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GI2 > Smallies 1 > Flashcards

Smallies 1 Flashcards

1
Q

Define Tenesmus

A

Continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness

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2
Q

Define Haematochezia

A

Passage of fresh blood through the anus, usually in or with stools

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3
Q

Define Dyschezia

A

A functional condition characterised by at least 10 minutes of straining and crying before successful or unsuccessful passage of soft stools

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4
Q

Define Diarrhoea

A

An increase in faecal volume, water content and frequency of defaecation

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5
Q

Explain how the LI can compensate for the failure of the SI

A

The LI can reabsorb water but will not be able to compensate for nutrient absorption or digestion

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6
Q

What is the difference in water content in formed and unformed stool?

A

Formed: 60-80% water
Unformed: 70-90% water

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7
Q

List stool characteristics and general signs in SI disease

A

Large volume, watery, melaena, weight loss

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8
Q

List stool characterisitics and general signs in LI disease

A

Urgency, tenesmus, haematochezia, small volume, increased frequency, presence or mucus/fresh blood

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9
Q

Define Dysphagia

A

Difficulty swallowing

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10
Q

List clinical signs of dysphagia

A

Gagging, dropping food, retching, exaggerated swallowing effort, ptyalism, fear of eating combined with a ravenous appetite

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11
Q

Define ptyalism

A

Excessive salivation

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12
Q

List the 5 classifications of dysphagia and explain each where the abnormality is seen

A

Oral - prehending and transporting bolus to base of tongue
Pharyngeal - transporting bolus from oropharynx
Cricopharyngel - transporting bolus through upper oesphageal sphincter
Oesophageal - transporting bolus through oesophagus
Gastro-oesophageal - transporting bolus across the lower oesophageal sphincter

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13
Q

What are the 3 phases of vomiting

A

Prodromal, retching, expulsion

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14
Q

Explain the 3 phase of vomiting (prodromal, retching and expulsion)

A

Prodromal - see signs of nausea (e.g. ptyalism, appetite loss, lip licking) and excessive swallowing
Retching - get retrograde duodenal contractions with rhythmic inspiratory movements against a closed glottis and dilation of the cardia/lower oesophgeal sphincter
Expulsion - reduced oesophgeal and pharyngeal tone and active expulsion of gastric/duodenal contents by contraction of abdominal muscles

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15
Q

What are the possible causes of vomiting? (list categories, not specifcs)

A

Diet, stomach conditions, intestinal problems, abdominal, metabolic/endocrine, bacterial, viral, parasites, infections, toxins, iatrogenic, central/CNS

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16
Q

What are dietary causes of vomiting?

A

Change of diet (planned or unplanned)
Spoiled food
Food intolerance - non immune mediated
Food allergy - immune mediated

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17
Q

What are stomach condition causes of vomiting?

A

Inflammatory - gastritis (acute or chronic) or ulceration (less common but can be chronic)
Physical - FB, outflow obstruction, hiatal hernia
Functional - motility disorder
Neoplastic - adenocarcinoma, lymphoma, leiomyoma

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18
Q

What are intestinal condition causes of vomiting?

A

Inflammatory - IBD (common), infectious enteritis/colitis, SIBO/ARD
Physical - FB, intusussception, volvulus
Functional - ileus, constipation
Neoplastic - carcinoma, lymphoma, leiomyoma, MCT

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19
Q

What are abdominal causes of vomiting? (list by organ)

A

Pancreas - acute or chronic pancreatitis, pancreatic tumour, EPI with SIBO
Peritonitis - septic
Liver disease - cholangiohepatitis, chronic hepatis, cholecystitis, biliary obstruction
Renal - CKD, AKI, pyelonephritis, urinary tract obstruction
Uterine - pyometra, pregnancy
Prostatic disease - prostatisi, paraprostatic cyst, prostatic tumour, benign hypoplasia

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20
Q

What are metabolic/endocrine causes of vomiting?

A 
Hyperthyroidism
Azotaemia
Hypoadrenocorticism
Diatbetic ketoacidosis
Hypercalcaemia
Hepatic encephalopathy - congenital PSS
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21
Q

What are bacterial causes of vomiting

A 
Salmonella
Clostridium perfringens
E.coli
Campylobacter jejuni
Yersinia
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22
Q

What are viral causes of vomiting?

A 
Parvovirus/feline panleucopenia
Coronavirus (FIP)
FeLV
FIV
Distemper
Canine Adenovirus
Rotavirus
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23
Q

List parasitic causes of vomiting?

A

Worms - toxocara, taenia, uncinaria, trichuris

Protozoa - isospora, cryptosporidium, giardia, tritrichmonas

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24
Q

List toxin causes of vomiting?

A

Ethylene glycol, raisins, theobromine, lead, lilies, ivy, conkers, adder bites

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25
Q

List drug (iatrogenic) causes of vomiting?

A

Antibiotics, NSAIDs, cyclosporine, digoxin

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26
Q

List central/CNS causes of vomiting?

A 
Motion sickness
Idiopathic vestibular disease
Encephalitis
Limbic epilepsy
Tumours
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27
Q

What are the indications to induce emesis?

A

Gastric decontamination after toxin ingestion

Foreign body ingestion

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28
Q

What are the contraindications of inducing emesis?

