Small Animal GI & Dentistry Flashcards
Hematemesis
the vomiting of blood
Which of the following is considered a Primary GI cause of vomiting
Dysautonomia
Vestibular disease
Addison’s disease
Non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs
Along with fresh blood in the stool, which of the following is most consistent with Large Bowel Diarrhea
A) large volume of feces
B) weight loss
C) tenesmus
D) melena
tenesmus
Along with blood in the feces, which of the following would most motivate you to submit a fecal culture for Salmonella
raw food diet
Both Whipworms & Hookworms cause anemia, which one of these is most likely to cause melena
Hookworks
(Small Bowel Diarrhea)
An elevation in which cell type on the CBC is most consistent with intestinal parasitism
eosinophils
The pancreas is critical for the absorption of which of the following in the distal small intestine
cobalamin
Young German Shepherds appear to be susceptible to a number of GI problems, including Exocrine Pancreatic Insufficiency (EPI). The best test for EPI is to measure
trypsin-like immunoreactivity
Are hookworms zoonotic
Yes
Which MDB abnormalities are most consistent with a protein-losing enteropathy
hypoalbuminemia & hypoglobulinemia
Physical examination confirms that Dixie’s belly is distended, and fluid analysis identifies a TRANSUDATE. Which of the following causes a transudate
hypoalbuminemia
Which Breed appears to be predisposed to developing Lymphangiectasia
Yorkshire terriers
What is the drug of choice for treating constipation in cats?
cisapride
Physical examination and minimum database suggest Rex has chronic kidney disease. Is this a Primary or Secondary GI rule-out for the clinical sign of vomiting
Secondary GI
Radiographs reveal that Rex is constipated. Could constipation cause Rex’s clinical signs of vomiting and decreased appetite ?
Yes due to the colonic input to the emetic center
Chronic diarrhea & weight-loss are most consistent with disease of the
A) Esophagus
B) stomach
C) Small Intestine
D) Large Intestine
Small Intestine
In a 14 yr old cat (geriatric) presenting for chronic diarrhea & weight-loss, the top 2 Primary GI rule-outs would be
1) IBD
2) Lymphoma
Because of the acute vomiting you suspect a GI foreign body and order abdominal radiographs. The radiographs reveal gas in the duodenum and loss of corrugated intestines; both of which might be seen with a GI FB. What 4 radiographic signs put Pancreatitis on your rule-out list
1) Gas-filled Duodenum
2) Soft Tissue Opacity
3) Decreased serosal detail
4) Wide Pyloric Duodenum Angle
Is the Pre- and Post Prandial Bile Acids test specific to diagnosing a Portosystemic Shunt?
NO
You run a SNAP for pancreatic lipase and it is elevated; do you consider this result definitive for the diagnosis of pancreatitis
No
Your physical examination reveals a “fluid wave”, consistent with abdominal fluid, or ascites. A sample of this fluid finds it to be a transudate. Which of the following results in a transudate
hypoalbuminemia
Physical examination reveals that Alpo is icteric (jaundice). If you could run only ONE diagnostic test to start your work-up of Alpo, it would be
Crit tube for packed cell volume and total protein
Physical examination reveals that Fred is jaundice and febrile. The minimum database is consistent with neutrophilic cholangitis. Abdominal radiographs reveal corrugated intestines and loss of serosal detail, consistent with what additional condition
pancreatitis
The 3 conditions are involved in the “Feline Triaditis”
Pancreatitis, Cholangitis, IBD
A chemistry panel reveals a significant elevation in ALP. Which other parameter is thought to be a measure of cholestatic liver disease
GGT
Hepatic lipidosis is the feline version of a K9 Reactive Hepatopathy. It represents intra-hepatic changes in metabolism secondary to a period of anorexia. The most important aspect of your treating Mouse would be
Esophageal feeding tube
What is seen in the vomiting process
Nausea/salivation
Retching (active process) +abdominal contractions
Bile (possible)
Is tenesmus seen in small or large bowel diarrhea?
Large bowel
Is increased frequency of defecation seen in small or large bowel diarrhea?
Large bowel
Is increased fecal volume typically seen in small or large bowel diarrhea?
Small bowel
Is fecal mucus seen in small or large bowel diarrhea?
Large bowel
Is melena seen in small or large bowel diarrhea?
small bowel
Is hematochezia seen in small or large bowel diarrhea?
Large bowel
Is increased urgency to defecate seen in small or large bowel diarrhea?
Large bowel
Is vomiting typically also seen in small or large bowel diarrhea
Small Bowel
Is weight loss seen in chronic small or large bowel diarrhea?
Small Bowel
Is Steatorrhea seen in small or large bowel diarrhea
Small bowel
What is steatorrhea
the excretion of abnormal quanitities of fat with the feces owing to reduced absorption of fat by the intestines
Clinical sign of small bowel diarrhea
Will you get small or large bowel diarrhea due to Trichuris vulpis infection?
Large bowel- hematechezia, weight loss, dehydration, anemia, and death
Will you get small or large bowel diarrhea with Ancylostoma caninum and Uncinaria stenocephala infection?
