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SAMS 1 > Lecture 17: Feline GI disease and pancreatitis > Flashcards

Lecture 17: Feline GI disease and pancreatitis Flashcards

1
Q

Define feline chronic enteropathy

A

GI signs > 3 weeks without extra intestinal or infectious causes

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2
Q

what are 3 causes of feline chronic enteropathy

A
  1. Food responsive enteropathy
  2. IBD/CIE
  3. Lymphoma- small and large cell
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3
Q

what are the clinical signs of feline chronic enteropathy

A
  1. Weight loss- most common
  2. Vomiting
  3. Anorexia
  4. Small bowel diarrhea
  5. Lethargy
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4
Q

what are you ddx for feline chronic enteropathy: primary and secondary GI

A

primary: FRE, IBD/CIE, lymphoma, parasites, fungal

Secondary: liver disease, hyperthyroidism, diabetes, pancreatitis, EPI, kidney disease

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5
Q

where is cobalamin absorbed

A

ileum/distal SI

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6
Q

low cobalamin indicates what

A

ileal malabsorption

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7
Q

If patients cobalamin is low where is the disease localized

A

ileum

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8
Q

what is normal and abnormal ranges for cobalamin

A

normal: 500-1000+
Abnormal: <500

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9
Q

what is supplementation protocol for cobalamin: oral and SQ

A

oral: 250mcg once daily for 12 weeks, discontinue, recheck 4 weeks

SQ: 250mcg once weekly for 6 weeks, then 1 month later, then check 1 month after

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10
Q

if cobalamin is not > ___ after supplementation then continue and recheck monthly

A

800-1000

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11
Q

where is folate absorbed

A

duodenum and jejunum

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12
Q

Low folate indicates

A

malabsorption

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13
Q

high folate indicates

A

bacterial overgrowth, dysbiosis

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14
Q

What is the most common finding and other findings on ultrasound that indicate feline chronic enteropathy

A
  1. Thickening of Muscularis- most common
  2. Lymphandenopathy
  3. Muscularis striations
  4. Loss of wall layering
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15
Q

identify layers 1-4 and is this normal or abnormal intestine

A
  1. Serosa
  2. Muscularis
  3. Submucosa
  4. Mucosa

Normal

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16
Q

normal or abnormal intestine

A

abnormal- Muscularis thickening

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17
Q

normal or abnormal intestines

A

enlarged lymph nodes

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18
Q

when would this be normal vs abnormal sign

A

mucosal striations- dilated lacteals
Normal after meal
Abnormal if fasted- lymphangiectasia, fibrosis, scaring

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19
Q

what diet would you try for feline chronic enteropathy and for how long

A

hydrolyzed or novel protein for 2 weeks

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20
Q

what part of intestines is included in upper GI endoscopy

A

Stomach, duodenum +/- proximal jejunum

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21
Q

what part of intestines is included in lower GI endoscopy

A

colon, ileum

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22
Q

what are the most common sites of intestines for diseases related to feline chronic enteropathy

A

jejunum and ileum

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23
Q

what changes on histo pathology would indicate IBD over lymphoma

A

mixed infiltrates of lymphocytes and plasma cells

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24
Q

what changes on histo would indicate SCL over IBD

A

monomorphic population of small lymphocytes

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25
what tests can you do to further differentiate IBD vs SCL
IHC, PARR
26
how does IHC work
uses specific antibodies to bind antigen
27
what antibody is used for T cell, B cell and proliferation
T cell- CD3 B cell- CD20 and CD79 Ki67- proliferation
28
following IHC using CD3 what wrong
T cell lymphoma
29
How does PARR work
tests for clonality, DNA of B and T cell receptor genes are amplified
30
what would a monoclonal PARR finding indicate
cancer
31
what would a polyclonal PARR finding indicate
IBD
32
what is tx for CIE/IBD
1. Hydrolyzed or novel protein diet 2. Prednisolone or budenoside 3. Alternative immunosuppressants: cyclosporine, chlorambucil 4. Probiotics
33
what is MOA for cyclosporine
calcineurin inhibitor—> IL-2 inhibitor—> blocking T cell activation
34
what are side effects of cyclosporine
GI, hepatotoxicosis, secondary infections
35
what is MOA for chlorambucil
alkylating agent—> cross linking—> apoptosis
36
what are side effects of chlorambucil
myelosuppression, GI, hepatotoxicity
37
what is prognosis for CIE/IBD
good- 3-5+ years
38
what is tx for small cell lymphoma
prednisolone and chlorambucil
39
what is prognosis for SCL
1-3 years
40
what is tx for LCL and prognosis
tx: CHOP Prognosis: 6-9 months
41
what type of inflammation is seen with acute pancreatitis
neutrophilic
42
what is mechanism for acute pancreatitis
premature activation of trypsinogen—> trypsin—> activates proteases and lipases—> cellular damage, necrosis and inflammation
43
what is cause of acute pancreatitis
idiopathic
44
what are CBC findings with acute pancreatitis
increased HCT: dehydrated Inflammatory leukogram
45
what are chemistry findings for acute pancreatitis
1. Elevated ALT, ALP, bilirubin 2. Elevated BUN, creatinine 3. Hypo or hyperglycemia 4. Hypocalcemia
46
what does abdominal ultrasound look like with acute pancreatitis
1. Hyperechoic mesenteric 2. Pancreatic enlargement 3. Abdominal effusion
47
t or f: lipase is a useful diagnostic tool for acute pancreatitis
false
48
what is the highly specific pancreatic lipase used to dx acute pancreatitis in cats
feline pancreatic lipase immunoreactivity
49
>__fPL likely pancreatitis
8.8
50
what is tx for acute pancreatitis
fluids, anti-emetics, pro kinetics, pain management, appetite stimulants, enteral/NG feeding
51
t or f: steroids and abx are used to tx acute pancreatitis
false
52
what is prognosis for mild to moderate pancreatitis vs severe
mild to moderate: good Severe: guarded to grave- 40% morality
53
what are some negative prognostic indicators for severe pancreatitis
low iCa2+, azotemia, hypoglycemia
54
what type of inflammation and histo signs are seen with chronic pancreatitis
lymphoplasmacytic inflammation, fibrosis, acinar atrophy
55
How do you dx chronic pancreatitis
1. AUS- hyperechoic, irregular margins 2. PLE 3. Biopsy
56
in addition to supportive therapy what else is involved in tx of chronic pancreatitis especially if concurrent IBD and cholangitis
prednisolone, cyclosporine
57
what are some consequences of chronic pancreatitis
DM, EPI
58
how do you dx EPI and what results are positive vs normal
TLI <8= EPI >12 normal
59
what are the main clinical signs of chronic pancreatitis
weight loss, diarrhea
60
what is prognosis for chronic pancreatitis
good- but lifelong management

SAMS 1 (17 decks)

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