GIT, pancreas, liver Flashcards
What is the most common viral agent identified in cats with feline gingivostomatitis?
Feline calicivirus
Nakanishu JFMS 2019
What is the most common oral bacteria in healthy cats?
In cats with feline gingivostomatitis?
Healthy - pasteurella multocida
FGS - Enterococcus faecali and aenaerobic bacteria
Nakanishu JVIM 2019
What concurrent disease is frequently seen with feline gingivostomatitis?
What areas does it affect and in what percentage of cases?
Oesophagitis
Proximal - 75%
distal - 90%
Kouki JVIm 2017
Do cats with feline gingivostomatitis and concurrent oesophagitis frequently have GIT clinical signs?
No - 0/58
Kouki JVIM 2017
What is the preferred method for assessing dysphagia?
videofluoroscopic swallowing study utilizing a normal physiological feeding position.
Harris JVIM 2017
Is gastric reflux always an abnormal finding on physiological feeding position videofluoroscopic swallowing studies?
No - can be seen in healthy dogs
Harris JVIM 2017
Is radiation effective for the treatment of sialocele in dogs? If so what is the minimum dose recommended?
Yes with 54% achieving complete remission adn 45% achieving partial remission, including 3 dogs with repeat radiation that achieved remission after the second round of radiation.
16 or 20Gy in 4 Gy fractions.
Poirier JVIM 2018
What is the recurrence rate for sialocoels after initial surgery?
5-14%
Poirier JVIm 2018
Aside from strategic oral or gastrostomy tube feeding, are there any other options to minimize aspiration pneumonia in dogs with megaoesophagus?
What is the median survival time after implementing this?
at home suction of oesophageal contect via either oesophagostomy tube or per os.
median survival - 13.5 months. with none or infrequent aspiration events.
Manning JVIM 2016
What are possible complications of at home oesophageal suctioning in dogs with megaoesophagus?
- obsturction of O-tube
- skin infection at insertation site
- oesophagitis
Manning JVIM 2016
What is the frequency of gastro-oesophageal reflux in cats undergoing anaesthesia?
33%
Gargia JVIM 2017
Does 2 doses of omeprazole 1,5-2mg/kg PO in 24h increase the gastric and oesophageal pH significantly?
If so, to what pH?
Does this affect serum gastrin concentrations?
Yes
Increases pH from 2.8 to 7.2
Does not affect serum gastrin concentrations
garcia JVIm 2017
In regards to canine oesophageal foreign bodies, what is:
- the most common cause?
- the most common region of lodgement?
- the percentage that die in hospital
- the risk factors associated with death in hospital?
- percentage that have post removal oesophageal strictures?
Cause - bone (81%)
Region - distal oesophagus
% that die - 5% in hospital
Risk factors for death - surgery, declining surgery to try endoscopy again, and increased complications especially oeophgeal perforation, and post procedure oesophageal haemorrhage
Stricutres reportedin 2.1% of survivors.
Burton JVIM 2017
What are the benefits of indwelling oesophageal balloon dilation feeding tube for treatment of benign oesophageal stricture?
- well tolerated
- significant improvement in modified dysphagia score
- reduced anaesthetic time.
- more economical
Tan JVIM 2017
What complications were noted with indwelling oesophageal balloon dilation feeding tube for treatment of benign oesophageal stricture
- swallowing and gagging during insufflation of the balloon
- regurgitation
- skin site infection
- vomiting
- dislodgement of the tube
- repeat GA to replace tubes that had moved or been vomited up.
Tan JVIm 2017
How can dogs with lower oesophageal sphincter achalasia-like syndrome be diagnosed?
Via the video fluoroscopic swallowing study ising a free-feeding protocol.
Grbman JVIM 2018
What findings and in what percentage of cases with lower oesophageal achalasia-like syndrome in dogs were seen?
- megaoesophagus - 73%
- baseline oesophageal fluid line - 68%
- “bird beak” 63%
- acontractile oesophagus - 8/19
- hypomotile oesophagus - 8/19
- hypermotile oesophagus - 3/19
Grobman JVIM 2018
What treatment options may exist for dogs with function obstruction of the lower oesophageal sphincter?