Small Bowel- anemia, melena, death
respiratory manifestation and interdigital dermatitis
Will you get small or large bowel diarrhea with Toxocara canis and Toxascaris leonina infection?
Small Bowel
Pot-bellied, vomiting up worms, pulmonary disease, acute death
What are the two most popular GI parasites in cats
Giardia
Tritrichomonas
What is the cause of the microcytic hypochromic, often non-regenerative anemia seen with Chronic GI bleeds?
Iron deficiency anemia
A Blood Urea Nitrogen to Creatinine ratio of _______ is consistant with a GI bleed
30
A BUN:Cr ratio of 30 is consistant with what
a gastrointestinal bleed
If a dog has hypoalbuminemia and the globulins are decreased, what is the likely cause?
GI disease, likely protein losing enteropathy
If a dog has hypoalbuminemia and the globulins are increased, what are the likely cause
1) Liver disease - lack of production
2) Kidney - loss
What is a likely cause of a hypochloremic metabolic alkalosis
-A pyloric obstruction
HCl is lost through vomiting, bicarbonate is retained leading to alkalosis
What tests are included in the Texas A&M GI panel
-Colbalamin Fasting
-Folate fasting
-TLI fasting
-Pancreatic Lipase Immunoreactivity Fasting
Where is folate absorbed?
In the proximal small intestine
What makes intrinsic factor, which is important in the uptake of cobalamin in the small intestine
Pancreas
What are your two differentials for low cobalamin
1) Distal Small Intestine problem
2) Pancreas problem (decreased intrinsic factor)
Where is cobalamin (vitamin B12) absorbed
the distal small intestine
What is the test of choice for exocrine pancreatic insufficiency (EPI)
Trypsin-like immunoreactivity (TLI)
Parasites, infectious, idiopathic, anatomic, dietary, inflammation and neoplasia are all ruleouts for what
Primary Gastrointestinal Disease
Hypoadrenoacorticism, Hyperthyroidism, Pancreatitis, Exocrine Pancreatic insufficiency, Hepatopathy, and Renal disease are all ruleouts for what
Secondary Gastrointestinal Disease
Is Boxer colitis an acute or chronic GI disturbance
Chronic
What is pseudoanorexia
anorexia caused by either dental disease, oral cavity pain, musculoskeletal disorders, routine changes, anxiety/depression, Whisker fatigue, bowel design, etc.
Primary Anorexia is consistant with what?
CNS disease causes of not eating (Hypothalmus, Anosmia, Trauma, Mass, inflammation, neoplasia)
Secondary Anorexia is consistant with what?
Diseases not in the CNS like CKD, Cholangitis, Pancreatitis, Respiratory, Infection, DKA, DM, Hyperthyroidism
What is a likely cause of gastric ulceration discovered during endoscopy
NSAID toxicity
Patients with Addisons lack what finding on a CBC?
A Stress Leukogram
(Lack of neutrophilia, Lymphopenia, Eosinopenia)
What will the basal cortisol be of a patient with Addisons disease
< 2.0 ug/dl
Patients with atypical Addisons will not have what?
Electrolyte disurbances
will only have GI signs of vomiting and diarrhea
What is the treatment for atypical Addisons
Prednisone 0.2mg/kg/day
How should you treat Granulomatous colitis of Boxer Dogs?
Enrofloxacin
How do you distinguish feline trichomoniasis from giardia in a fecal flotation
giardia moves like a fallen leaf under the microscope
What are your two differentials of a dog with diarrhea and eosinophilia
1) Parasitic infection
2) Allergies
A 2 year old male castrated german shepard presents to you with chronic small bowel diarrhea (large volume) with polyphagia and weight loss. Fecal, dewormers, antibiotics, and diet changes have all been failed treatments. What is your primary differential diagnosis? And what test should you order
Exocrine Pancreatic Insufficiency (EPI)
*Test trypsin-like immunoreactivity
What is the likely cause of an ascites that was determined to be a transudate upon aspiration?
1) Hypoalbuminemia from decreased oncotic pressure
-Renal loss
-Decreased hepatic production
-GI loss
-Severe starvation
-Third space sequestration of protein
2) Sustained portal hypertension (rare): intestinal lymph leakage and a transudate
What is the likely cause of an ascites that was determined to be a modified transudate upon aspiration (Protein 2.5-6g/dl ; Cells 500-20000)
1) Hepatic vascular congestion: causes leakage of high protein fluid from the hepatic lymph vessel.
