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Y3 MOD Gastroenterology > SA Acute Gastroenteric Disease > Flashcards

SA Acute Gastroenteric Disease Flashcards

1
Q

Most acute vomiting and diarrhoea is ..?

A

Self limiting

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2
Q

Most chronic diarrhoea requires…?

A

A specific diagnosis before treatment

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3
Q

What are the categories of acute vomiting and diarrhoea?

A
  • Non-fatal / self-limiting e.g. parasitism
  • 2° to extra-intestinal / systemic disease
  • Severe potentially life-threatening
  • Secondary to other organs
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4
Q

What are some examples of severe potentially life threatening causes of V&D?

A
  • Enteric infection
  • AHDS/HE – acute haemorrhagic diarrhoea syndrome/haemorrhagic gastroenteritis
  • Intestinal obstruction
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5
Q

Name some examples of surgical disease that can cause V&D

A
  • Intussusception
  • Volvulus
  • Incarceration
  • Stricture/partial obstruction
  • Foreign body
    N.B. Vomiting is the major sign
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6
Q

What is the most important part of care/treatment in a patient with V&D?

A

Prevention of dehydration

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7
Q

How much of the daily fluid volume that enters the gut is absorbed by the gut?

A

98%

So 2% is lost in faecal water

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8
Q

What decisions need to be made when presented with a V&D patient

A
  • Is intensive emergency treatment needed (fluid/ electrolyte, acid/base) ?
  • Is there an underlying non-enteric cause ?
  • Is surgical management needed ?
  • Is hospitalisation needed ?
  • Is an infectious cause likely ?
  • Is non-specific treatment sufficient ?
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9
Q

What are the clinical signs of V&D

A
  • Vomiting ± abdominal pain
  • Profuse diarrhoea
  • Mucoid diarrhoea + tenesmus
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10
Q

Describe the features of diarrhoea that would localise it to the SI

A
  • Large volumes
  • Normal to mild increase in frequency of defaecation
  • No tenesmus
  • No blood or mucus
  • Weight loss occurs with time
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11
Q

Describe the features of diarrhoea that would localise it to the LI

A
  • Normal to increased volume
  • Frequent defaecation
  • Tenesmus present
  • Blood/mucus seen
  • Weight loss not usually seen
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12
Q

Describe the features of acute gastritis

A
  • Acute onset of frequent vomiting
  • Often associated with acute diarrhoea
  • Very common
  • But often self-limiting
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13
Q

What are some causes of acute gastritis?

A

Many causes; not all ‘inflammatory’:

  • Dietary indiscretions, garbage intoxication
  • Foreign material
  • Hairballs (bezoars) in cats
  • Certain drugs
  • Acute systemic disease
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14
Q

An acute onset of profuse diarrhoea is a sign of?

A

Acute enteritis

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15
Q

What are the causes of acute enteritis?

A

Aetiology often obscure
Usually self-limiting
Dietary indiscretions, garbage intoxication
Enteric infection

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16
Q

Define Tenesmus

A

Excessive straining even if the bowel is empty

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17
Q

Acute colitis is rare and common in which spp?

A

Fairly common in dog; rare in cat

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18
Q

What are the causes of acute colitis?

A
  • Idiopathic
  • Garbage ingestion
  • Whipworms
  • Protozoa (Giardia, Cryptosporidium etc)
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19
Q

Describe the steps in making a diagnosis

A
  • History
  • Physical exam
  • Biochemistry testing
  • Imaging
  • Response to symptomatic treatment
  • Reassess if signs persist for more than 48 hours
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20
Q

What information should be gathered in the history of a dogs with V&D?

A
  • Age and vaccination status
  • Recent dietary intake
  • Exposure to toxins, f.b. or infectious disease
  • Nature of signs
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21
Q

How can hydration of a patient be assessed?

A

PCV / TP
MM
Skin tenting

22
Q

Which tests can be carried out to help diagnose issues with V&D?

A
  • haematology
  • serum biochemistry
  • urinalysis
  • faecal examinations for parasites
23
Q

Which faecal microbiology tests can be used?

A
  • ELISA test for viral antigen
  • Electron microscopy
  • Direct smears and floatation for Giardia parasites
  • Wet-prep for Tritrichomonas (cats)
  • Giardia SNAP test
  • Parvovirus SNAP test
24
Q

What is imagine used for in V&D diagnostics?

A
  • Rule out obstruction / other surgical dz.

- Ultrasound for intussusception

25
Q

What are the emergency diagnostics when presented with a patient in peracute crisis?

A
  • PCV/total protein (refractometer)
  • Examine blood smear
  • Blood glucose (glucometer)
  • Blood urea (dipstick)
  • Urinalysis
26
Q

What are some principles of treating V&D?