- injecting the LOS with botulinum toxin A
- pneumatic LOS dilation
- Surgical LOS myotomy
Grobman JVIm 2018
What proportion of cats with oesophageal feeding tube placement had complications?
what were the most common complications?
In which patients?
35% had complications
- tube dislodgement (14.5%) and stomasite infections (12%) were most common complications
- Patient on glucocorticoids, chemo or with discharge at the stoma site had an increased odds of stoma site infections
Breheny JVIM 2018
Cats with which diseases and an Otube had an increased odds of death?
- lower weight
- pancreatic disease
- neoplastic
- respiratory
- urogenital
- infectious diseases
had increased odds of death
duration of time in place or discahrge with tube in were not associated with increased odds of death.
Breheny JVIM 2018
Idiopathic oesophageal dysmotility is most common in what type of dogs? of what age?
- brachycephalic dogs
> 1 year old
Eivers JVIM 2019
What feature of idiopathic oesophageal dysmotility are most commonly seen in brachycephalic dogs?
- prolonged oesophageal transit time
- decreased propagation of secondary peristaltic waves
- GER
- hiatial hernia
Eivers JVIM 2018
What is the oesophagostomy tube complication rate in dogs and cats?
44%
Nathanson JVIm 2019
what percentage develop infection and of these, what percentage required surgical debridement of O tube sites in dogs and cats?
Cats - 17% infection, 22% surgical debridement
Dogs - 13% infection, 35% surgical debridement
Nathanson JVIM 2019
What percentage of animals are euthanized as a result of complications associated with oesophgeal tube placement?
3%
Nathanson JVIM 2019
What treatments can clinically improve outcomes in dogs with lower oesophageal sphincter achalasia-like syndrome in dogs?
- mechanical dialation with botulininum toxin A for 40 days
- myotomy and fundoplication - effective in the long term
Grobman JVIm 2018
What percentage of dogs that underwent mechanical dilation and botulinum toxin A injection for lower oesophageal sphincter achalasia-like syndrome had improvement in clinical signs?
what improved?
100% had improvement
- body weight increased 20%
- Body condition score increased
- regurgitation reduced by 80%
Grobman JVIM 2018
What percentage of dogs and cats undergoing PEG tube placement are likely to have complications?
Is this worse if they are receiving steroids?
74% developed some level of complication
78% of patients on steroids had a complication compared to 57% of those not on steroids
Severe complications were seen in 43% of patients with steroids vs 18% in those not
Aguiar JVIm 2016
What effects can sucralfate have in the management of stress-related mucosal disease in dogs (ex vivo model)?
- applied at the time of injury or after injruty hastened recovery fo teh barrier function and restroed defects in gastric barrier function.
Hill JVIM 2017
What make sucralfate an attractive potential choice over PPis for stress-related mucosal damage in dogs?
- binds to negatively charged subepithelial proteins exposed during mucosal injury => viscous layer that protects vascular bed
- absorbs and reduces pepsin
- stimulates mucus and bicarb synthesis and secretion
- doesn’t alter pH and thus doesn’t impace bacterial colonization so has lower likelihood of clostridium difficile-associated diarrhoea
- protective against nosicomal pneumonia in people.
- doesn’t afffect cytochrom P450 enz
Hill JVIM 2017
What are the odds of that dogs receiving:
- aspirin
- prednisolone 2mg/kg
- both aspirin and prednisolone
will develop endoscopic mucosal lesions > or = 4?
Aspirin: no different from placebo
pred: 11.1 x higher
both: 31.5 x higher
Whittemore JVIM 2018
What is the most common type of hiatial hernia seen in cats?
At what age group?
Type 1 (85%) > 3 years old at diagnosis (64%)
Phillips JVIM 2018
What are the survival times of cats with hiatial hernias treated:
- medically
- surgically?
Medically - 2559 days
Surgically 771 days
Phillips JVIM 2018
What is the % of cats with hiatial hernia that also have concurrent diseases?
What are common concurrent problems?