-Right sided congestive heart failure
-Pericardial disease
-Obstruction of caudal vena cava or hepatic veins
also: Hepatic insufficiency, neoplasia, chyloperitoneum, inflammatory disease
What is the likely cause of an ascites that was determined to be an exudate upon aspiration (Protein >3.5 g/dl; Cells >5000/cmm)
1) Infectious/Inflammatory cause: Feline infectious peritonitis (FIP), Bacterial peritonitis
2) Chemical irritation: Pancreatitis, bile or urine leakage
What are your big three rule outs for a patient with protein-losing enteropathy
1) Lymphangiectasia
2) Inflammatory bowel disease
3) GI neoplasia- lymphoma
*dietary and heavy parasite burden may have some degree of PLN
*diagnose by biopsies and histopathology
What is megacolon in a cat
generalized dysfunction of the colonic smooth muscle in the cat
leads to recurrent constipation to obstipation to megacolon
poorly responsive to therapy
What are the clinical signs of megacolon in a cat
Constipation
Vomiting
Lethargy
Inappetence
Discomfort
Tenesmus
What are the steps in treating a constipated cat
1) Hydration (canned food/adding water, extra bowls, calm juice, low-sodium broth, Pedialyte, tuna juice)
2) Diet (Psyllium-enriched)
3) Laxatives
4) Prokinetics (Cisapride)
5) Treat underlying conditions
What are the effects of a congenital portosystemic shunt
1) Lead to hepatic encephalopathy
2) Develop Ammonia Biurate crystals w (PU/PD)
3) Growth abnormalities
4) Gastrointestional (Vomiting/Diarrhea)
5) Microcytosis on CBC
What are the symtpoms of hypoglycemia in dogs
Lethargy/weakness, confusion, restlessness, muscle incoordination, nervousness, trembling, seizures
What tube should you use for processing a CBC
purple top tube (EDTA)
What tube should you use for processing a chemistry panel
red top tube for blood serum
What will be seen in onion toxicity?
Heinz body anemia from oxidative injury to the RBC (hemoglobin degradation, protein oxidation, lipid peroxidation)
What 4 findings will you see from decreased metabolic function of the liver
Hypoalbuminemia
Hypocholesterolemia
Low BUN
Hypoglycemia
Ingestion of food stimulates ______________ to signal the gallbladder to release bile into the cystic duct
Cholecystokinin (CCK)
An acquired liver shunt will cause the liver to become ___________
cirrhotic - decreased function
increased bile acids will be present
What two liver enzymes signify cholestatic issues
ALP and GGT
A yellow patient that is hyperbilirubinemic with pre-hepatic causes will have______________
Low PCV/Normal TP
(e.g RBC hemolysis from IMHA)
How do you diagnose post-hepatic causes of hyperbilirubinemia like a gall ballder mucocele, extrahepatic biliary obstruction, and pancreatitis
Ultrasound
What could be the reasons for an elevated ALP in a biochemistry panel?
1) Cholestasis (GB mucocele, EHBO, Pancreatitis, Fatty liver)
2) Infection/Inflammation/Metabolic
3) Induced (Steroids, Phenobarbital, Cushings Dz)
What CBC abnormality will you see in a patient with a congenital portosystemic shunt
Microcytosis of RBC
What urinalysis findings will you see in a patient with a congenital portosystemic shunt
1) Low urine specific gravity (PU/PD)
2) Ammonium biurate crystalluria
What Chemistry abnormality will you see in a patient with a congenital portosystemic shunt
Liver is not working well
-Hypoglycemia, low BUN, hypoalbuminemia, hypocholesterolemia,
-Elevated post prandial bile acids
-Liver enzymes?
What are the symptoms of copper-associated hepatitis in dogs?
Clinical signs: Anorexia, vomiting, weight loss, jaundice, hepatic encephalopathy, ascites, PU/PD
Lab abnormalities: Increased ALT (ALP), total bilrubin, clotting times, decreased PCV, Fanconis syndrome
What dog breeds are sensitive to copper associated hepatopathy
Labrador retrievers
T/F Patients with congenital portosystemic shunts typically present icteric
False
What does oral diazepam in cats cause?
acute hepatic failure
-administer IV, orally causes absorption and travel to the liver through the vascular portal where it is metabolized to a toxic metabolite and subsequent oxidative injury due to deficiencies in glucuronidation
Is diazepam given to cats orally or IV?
IV, orally will cause oxidative injury
What can be given to treat oxidative injury in cats
S-adenosylmethionine
If you can only run one diagnostic test to workup an icteric cat, what should it be
Check PCV/TP to rule out pre-hepatic causes of hyperbilirubinemia
What are your differentials for the etiologies of hemolytic anemia in an icteric cat?
