas –> slides under rumen) - usually after calving, ping on left side of abdomen

right displaced abomasum +/- volvulus - right sided ping

abomasal ulceration - black feces, can rupture and kill by peritonitis

caecal dilation - palpate per rectum

caecal torsion - can release toxins when untwisted

small intestinal torsion

72
Q

viral causes GI disease - ruminants

A

rotavirus - young, 2-12 weeks- peracute diarrhoea, high mortality
coronavirus - young, 1-3 weeks - shedding up to 2 weeks
BVD - 6 months - 2 years - diarrhoea not main sign

73
Q

bacterial causes GI disease - ruminants

A

e. coli - neonates - environmental bacteria
salmonella - calves and older - acute mucoid watery diarrhoea, spread in feces
clostridia - different strains, closridium perfringens
johnes - mycobacterium paratuberculosis - slow burn, notifiable

74
Q

parasitic causes of GI disease - ruminants

A

protozoa
- cryptosporidium parvum - young - oocysts in feces, hygiene important
- coccidiosis - eimeria - older calves (around weaning), persists in environment - rectal prolapse

worms
- strongyles - usually when turned out at pasture
- liver fluke - older animals grazed in wet areas, autumn winter time

75
Q

nutritional causes of GI disease - ruminants

A

milk scours
peri-weaning scours
SARA
grain overload
dietary changes - up to 6 weeks to stabilise to new diet
gorging
wrong mix of milk powder
feeding of whole milk

usually young animals

76
Q

environmental and husbandry causes of GI disease - ruminants

A

failure of passive transfer
poor equipment hygiene
poor housing hygiene
mixing of age groups - leaves younger more vulnerable
stress

77
Q

healthy calf parameters

A

temp - 38-38.9
rr - 15-30bpm
CRT - <2 secs
mm - pink and moist
quick standing for feeding
semi firm feces
ear and head position upright
no cough

78
Q

diagnosis - GI disease in calves

A

scour check kit - rotavirus, coronavirus, crypto, e. coli
fecal worm egg counts
fecal culture - salmonella, johnes, clostridial toxin, rotavirus, coronavirus
serology - johnes, BVD
bulk milk surveillance - fluke, BVD, IBR, johnes, salmonella
postmortem/abattoir feedback - fluke, other parasites, gross anatomy changes

79
Q

incisor examination - horse

A

overbite
underbite
slant/smile mouth
cribbing
calculus
mobility
diastema
look for draining tracts

80
Q

canine and wolf teeth examination - horse

A

calculus
fractured canines
displaced wolf teeth
blind wold teeth - unerupted
mandibular wolf teeth

81
Q

cheek teeth examination - horse

A

interdental spaces
buccal mucosa
dental overgrowth
dental fractures
displaced teeth
supernumerary teeth
diastema

82
Q

dental exam sedation - horse

A

alpha-2 agonist - romifidine, xylazine or detomidine
opiate - butorphanol or morphine

PCP (10 decks)

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