77% have concurrent diseases
- GIT signs (96%)- vomiting, weight loss and anorexia
- Respiratory disease (29%) - brachycephalic, chornic infections, aspriation pneumonia
Phillips JVIM 2018
Are ulcers common in dogs receiving clopidogrel? What about clopidogrel and pred?
not seen in dogs with clopdiogrel only
7 x higher odds of ulcers in dogs receiveing pred only or clopidogrel and pred.
Whittemore JVIM 2019
Do synbiotic + diet change have a more significant effect on CCECAI scores in dogs with chronic enteropathy, than diet change alone?
No.
No difference between treatment groups.
Schmitz JVIm 2015
Is serum Vitamin D (25(OH)D generally lower or higher in dogs with chronic enteropathy? What does this predict? what are the odds of this occurring in these dogs?
- Lower isn dogs with CE
- significant predictor of death
- Odds ratio 1.08
Titmarsh JVIM 2015
What bacteria is associated with neutrophilic IBD in cats?
What other infectious agent has it been noted with in cats?
What layer of the intestine is it found in?
What does this suggest about this bacteria?
- Campylobacter coli
- tritrichomonas foetus
- mucosa
- C.coli either produces compound which stimulate neutrophils or induces intestinal cell to produce neutrophil chemoattractants
Maunder JVIM 2016
What is the clinical presentation of intestinal leiomyositis?
what is the median survival?
5.4 yr old + signs of intestinal pseudo-obstruction
vomiting
regurg
small bowel diarrhoea
median survival - 19 days post diagnosis
Zacuto JVIM 2016
What are the histopathological changes associated with intestinal leiomyositis?
In what layer?
- mononuclear inflammation
- myofiber degeneration and necrosis
- fibrosis within regions of myofiber loss
- in muscularis propria
Zacuto JVIM 2016
What is the suspected pathogenesis of canine intestinal leiomyositis?
- idiopathic/autoimmune disorer possible associate with autoreactive T-cell response
=> affects contractilityof enteric smooth muscle cells because of infiltration of lymphocytes between functional myocytes => ileus.
Zacuto JVIM 2016
Is oral cobalamin effective at resolving hypocobalaminaemia in dogs with chronic enteropathy?
Yes
Toresson JVIM 2016
Does 6 weeks of parenteral cobalamin supplementation resolve the clinical signs of low Vit B12 in the short term?
in the long term?
Does it normalize cellular B12?
- resolves clinical signs while receiving treatment
- clinical signs returned after discontinuation of therapy
- Serum and urinary MMA concentrations decreased during treatment (but did not normalize) and then increased with discontination of therapy, suggestive that despite normalization of serum cobalamin, cellular deficiency still persisted.
Kempf JVIM 2017
What can 99m Tc-labeled human serum Albumin Scintigraphy be used for?
- Confirmation and possible localization of gastrointesitnal protien loss in dogs with hypoalbuminaemia.
Englemann JVIM 2017
What are the common causes of chronic diarrhoea in dogs and the percentage they occur in?
Primary enteropathy: 90%
- Inflammatory - 71%
- dietary 66%
- idiopathic -23%
- antibiotic responsive 11% - Infectious - 13%
- Neoplastic 4%
- Other - mechanical or systemic vasculitis
Secondary causes: 10%
- Exocrine pancreas 6%
- endocrine 2%
- other: hepatic, renal, cardiac.
Volkmann JVIM 2017
what percentage of dogs with chronic diarrhoea had clinical remission?
87% had clinical remission.
Volkmann JVIM 2017
What findings were associated with a lack of recovery in dogs with chronic diarrhoea?
- primary idiopathic or neoplastic disease
- increased disease severity scores
- anaemia
- severe hypoalbuminaemia
- severe hypocobalaminaemia
Volkmann JVIM 2017
What histopathological differences are noted between dogs with chronic enteropathy and normal albumin and dogs with chronic enteropathy and hypoalbuminaemia?