Infectious: Mycoplasma hemofelis, FIV/FeLV, FIP, dirofilariasis, Cytauxoon felis
Chemicals/Toxins: onions, acetaminophen
Hypophosphatemia: DKA treatment
Methimazole drug reaction
Lymphoma
Transfusion reactions
Neonatal isoerthyrolysis
Primary IMHA
What is the most common cause of feline cholangitis and how should you diagnose it
Neutrophilic
Do a cholecystocentesis, cytology and culture to check for bacterial infection (Ecoli, Salmonella, Klebsiella, Enterobacter, Strep, Enterococcus, Actinomyces, Pasteurella, Clostridium)
Clinical signs: lethargy, anorexia, vomiting, ptyalism, janidce, febrile, dehydrate, cranial abdominal pain
Diagnostics: ALT, GGT, > ALP, elevated total bilrubin, leukocytosis
Abdominal US: thick gallbladder wall with echogenic particulate mater. tortuous and dilated cystic and common bile ducts
What will you see upon the ultrasound of a cat with feline cholangitis
Thick gall bladder wall
Echogenic particulate matter
Tortuous and dilated cystic and common bile ducts
What liver enzymes will be elevated in feline cholangitis of neutrophilic origin
ALT and GGT > ALP
How do yo treat feline cholangitis neutrophilic (acute or chronic)
Supportive Care, Fluids, Electrolytes, Nutrition, Pain management, Vitamin K, antibiotics
What is your number one differential for a cat with an ALP that is 6x elevated and a GGT that is within normal limits
Clinical signs: anorexia, weight loss, jaundice
Hepatic lipidosis
Does Tritrichomonas foetus (blagburni) cause large or small bowel diarrhea in kittens
Large bowel diarrhea
What are the 4 components of a minimum fecal diagnostic plan for infectious diarrhea
1) Fecal floatation- centrifugation for oocysts, eggs, and cysts
2) Wet mount for trophozoites (Giardia and Tritrichomonas)
3) Rectal cytology for neutrophils/eosinophils, spore forming rods, spirochetes
4) Giardia antigen test or FA for Giardia and Cryptosporidium
What are the two parasites that cause emesis and their eggs are rarely shed in the feces
1) Physaloptera (Cats and Dogs; Intermediate host: crickets, beetles, cockroaches, mice)
Treatment: Pyrantel
2) Ollulanus tricuspis (Cats; ingest vomitus)
Treatment: Fenbedazole
How is Physaloptera spread to dogs and cats
through the ingestion of an intermediate hosts (crickets, beetles. cockroaches, mice)
causes vomiting and eggs are rarely shed in the feces
How do you treat a dog or cat with Physaloptera infestation
Pyrantel
How do you treat a cat with Ollulanus tricuspis
Fenbedazole
You have a 4yr MC labrador with a history of time spent in the mountains. Presents to you with intermittent diarrhea (straining, hematochezia, and mucous). CBC shows an eosinophilia. What is the most likely parasite causing this
Trichuris vulpis (Whipworm)
-Causes mixed bowel diarrhea (or just large bowel)
Fecal oral transmission
*Treat with Fenbendazole, febantel, or milbemycin
How should you treat Trichuris vulpis infection?
with Fenbendazole, febantel, or milbemycin
You have a puppy from the Larimer Humane society that presents to you with small bowel diarrhea and fecal mucus. No vomiting is present You notice 9x11um cyst in fecal evaluation. What is the likely cause
Giardia
confirm with testing and treat with Fenbendazole first, if unresponsive move to Metronidazole
T/F All giardia is zoonotic
F. there are are pet specific genotypes but pets can get the zoonotic genotypes so all giardia can potentially be zoonotic
Name the 5 tests for giardia
1) Wet mount slide (least sensitive)- do on all diarrhea cases
2) Fecal flotation - all cases
3) Giardia antigen assays- increase sensitivity if needed
4) Giardia/Cryptosporidium IFA (research gold standard)
5) Giardia PCR (only for genotype, can be falsely negative)
What can potentially result from a Giardia PCR assay
it can be falsely negative from the PCR inhibitors
How should you treat Giardia in dogs and cats
1)Fenbendazole first and then if unresponsive, move to Metronidazole
Fenbendazole causes less destruction to the gut microbiome
2) EN fiber balance diet
3) FortiFlora Pro SA synbiotic
*Also other -azoles like Secnidazole, Ronidazole or Drontal Plus (febantel) have been proven as effective treatments
Do dogs that are asymptomatic for Giardia but still test positive or shed cysts require treatment?
No they may not require treatment if there are no symptoms
unless the owner shares concerns about the animal shedding as they are immunocompromised
What should you do if an anima failed 2 different drug treatments for giardia, fiber/probiotic/low fat diet and is still cyst/antigen positive with diarrhea?
Finish the workup.
look for coinfections (Crpytosporidium, Tritrichomonas)
Often other GI diseases (Inflammatory bowel disease or pancreatic exocrine insufficiency)
A pixie bob cat from a cattery presents to you with bloody mucous diarrhea (large bowel) of 5 weeks duration with multiple failed therapeutic trails. What is the likely parasite?
Tritrichomonas foetus (blagburni)
can cause diarrhea duration up to 9 months
-does not make a cyst, just trophozoite -cant readily find on fecal exam (use combination of tests- cytology, culture, PCR)
How do you diagnose Tritrichomonas foetus in a cat?
If you cant see on fresh feces wet mount go to PCR (can also do cytology or culture)
positive PCR result does not prove illness
How should you treat a cat with Tritrichomonas foetus infection?
Ronidazole
*Beware of neurotoxicity
-also use Tinidazole, Enrofloxacin, or Pradofloxacin
What is a large animal parasite that you have to beware of as it is zoonotic and causes intense small bowel diarrhea?
Cryptosporidium parvum
What is the most sensitive method to diagnose cryptosporidium?
*PCR (genotyping)
then ELISA for antigen
then fluorescent antibody staining
then staining techniques
then flotation techniques
How do you treat diarrhea from cryptosporidiosis?
No drug eliminates the infection but just helps resolve diarrhea and lessen the oocyst shedding
Treat with Tylosin, Azithromycin, or Nitazoxanide for at least 7 days
A 12week, FI, DLH from a petstore presents with small bowel diarrhea with blood present, Multiple other littermates are affected. Upon fecal flotation you notice oocysts containing many sporocysts within them. What is the diagnosis
Isospora spp./ Cystoisospora
Isospora typically only causes diarrhea in ________ but not ___________
kittens; but not aduults
How do you treat Isospora spp. infection in dogs and cats?
