GIT Flashcards by Lisa McArdle

name 3 anti-emetics
which is also a pro-kinetic

Maropitant, metoclopramide, ondansetron
metacloprimide

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name 3 gastroprotectants
which can’t be used in pregnant animals

Omeprazole, misoprostol*, sucralfate

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how to further investigation each of the possible trigger zones for vomiting

Vomiting centre: neurological disease; neuro exam

Vestibular apparatus: vestibular disease; clinical and neuro exam

Chemoreceptor trigger zone: blood derangements; toxin history, bloodwork

Peripheral receptors: inflammation/distension; clinical exam, imaging

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treatment for helicobacter

Triple therapy:
Amoxiclav, Metronidazole and a PPI (like Omeprazole)

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signs of gastric carcinoma

Chronic vomiting
Haematemesis
Weight loss
Poor gastric layering on US (also reduced motility and enlarged LNs)

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signs of gastric lymphoma

Chronic vomiting
Haematemesis
Weight loss

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broad categories of chronic gastric vomiting

Inflammatory (chronic gastritis): From diet, idiopathic, infectious (Helicobacter)
Neoplastic (lymphoma, carcinoma, polyps)
Metabolic (billous vomiting, gastric ulceration, secondary gastroparesis)

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broad categories of acute intestinal vomiting

Obstruction: Foreign Body, Intussusception
Toxin: Dietary indiscretion or Drugs (NSAIDs, steroids, antibiotics, chemotherapy)
Inflammatory: (Acute enteritis)
o Dietary indiscretion
o Idiopathic (Lymphocytic Plasmacytic/Eosinophilic)
o Infectious

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signs of pancreatitis

Lethargy/weakness
Anorexia – suspect pancreatitis in any cat not eating normally
Vomiting
Diarrhoea
Abdominal pain
Ascites
Dehydration
Fever

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dx of pancreatitis

cTLI and fTLI (trypsin like immunoreactivity): Increase rapidly in early stages of pancreatitis but decline quickly (low in chronic)

pancreatic lipase (cPL and fPL) = high

Amylase, lipase: Non-specific but high

US: Enlarged pancreas, peritoneal effusion, necrosis, fibrosis, duct dilation

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diet for pancreatitis

high carb
low fat
enzyme supplements

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signs and tx of megaoesophagus

regurgitation soon after eating
feed from height. Guarded prognosis.

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what is hiatal hernia

BOAS breeds, like French Bulldogs.
Oesophagus and diaphragm are poorly attached = when breathing the diaphragm slides up = cranial stomach herniates into chest = Gastro-oesophageal reflux.
- See regurgitation, worse when excited

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what is PPDH

Pericardio-peritoneal diaphragmatic hernia
A midline defect at birth, which allows abdominal contents to herniate into the pericardial sac!

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name 3 causes of diarrhoea due to failure in digestion and absorption

EPI: inadequate secretion of pancreatic enzymes  maldigestion and steatorrhoea (fatty poop)
Biliary disease (choleliths (gall stones), cholestatic liver disease, extrahepatic biliary obstruction): failure of emulsification by lipase = maldigestion
Intestinal mucosal abnormalities (inflammation, viral/bacterial infection, neoplastic infiltration) = Malabsorption and maldigestion

all lead to osmotic diarrhoea

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large v small intestinal diarrhoea

Small:
* Weight loss common (RARE)
* Watery/bulky faeces (VARIES)
* Increased volume (NORMAL/DECREASED)
* Defecate 1-3 times a day (OVER 6)
* No tenesmus (TENESMUS)
* No mucus (MUCUS)
* Melena (FRESH BLOOD)

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Name an anti-motility drug
bulking agent
synbiotic

Opioids like Loperamide
Peridale granules
Pro-kolin

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name some common infectious causes of diarrhoea

o Viral: Parvovirus, coronavirus, adenovirus, rotavirus, FeLV (from lymphoma)
o Bacterial: salmonella, campylobacter, E.coli, Clostridia (C.Perfringens, C.difficile),
o Parasitic: Helminths, Protazoa (Giardia, Tritrichomonas)

signs of a parvovirus infection

infects rapidly driving cells (crypts, BM, lymphoid)
vomiting, fetid haemorrhagic diarrhoea, dehydration, Panleukopenia, anorexia, loss of mucosal barrier (septicaemia)