Does with hypoalbuminaremia are more likely to have (and to have higher scores in):
- villous stunting,
- epithelial injury,
- crypt distension
- lacteal dilation
- intraepithealial lymphocytes
- lamina propria neutrophils
Wennogle JVIm 2017
What is the sensitivity and specificity of the granulocyte immunofluorescence assay to detect food responsive disease?
What is this assay measuring?
Sensitivyt 0.61
Specificity 1.0
Measures anti-neutrophil cytoplasmic antibodies
Florey JVIM 2017
Dogs with IBD have what changes to the immunphenotype of peripheral blood lymphocytes?
- reduced percentage of TCRyd+ T lymphocytes (also increased in intestinal intraepithelial lymphocytes)
- reduced percentage CD21+ B cell
Galler JVIm 2017
What associated is seen between FRD, SRD and healthy dogs and:
- peripheral eosinophilia
- serum 3-BrY
And CCECAI and serum 3-BrY?
Peripheral eosinophilic: no difference
serum 3-BrY - higher in dogs with steroid responsive disease
CCECAI and serum 3-BrY - no correlation.
Sattasathuchana JVIM 2017
do cats with chronic intestinal disease have alterations to their whole blood taurine levels?
What is the proposed mechanism of this?
- taurine was wnl but cats with large intestinal signs and chronic inflammatory enteropathy had significantly lower concentrations than those with small or mixed bowel signs.
2 proposed mechanism of decreased taurine:
- reduced absorption of taurine conjugated bile acids due to ileal disease
- increased production of taurine-conj bile acides due to increase cholecystokinin => increased elivery to the colon => inflam from alterations to the microbiota.
Kathrani JVIm 2017
What impact does using an animal protein-free diet have on the faecal microbiota of:
- healthy dogs
- dogs with food responsive enteropathy
Healthy dogs - no impact
Dogs with FRE - increased microbial richness but not return to normal (initially lower bacterial alpha diversity)
Bresciani JVIM 2018
what changes in faecal bile acids are noted in dogs with CE?
incresed % of primary bile acids in faeces compared to controls
Giaretta JVIM 2018
What changes in intestinal expression of apical sodium-dependent bile acid transporters are noted in dogs with CE?
What are the proposed mechanisms of this?
- decreased expression in the ileum => negatively correlated with histopath score
=> down regulation of apical sodium-dependent bile acid transporter in ileium may be secondary to inflam, dysbiosis or faecal bile acid dysmetabolism.
Giaretta JVIM 2018
regarding eosinophils, what is the limitation of H&E staining on histopath samples?
- doesn’t detect degranulated eosinophils.
Bastan JVIM 2018
What staining technique can improve detection of intact and degranulated eosinophils?
When is this useful?
use of monoclonal antiboides against the eosinophile granule protein (eosinophile peroxidase) then stained with H&E.
Useful for the detection of eosinophilic GIT disease and detecting degranulated eosinophils.
Bastan JVIM 2018
In dogs with eosiniphilic GIT disease, what area and layer of the gut has the highest number of eosinophils compared to the control group?
- duodenum
- lamina propria
Bastan JVIm 2018
In dogs with PLE, is serum tryptophan usually increased or decreased? What else does this correlate with?
- decreased
- correlates with serium albumin in dogs with PLE.
Kathrani JVIIM 2017
What are the limitations generally to consider regarding biomarkers?
- Quantitative - can have grey zones
- performance criteria including analytical performance (eg bedside tests) and preanalytical validation
- Biological variability and evalation of the critical change value to ensure alterations are relevant and nor a relfecion of biological or analytical variability
- diagnostic accuracy (sensitivity, specificity)
- diagnostic performance - PPV/NPV
Helimann JVIM review 2018
What are the goals of an ideal biomarker?
- assessment of the risk for disease development
- diagnosis of disease
- evaluation of organ function
- determination of organ origin
- assessment of disease severity
- assessment of response to treatment
- prediction of individual outcomes
- monitoring
- detection of disease flares
Helimann JVIM review 2018
What biomarkers are currently used for chronic enteropathies in dogs?