*Ponazuril (Toltrazuril)
-Sulfadimethoxine
-Trimethoprim sulfa
-Clindamycin
What is Ponazuril (Toltrazuril) used for
For the treatment of Isospora as it is cocidio-cidal
may sterilize the bowel
consider treating all in contact animals
A 3 year old MS DSH named Duncan is presented to you with what the owner mentions as “rice grains on his butt” He is an outdoor cat with a history of hunting. What is the likely diagnosis and how do you treat?
Taenia species
Treat with Praziquantel
Is Taenia zoonotic?
No
What tapeworm is transmitted through fleas
Dipylidium caninum
How do you treat tapeworms such as Taenia, Dipylidium caninum, and Echinococcus
Praziquantel or Epsiprantel
*depending on species- prevent with flea treatment or restrict outdoor access to rodents
Is Dipylidium caninum zoonotic?
only if you somehow eat the flea on the pet
Are Echinococcus species zoonotic?
Yes
What tapeworm species are transmitted through carnivorism?
Taenia and Echinococcus species
Diphyllobothrium latum and Spirometra mansonoides are cestodes transmitted through __________
fresh water copepods, fish, watersnakes, etc.
What type of parasite is Mesocestoides lineatus
a tapeworm
Eurytrema pancreaticum is a GI fluke native to Florida and Hawaii. How is it transmitted?
When cats eat geckos
treat with praziquantel
Platynosomum fastosum is a GI fluke that is transmitted to dogs by _______________
ingestion of frogs
treat with praziquantel
Fluff is a 5 year old male castrated DSH cat with a 2 day history of small bowel diarrhea and fever. He is a hunter and found with bird feathers 5 days ago. Well vaccinated for feline panleukopenia
CBC reveals neutrophilic leukocytosis
FeLV/FIV test is negative
Fecal is negative
Rectal cytology shows multiple neutrophils
What is your likely diagnosis?
What is your treatment?
Salmonella Typhimuriosis (Songbird Fever) from migrating songbirds
Tx: If only diarrhea- probiotics and self limited diet
Antibiotics (only if bacteremic): Ampicillin IV, add quinolones parenterally if septic
Clementine is a 4 year old male castrated DSH with a 2 day history of mixed bowel diarrhea and fever. His owner has him on a raw food diet.
CBC reveals a neutrophilic leukocytosis.
FeLV/FIV test is negative
Fecal is negative
Rectal cytology shows multiple neutrophils
What is your likely diagnosis?
What is your treatment?
Salmonellosis
Tx: If only diarrhea- probiotics and self limited diet
Antibiotics (only if bacteremic): Ampicillin IV, add quinolones parenterally if septic
How do you treat animals with Capylobacter jejuni and Campylobacter coli infections?
Probiotic and diet trial first
Tylosin or a quinolone orally if fails
-Erythromycin causes vomiting
What kind of diarrhea does Campylobacter jejuni and C. coli infections cause
Mixed bowel diarrhea
What is the etiology of Granulomatous Colitis seen in Boxers and French Bulldogs and how do you treat it?
Pathogenic Escherichia coli
must treat with enrofloxacin for a minimum of 6-8 weeks
T/F: The presence of spore forming rods proves that the diarrhea is caused by Clostridium
False
What is likely the cause of acute hemorrhagic diarrhea syndrome in the dog?
Clostridium perfringens (but rule out hypoadrenocorticisms with a screening cortisol)
How does Clostridium perfringens infection manifest?
Likely nosocomial or from overgrowth from stressful situations
Clostridium perfringens causes_____________
Acute large bowel diarrhea
(can manifest as acute hemorrhagic diarrhea syndrome)
T/F the best way to diagnose Clostridium perfringens infection is with culture
F: not very sensitive
Clostridium is part of normal flora so culturing, testing for spores, or enterotoxin is not helpful
How do you treat Clostridium perfringens infection?
1) High fiber diet or probiotic trial first
2) Antibiotics only if dietary management fails or animal appears septic (Tylosin, Amoxicillin/Ampicillin, Metronidazole)
3) If failure- complete workup, possibly IBD
Can you use dog parvovirus antigen kits with cat feces?
Yes but but take care with the interpretation in recently vaccinated cats
-Modified live vaccines (Fecal PCR may be psotive for a few days) for feline panleukopenia
Why should you do a full workup when you diagnose canine parvovirus?
Coinfections may contribute to CPV infections to detect which comorbidities you need to treat
What is the standard 5 components for treatment of Canine Parvovirus enteritis?