dx of parvovirus

Diagnosis - faecal Ag SNAP test or PCR
Bloods: Panleukopenia,

tx of clostridia

diarrhoea from enterotoxins
metronidazole

tx of campylobacter

4-fluoroquinolones

tx for giardia

snap test available
tx; fenbendazole

what is FRE and ARE

food response enteropathy
- conduct food trial

antibiotic responsive / dysbiosis
- bacterial overgrowth common in many conditions
- responded to antibiotics
- treat primary cause

what is SRE

Steroid responsive enteropathy - characterised by cellular infiltrate in mucosal layer on a biopsy - due to loss of GALT tolerance = uncontrolled inflammation lymphocytic plasmocytic most common then eosinophilic Tx: Prednisalone +/- metronidazole, coalbamin supplements low protein diet, highly digestible

lymphangiectasia (PLE) patho dx tx

like lymphangiectasia villus lymphatics dilate due to inflammation = lymph leaks into GIT = lipid malabsorption and diarrhoea low albumin and globulins white spots on villus If lymphangiectasia is primary - low fat diet, IVFT, albumin/colloids

what is feline triaditis

CE/IBD + Pancreatitis + Cholangiohepatitis

signs of dehydration

tacky MM, sunken eyes, skin tent

signs of hypovolaemia and sepsis

H: Pale MM, increased CRT, weak pulses, tachyP, tachyC, cold extremities S: Red MM, decreased CRT, poor pulses, tachyP, tachyC, pyrexia

key things to test in hypovolaemic patients

BP and lactate = indicator of perfusion

how to differentiate sepsis V hypovolaemia

give 3x fluid boluses every 15 minutes should see increased perfusion... ... if not, dog is septic

sepsis treatment

Dobutamine vasodilator Plasma transfusion

how to calculate fluid needed

deficit % X body weight (over 24 hour period) + maintenance (2ml/kg/hour) + ongoing losses

steps to deal with toxin exposure eaten skin already metabolised

Eaten * Induce emesis : Apomorphine * Gastric decontamination: Stomach lavage + Activated charcoal adsorbent Skin exposure * Wash skin with water * Lipid based soap for lipid based contaminants If metabolised * Dilute with IVFT. (Lipid infusion for lipid soluble compounds)

treatment approach depending on what area of the body is effected (Neuro, heatpci, AKI, CAR, GIT, haematological)

- Neuro: Seizure control - diazepam, Levetiracetam, phenobarbital, propofol - Hepatic: Supportive nature. SAMe, USD acids, Silybin - AKI: IVFT +/- diuretics, dialysis CAR: Anti-arrythmics (lidocaine, amiodarone), beta-blockers, Blood pressure management (IVFT, vasopressor, anti-hypertensives) - GIT- Anti-emetic if irretractable vomiting Diarrhoea = IVFT, diet Haematological - Clotting: Give vitamin K1 and plasma - Anaemia: Give packed RBC or whole blood

specific treatments: NSAIDs Aspirin Paracetamol Warfarine

NSAIDs Tx: Prostaglandin analogue: Misoprostol Aspirin: same as above but also inhibits Thromboxane so may see thrombocytopenia so need blood transfusion Paracetamol: N-acetyl cysteine, liver and AKI support BROWN MM Warfarin: Vitamin K and fresh frozen plasma

signs of paracetamol and chocolate and pyrethroids

P CS: Brown mm, jaundice, abdominal pain, vomiting, signs of hypoxia C CS: Hyperactivity, D/V, tachy dysrhythmias, seizures, coma P CS: acts on neurones (tremors, ataxia), hypersalivation, vomiting

what causes slug poisining thing

Metaldehyde shake and bake - tremors and high temperature

What lateral mesenteric structures can be used to visualise dorsal structures in laparotomies

Pull duodenum from right to left Pull ascending colon from left to right allows visualisation of kidneys and ovaries

what side do PEG tubes come out of

left side = where greater curvature of stomach is

where to make incision fro gastrotomy

Gastric body separates into seromuscular and submucosal mucosal (can do as inverting suture pattern)

what Side fo make incision during intestinal surgery

anti-mesenteric border try avoid Peyers Patches

Enterotmy for FB removal process

orthogonal x-rays to localise - proximal to obsutrciton = distended - distal = empty - incites through unaffected bowl and milk proximal material close- single layer, drape ometilise and non-cutting needle

feline idiopathic megacolon

CS: recurrent constipation, hypomotility causes; often idiopathic but can be spinal/sacral deformity Tx: lactulose laxatives, soapy enemas, high fibre surgery; subtotal colonectomy. antibiotics before, no enema before. Slow to heal and risk of breakdown. Try maintain illeal-caecal junction