A
  • Signs usually self-limiting
  • Treat the specific cause if identified
  • Important to maintain hydration
  • Good prognosis for complete recovery
  • Reassess if persists for > 48 hours
27
Q

Which drugs are contraindicated in V&D cases?

A

Corticosteroids / NSAIDs

28
Q

How can hydration be maintained?

A

Oral rehydration solutions if not vomiting or severely dehydrated
Glucose- electrolyte solutions
If vomiting water give parenteral fluids

29
Q

What are some symptomatic treatment methods

A

Restricted GI intake

  • Fasting for a minimum of 12 hours
  • Followed by frequent feedings
  • Small amounts of bland, low-fat food eg. boiled rice & chicken
30
Q

What are the advantages of ‘Feeding through diarrhoea’?

A

Reduces potential of sepsis

Speeds recovery

31
Q

Why is ‘Feeding through diarrhoea’ not practical?

A
  • Concurrent vomiting

- Cosmetic problem

32
Q

When can anti-emetics be used?

A

When an obstruction has been ruled out

33
Q

Name some anti-emetic drugs

A
  • Maropitant
  • Metoclopramide
  • Chlopromazine
  • Atropine
34
Q

What is the ROA for Maropitant?

A 
Subcutaneous injection (1 mg/kg)
Oral preparation (2 mg/kg)
35
Q

What are the uses of gastric mucosal protectants

A

If vomiting persists

If ulceration present

36
Q

Why are NSAIDs contraindicated?

A
  • Anti-inflammatory and analgesic
    BUT
  • Damage GI mucosa and damage kidneys if hypovolemic
37
Q

How do anti-diarrhoeals work?

A

Absorbents / protectants

  • protect’ mucosa
  • bind toxins
  • bind excess water
38
Q

Name some anti-diarrhoeal drugs that bind excess water

A

Kaolin-pectin
Activated charcoal
Bismuth subsalicylate

39
Q

Name the motility modifying anti-diarrhoeal drug

A

Opioids

  • slow the rate of transit
  • anti-secretory
40
Q

What are the pros and cons of using antibiotics in V&D treatment?

A 
Cons:
- ‘upset’ the natural flora
- cause diarrhoea
- risk of sepsis if mucosal barrier compromised
Pros:
- Promote resistance
41
Q

What are the indications for antibiotic use in cases of V&D?

A
  • Haemorrhagic diarrhoea
  • Diarrhoea + pyrexia
  • Known infection: Salmonella, Campylobacter, pathogenic E. coli
42
Q

Describe the features of probiotics

A
  • Live micro-organisms
  • Administered orally
  • Alter the intestinal microflora proposed to have a beneficial effect on health
43
Q

What are the 2 main methods of removing a gastric foreign body?

A
  • Induction of vomiting

- Natural passage

44
Q

Describe induction of vomiting to remove a f.body and which drugs can be used?

A
  • Only if smooth object recently ingested
  • Also useful if non-corrosive poison ingested
  • Apomorphine
  • Xylazine
45
Q

When is natural passage of a f.body indicated?

A
  • Small objects if no signs of gastric disease

- Failure to pass in 48 hours necessitates surgery

46
Q

What are 2 viral causes of acute gastroenteritis?

A

Parvovirus

Coronavirus

47
Q

Name 3 bacterial causes of acute gastroenteritis

A

Salmonella
Campylobacter
E. coli

48
Q

What are the main features of Canine acute haemorrhagic diarrhoea syndrome

A
  • Affects all ages
  • Especially toy and miniature breeds
  • Syndrome of unknown aetiology
  • Not an inflammatory disease altered mucosal permeability or secretion
49
Q

What are the clinical signs of Canine acute haemorrhagic diarrhoea syndrome

A
  • sudden onset of vomiting ± blood
  • may precede diarrhoea by a few hours
  • severe bloody diarrhoea
  • marked haemoconcentration
  • depression
  • shock
50
Q

What will be seen on the clinical exam/diagnostics in a patient with Canine acute haemorrhagic diarrhoea syndrome

A
  • Marked elevation of PCV - often 60 to 80
  • Normal skin turgor
  • Normal WBC, radiographs, blood chemistries
51
Q

How is Canine acute haemorrhagic diarrhoea syndrome treated?

A
  • Prompt vigorous fluid therapy is essential
  • IV balanced electrolyte solution
  • 80 ml/kg/hr infused rapidly until: CRT normal, PCV <50
  • Also withhold all food and water
  • Parenteral broad-spectrum antibiotics
  • Protectants
52
Q

What is the prognosis of Canine acute haemorrhagic diarrhoea syndrome?

A
  • If untreated death occurs rapidly due to shock and circulatory failure
  • If treated mortality is low. Some dogs have repeat episodes

Y3 MOD Gastroenterology (3 decks)

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