1) Administer IV fluids- crystalloid, standardized KCl supplementation
2) Cefoxitin (2nd gen cephalosporin)
3) Maropitant (Cerenia)
4) Nasogastric tube (10% RER per feeding)
5) High digestable, bland food- 24h after vomiting stops
*Alternate: 4 quadrant approach with a) IM/IV Enrofloxacin and IV Ampicillin or b) Metronidazole
*Additionally a fecal microbiota transplantation has been proven to be effective
When is it a good idea to begin feeding a dog with canine parvovirus enteritis
As soon as you can. Use a nasogastric or esophageal feeding tube
Rebound is a recuperation formula that can also be used
should you discharge canine and feline parvovirus cases with oral antibiotics
Once the enterocytes are regenerating, bacteremia is unlikely
Oral antibiotics cause dysbiosis that may take weeks to resolve
Use a probiotic instead
What is a homodont and name species with this teeth shape
All of the teeth are same shape
ex: dolphin
What is a heterodont and name species with this teeth shape
The teeth have different shapes
ex: dog, cat, horse, etc
What are elodonts and name species with these teeth
Species that have teeth that continually grow throughout the life time (open root apex), often aradicular
ex: Rabbits
need to be grinded down or else risk for overgrowth and malocclusion
What are enelodonts and name species with these teeth
Species that have a closed root apex and therefore do not continually grow during the life of the animal.
ex: Dog, cat, horse, etc
What are brachydonts and name species with these teeth
Species that have a shorter crown to root ratio
ex: carnivores (dog, cat, etc)
What are hypsodonts and name species with these teeth
Species that have a longer crown to rot ratio
ex: Cheek teeth of horses and cows (radicular)
Lagomorphs and incisors of rodents (aradicular)
What species are classified as being heterodont, anelodont, brachyodont, and diphyodont
Dogs and Cats
(Different shapes, Closed Root Apex, Short Crown to Root ratio, and have deciduous teeth)
What species are classified as being heterodont, aneodont, hypsodont, and diphyodont
Horses
(Different shapes, Closed Root Apex, Long Crown to Root ratio, and have deciduous teeth)
If you are diphydont, that means you have ___________
deciduous teeth
What 4 structures hold the tooth in place?
1) gingiva
2) cementum
3) periodontal ligament
4) alveolar bone
What does the periodontal ligament bind together
The cementum to the alveolar bone
What is the mesial aspect of the tooth
the forward side of the tooth that is closest to the midline of the face
What is the dental formula of dogs permanent teeth
2x(3/3I, 1/1C, 4/4PM, 2/3M) = 42 teeth
How many teeth do dogs have (permanent set)?
within that, how many:
Incisors?
Canines?
Premolars?
Molars?
42 teeth
3 incisors on each side (max and mand) x 2 = 12
1 canine on each side (max and mand) x 2 = 4
4 premolars on each side (max and mand) x 2= 16
2 molars on each side (max) , 3 molars on each side (mand) x 2 = 10
What is the dental formula for the deciduous teeth of dogs?
28 teeth
2x(3/3I, 1/1C, 3/3PM) = 28
Lack molars (-10)
Have one less premolar (-4)
What is the dental formula for the permanent cat teeth?
30 teeth
2x(3/3I, 1/1C, 3/2PM, 1/1M) = 30
What is the dental formula for the deciduous teeth of cats?
26 teeth (lack a set of molars - minus 4)
2x(3/3I, 1/1C, 3/2PM)
How many roots do the incisor teeth of dogs and cats have?
One root
How do the permanent incisor teeth erupt in respect to the deciduous teeth in dogs and cats
Palatal/Lingual to the deciduous teeth (just behind)
How many roots do the canine teeth of dogs and cats have
One root
(Crown is only 1/3 the length of the tooth)
How do the permanent canine teeth erupt in respect to the deciduous teeth in dogs and cats
Maxillary will erupt mesial to the deciduous teeth (infront)
Mandibular will erupt lingual to the deciduous teeth (behind)
How do the permanent premolar teeth erupt in respect to the deciduous teeth in dogs and cats
Permanent premolar teeth will erupt palatal/lingual in respect to deciduous teeth (towards the midline)
How many roots do the dog and cat 4th premolars have
Three Roots
T/F There are no deciduous molars
True
Which teeth have long spindly roots, large pulp chambers/root canals, thin dentinal walls, increased translucency, and small point crowns
Deciduous teeth
What is the premolar rule in regards to deciduous teeth
each deciduous tooth has the appearance of the permanent tooth distal to it
dPM4 looks like permanent M1
dPM3 looks like permanent PM4
dOM2 looks like permanent PM3
What is the order in which canine teeth typically erupt
Incisors (3-5 months)
Canine and Premolars (4-6)
Molars (5-7)
How do you number deciduous teeth?
500-800
500 (R MX)
600 (L MX)
700 (L MN)
800 (R MN)
Does the mandibular or the maxillary canine sit more mesial?
the mandibular sits more mesial (in front)
A Class 0 Occlusion is one regarded as ____________
a normal occlusion
A Class 1 Malocclusion is regarded as _______
a malocclusion where the jaw lengths are normal but there are rotated, tipped, or displaced teeth leading to a malocclusion
A Class 2 Malocclusion is regarded as _______
a malocclusion from Mandibular brachygnathism (overbite) leading to the mandibular canine having no where to rest, except for the palate. can lead to an oral-nasal fistula
no breed standard accepts this and it needs to be addressed
also can occur from persistent deciduous teeth
What can result from a Class 2 Malocclusion
An oral nasal fistula from the mandibular canine pressing on the palate
What can result from a Class 3 Malocclusion
roughening of the labial surface of the maxilla and a callus
A Class 3 Malocclusion is regarded as _______
a malocclusion from maxillary brachygnathism (underbite)
common among brachycephalic breeds
An asymmetrical malocclusion is regarded as
Wry Mouth- caused by the lack of symmetrical growth in one quadrant length
Evaluate where the teeth make contact and correct issue
What anatomical feature on canine and feline hard palate, just behind the incisors is often confused for neoplasia
An incisive papillae
What anatomical feature on lingual aspect of the feline 1st molar is often confused for neoplasia?
the lingual molar salivary gland
What is it called when you notice an abnormal curvature of the root upon dental radiography
Dilaceration - makes tooth extraction difficult
What is a dilaceration?