Functional biomarker:
- serum cobalamin
- serum Folate
- Faecal a1PI
Inflammatory marker
- serum CRP +/- faecal calprotectin
- rest not widely available
- likely useful for predicting response to treatment
Genomic marker
- not widely available
Helimann JVIM review 2018
Serum and faecal alpha-1PI:
- what is it?
- when to use?
- limitations?
Serum and faecal alpha-1PI:
- what is it:
- protease inhibitor produced by the liver.
- similar size to albumin thus lost in GI disease at similar rate but resists proteolysis - when to use:
- early detection of GI protein loss before hypoalbuminaemia/clinical signs
- differentiate GI protein loss from hepatic hypoalbuminaemia
- imporved accuracy in hypoalbuminaemic dogs - limitations:
- not very specific
- day to day variation => average over 3 days.
- <12m old
- corticosteroids
Helimann JVIM review 2018
Serum cobalamin: 1. what is it? 2. when to use? 3. limitations? in relation to chronic inflammatory enteropathy
Serum cobalamin:
- what is it:
- water sol vitamien absorbed in ileum wiht intrinsic factor (from pancreas) - when to use?
- reflects distal SI malabsoprion, dysbiosis or both
- hypoalbuminaemia => low B12 is a negative prognositic indicator - limitations?
- not specific for chronic inflammatory enteropathy (EPI)
- normal doesn’t rule out CE
heilimann JVIM review 2018
Methylmalonic acid: 1. what is it? 2. when to use? 3. limitations? in relation to chronic inflammatory enteropathy
Methylmalonic acid:
- what is it?
- metabolite that increases with reduced intracellular Vit B12 => marker of cobalamin deficiency at a cellular level. - when to use?
- superior (urine and serum) to cobalamin concentrations - limitations?
- cost
- techinical difficulty
Heilmann JVIm review 2018
- increased in serum with renal insufficiency
Folate: 1. what is it? 2. when to use? 3. limitations? in relation to chronic inflammatory enteropathy
Folate:
- what is it:
- absorbed by duodenum and jejunum
- chronic malabsorption in prox SI -> reduced levels - when to use?
- monitoring supplementation - limitations?
- falsely increased with dysbiosis
Heilmann JVIm review 2018
Faecal IgA 1. what is it? 2. when to use? 3. limitations? in relation to chronic inflammatory enteropathy
Faecal IgA:
- what is it?
- reflects IgA synthesis and scretion by intestinal mucosa - when to use?
- insufficient data
- may be decreased in German shepherds with chorinc GIT disease. - limitations?
- insufficient data
Heilmann jVIM 2018
Faecal and mucosal intestinal microbiome + FDI:
1. what changes?
2. when to use?
3. limitations?
in relation to chronic inflammatory enteropathy
Faecal and mucosal intestinal microbiome:
- what changes?
- reduced faecalbacterium and fusobacteria
- reduced abundance of spercific bacteria
- increased FDI, especially dogs with immunosuppressent responsive enteropathys (sens 74%, spec 95%) - when to use?
- assessment for IRE - limitations?
- expense
- not widely available
Heilmann JVIm review 2018
Metabolomic markers - serum: 1. what is it? 2. when to use? 3. limitations? in relation to chronic inflammatory enteropathy
Metabolomic markers - serum: 1. what is it? increased: - 3-hydroxybuturate - hexuronic acid - ribose - gluconic acid lactone => indicated oxidative stress and functional changes to the microbome
- when to use?
- monitor treatment and repsonse - limitations?
- exprnse
- not widely available.
Heilmann JVIM review 2018
CRP 1. what is it? 2. when to use? 3. limitations? in relation to chronic inflammatory enteropathy
CRP
- what is it?
- positive, tye II acute phase protein expressed int he liver.
- nonspecific - when to use?
- assess disease progression and response to treatment
- must increase or decrease by at least 2.7 fold be consider clinically relevant
- ditinguish anti-inflammatory or immunosuppressive treatment from those dogs responding to elimination diet or antibiotitic trial
=» or = 9.1mg/L = IRE. sens 72%, spec 100%
- high PPV - limitations?
- non specific marker on inflammation
- high biological variability
HeilmannJVIM review 2018