When there is an abnormal curvature of a root, makes tooth extraction difficult
What tooth commonly has supernumerary roots, which is why taking radiographs is exceptionally important to make sure it is removed when extracted
Premolar 3 (PM3)
What is ankylosis
When the tooth is fused with the periodontal ligament, extraction is difficult because it needs to be drilled and its hard to tell bone from tooth
-Appears as “snow-storm” on radiograph
Infection and inflammation of the periodontal structures (gingiva, periodontal ligament, cementum, alveolar bone) that can lead to loss of the periodontium
Periodontal disease
What are the 4 radiological findings of periodontal disease?
1) Rounding of the alveolar margin at the cementoenamel junction
2) Loss of integrity of the lamina dura
3) Widening of the periodontal space
4) Resorption of the alveolar margin (Horizontal and Verticle)
How can you correct vertical bone loss of teeth?
How about horizontal bone loss?
it can be filled with bone graft material
it cant be corrected
What is classified as a Stage 0 Furcation Exposure
no furcation present
What is classified as a Stage 1 Furcation Exposure
when there is bone loss so that the periodontal probe extends less than halfway under the crown in any direction of a multirooted tooth with attachment loss
What is classified as a Stage 2 Furcation Exposure
when there is bone loss so that the periodontal probe extends greater than halfway under the crown of a multirooted tooth with attachment loss but not through and through
What is classified as a Stage 3 Furcation Exposure
where there is bone loss so that the periodontal probe extends under the crown of a multirooted tooth, through and through from one side of the furcation out the other
Describe the 4 stages of periodontal disease
1) Gingivitis without evidence of alveolar bone loss
2) Periodontitis with <25% alveolar bone loss and/or stage 1 furcation exposure
3) Periodontitis with 25-50% alveolar bone loss and/or stage 2 furcation exposure
4) Periodontitis with >50% alveolar bone loss and/or stage 3 furcation exposure
*Rate on the tooth most effected by PD for the entire tooth
Infection and inflammation of the endodontic structures (Pulp, dentin pulp complex)
Endodontic lesions
An enlarged root canal diameter is a characteristic of ______________
Endodontic disease
Apical lucency is a characteristic of __________
Endodontic disease
What will you see on radiograph of an animal with endodontic disease
1) Enlarged root canal diameter
2) Apical lucency
What is the most common retained deciduous tooth?
The canines
What are 2 problems resulting from persistent deciduous teeth?
1) Malocclusion from abnormal position
2) Periodontal disease- lack of a circumferential gingival collar
How can persistent deciduous teeth result in periodontal disease
Due to crowding and the lack of a circumferential gingival collar (needed to be 360 to protect the root)
What methods should you use to remove persistent Deciduous teeth
Incisors?
Canines?
Premolars?
Fragile teeth, be careful and do not rush
Incisors- direct elevation
Premolars- direct elevation with sectioning
Canines - mucogingival flap- avoids fractures and damage of permanent teeth
How do you treat a Class 2 Malocclusion
If deciduous teeth- relieve the dental interlock via extractions
If permanent teeth
1) Incline plane or crown extensions move mandibular canine teeth
2) Vital pulp therapy to reduce height mandibular canine teeth
3) Extract mandibular canine teeth (least desirable)
what dog breed is known to get terrible periodontali disease and ankylosis
greyhounds
What is the most common physical exam diagnosis in dogs?
Periodontal disease
What is the normal gingival sulcus depth in the dog and the cat
Dog: 1-3mm
Cat: 0.5mm
Describe the pathogenesis of periodontal disease
Inflammation and destruction of the periodontium
shift from healthy (aerobic, gram + bacteria) to unhealthy (anaerobic, gram - bacterica) leading to production of endotoxins, LOPS, enzumes increase in crevicular fluid causing local tissue destruction and inflammation causing cytokine and stimulation of B cells for systemic effects
If you see calculus circumnavigating around a tooth, what is likely
there is an oronasal fistula. Also presents with nasal discharge if so
How do you treat patients with stage 1 or 2 periodontal disease
Do a dental cleaning
+/- closed rooting planing
home care
How do you treat patients with stage 2 or 4 periodontal disease
Do a dental cleaing
+/- closed (no flap) or open (flap) root planing
extraction(if complete furcation exposure- root dependent)
How do you treat patients with stage 4 periodontal disease
Extraction
-There is severe mobility and furcation exposure
Gingival enlargement is likely caused by what 4 reasons?
1) Drug induced (Ca2+ channel blockers, Diphenytoin, and Cyclosporine)
2) Neoplasia
3) Genetic (Great Danes, Boxers, Collies, SpringerSpaniels, Doberman Pinscher, Dalmation
4) Hormonal
What are the potential complications of gingival enlargement
1) Obstructive to normal occlusion and/or mastication
2) Pseudopockets- debris accumulation, inflammation and loss of periodontium
3) Painful when severe
How do you treat gingival enlargement
Reduce gingival height (measure overgrowth, create bulking points, excise bulk, sculpt remaining tissue, apply tincture of Myrrh)
Address inciting cause
What occurs in a carnassial tooth slab fracture
occurs due to chewing hard substances like bone, antler, ice cubes, cow hooves, etc.
The buccal wall of maxillary carnassial tooth (PM4- 108 and 208) pops off
The lingual wall of the mandibular carnassial tooth (M1-309 and 409) pops off
What is an uncomplicated crown fracture vs a complicated crown fracture
The crown is fractured but the pulp cavity is not exposed
The crown is fractured and the pulp cavity is exposed
What is an uncomplicated crown-root fracture vs a complicated crown-root fracture
both the crown and root are fractured but the pulp cavity is not exposed
both the crown and root are fractured and the pulp cavity is exposed
What are the causes of Endodontic disease
1) Tooth fracture (Permament or Deciduous)
2) Excessive wear
3) Carious lesions
4) Periodontal disease
5) Trauma leading to pulpitis
What is the difference between attrition and abrasion
Both are causes of endodontic disease
Attrition occurs through tooth on tooth wear from normal mastication or maloccluson
Abrasion occurs through wearing on tooth of bones, balls, or bars
What is tertiary dentin formation
occurs from slow tooth wear. When dentin is laid down on the tooth resulting in a brown discoloration
What are carious lesions?
“cavities” from enamel defects and bacterial infiltration into the pulp, can lead to periodontal disease
Molar teeth are the most affected
treat with restoration of crown +/- root canal therapy
Extraction
How can trauma lead to pulpitis (endodontic disease)
Concussive force trauma can create necrotic pulp tissue that creats pressure and kills the tooth
needs radiograph to diangose dead tooth
causes discolaration due to pulpal swelling (Intrinsic staining)
What teeth can cause suborbital swelling?
PM3 (distal root)
PM4
M1
What teeth can cause a retrobulbar abscess
M2 (drains intraorally)
What tooth causes suborbital swelling in brachycephalic breeds?
Canine teeth
A mucogingival fistula is highly indicative of what?
Endodontic disease
What are the 4 more common oral pathologies of the cat?
1) Periodontal Disease
2) Tooth Resorption
3) Gingivostomatitis (Juvenile and adult onset)
4) Neoplasia
What are signs of dental disease in cats?
-Change in food preferene
-Appetite but loses interest
-Frustration during eating
-Decreased grooming
-Reclusive behavior
-Ptyalism +/- blood
What are the clinical findings of cats with periodontal disease
1) Alveolar bone expansion
2) Supereruption
3) +/- tooth resorption
4) Kissing lesions (contact ulcerations where the buccal mucosa contacts the calculus
What 3 feline teeth have the highest predilection for tooth resorption
1) Mandibular PM3 (307 and 407)
2) Mandibular M1
3) All Canine teeth
What might have occurred if the third premolar is missing in a cat?
The tooth was reabsorbed
If you see a smaller crown upon oral examination in cat, what likely is happening
Gingival enlargement is rare in cat, it is likely that tooth resorption is occuring
What should you do to treat tooth resorption in a cat?
Extraction is often the only option
+/- periodontal ligament intact, roots clearly visible and defined within alveolar bone.
alveolar bone reaction
Crown amputation- roots resorbing/difficult to distinguish from bone. never a gingivostomatits cat
What is Type I Tooth Resorption in a cat and how do you treat it?
A tooth with a focal lesion, normal periodontal ligament and radiopacity
-fully extract the tooth
What is Type 2 Tooth Resorption in a cat and how do you treat it?
When there is a tooth with a focal or generalized lesion with loss of PDL and decreased radiodensity
-Fully extract or do a crown amputation
How do you treat Type 3 tooth resorption in a cat
do a partial full extraction +/- partial crown amputation
Are supragingival or subgingival lesions painful in cats and require emergency care
Supragingival
How many roots does the first premolar have in the dog
1 root
How many roots does the second premolar have in the dog
2 roots
How many roots does the second premolar (only maxillary) have in the cat
1 root
How many roots does the 3rd premolar have in the dog and cat
2 roots
What premolars are cats “missing” in comparison to the dog
Premolar 1 (both maxillary and mandibular)
Premolar 2 (missing mandibular)
Premolar 3 in both the dog and cat have _______________ roots
2 roots
Cats only have one molar on the mandible and maxilla. How many roots does it have
3 (Maxilla tooth- fused)
2(Mandibular tooth)
How many roots does M3 have in the dog?
1 root (this tooth is only present in the mandible)
How many roots does M1and M2 each have in the dog?
3 (Maxilla)
2(Mandibular)