A 
Caustic substance ingestion
Lethargy/debilitation
Dyspnoea
Neurological signs
Abdominal surgery
Spinal injury
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29
Q

Names drugs used to induce vomiting

A

Apomorphine - dopamine agonist
A2A - medetomidine or xylazine
Hydromorphone + midazolam

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30
Q

List reasons for ptyalism that is unrelated to nausea

A

Oropharyngeal disease
PSS
Salivary gland disease e.g. siadenitis

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31
Q

What points from a history should make you worry about a vomiting case?

A 
Several days duration
Rapid deterioration
Persistent vomiting and/or inappetence
Haematemesis
Profuse SI diarrhoea
Weight loss
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32
Q

What physical examination findings should make you worry about a vomiting case?

A 
Weak, collapsed,
MM: dry/tacky, pale or congested
Tachycardia, bradycardia, arrhythmias
Weak and thready pulses
Hypothermia or pyrexia
Abdominal pain or distention
Melaena or haemorrhagic diarrhoea
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33
Q

What screening tests can you do for a vomiting case?

A

Blood tests - haematology/CBC, biochemistry, electrolytes

Urinalysis - dipstick, USG, sediment exam +/- culture

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34
Q

What diagnostic imaging can you do for a vomiting case?

A

Radiograph - abdominal +/- thorax (mets, aspiration)

Ultrasound - abdomen +/- guided biopsy

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35
Q

When is endoscopy indicated and contraindicated in a vomiting case?

A

Indications - chronic disease

Contraindications - acute disease (unless confirming presence of an ulcer or FB)

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36
Q

What patient preparation is required for endoscopy?

A

Starve the patient - not performed ‘on the day’

Ideally after radiographic study

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37
Q

What specific disease tests can be used for a vomiting case?

A 
TT4
Pancreastic lipase immunoreactivity 
ACTH stim
FeLV/FIV 
Serum cobalamin
Serum folate
Pre and post prandial bile acid
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38
Q

/what supportive care and stabilisation can be done for a vomiting case?

A

Fluid therapy +/- electrolyte replacement
Anti-emetics (if no obstruction or history of toxin ingestion)
Gastroprotectants
Prokinetics
Nutrition
Nursing care

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39
Q

Describe the ideal anti-emetic drug

A

Broad spectrum activity - peripheral and central
Minimal CVS side effects - these patients may be dehydrated or haemodynamically unstable
Wide therapeutic index - clearance mechanisms may be compromised (e.g. renal/hepatic)
Minimal CNS side effects (sedation) - reduces risk of aspiration
Minimal negative effects on GI motility - reduces risk of ileus

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40
Q

What is Maropitant and discuss pros and cons of its use

A

Selective NK1 receptor antagonist
Effective against peropharal and central pathways
Advantages:
- Has analgesic properties so useful for painful conditions e.g. pancreatitis
- Suitable for cats and dogs
- Comes in oral and injectable forms
Disadvantages:
- Pain at injection site
- Can only use for 5 days (injection) or 14 days (oral)

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41
Q

What is Metoclopramide and discuss pros and cons of its use

A

Dopamine, 5-HT3 and H1 receptor antagonist
More central than peripheral effects
Variable prokinetic effects
Advantages:
- Suitable for cats and dogs
- Comes in oral and injectable forms
Disadvantages:
- Short acting (CRI may be best?)
- Rarely causes extrapyramidal side effects (agitation, ataxia, aggression)
Now replaced by Maropitant unless using aCRI

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42
Q

Explain how dogs and cats are normally resistant to bacterial gastritis

A

Very acidic environment
Monogastric stomach is a barrier to infection and prevents colonisation of the SI
Very few things can survive past the stomach
Sterile environment

43
Q

Give reasons for disruption to the gastric barrier to bacterial gastritis

A

Neonates - barrier functions not yet well developed

Abnormal gastric environment - food related or antacids (iatrogenic)

44
Q

How is the stomach protected from gastric ulceration from stomach acid?

A

the gastric mucosal barrier has tight intercellular junctions, a bicarbonate-rich mucous layer and local prostaglandins controliing mucosal blood flow, bicarb production and mucus.
It is also dynamic tissue so can have rapid epithelial turn over

45
Q

What are causes of gastric ulceration associated with failure of the mucosal barrier?

A

acid hypersecretion
direct physical injury e.g. FB
reduction of prostaglandins e.g. COX inhibitors (NSAIDs)

46
Q

What are benign causes of gastric ulceration?

A 
Iatrogenic e.g. NSAIDs
Metabolic/endocrine e.g. Addisions, azotaemia, 
Complication of IBD
SHock and sepsis
Stress
47
Q

What are malignant causes of gastric ulceration?

A

Primary gastric neoplasia e.g. adenocarcinoma, lymphoma
Gastrinoma
MCT
Ulcerative intestinal tumours

48
Q

What are physical causes of gastric disease?

A

FB - can cause gastritis, ulceration, obstruction, performation
Obstructive mass lesions e.g. neoplastic, inflammatory, granuloma, polyp
Gastric dilation +/- volvulus

49
Q

What are function causes of gastric disease?

A

Gastric motility disorders
Stasis - often associated with chronic gastritis/IBD, ulceration, infiltrating neoplasia or pancreatitis
Metabolic causes of stasis e.g. hypokalamia, hyper/hypocalcaemia

50
Q

What are neoplastic causes of gastric disease?

A 
Carcinoma
Lymphoma
Leiomyoma
Meiomyosarcoma
Fibrosarcoma
51
Q

What is bilious vomiting syndrome (+ signalment and common presentation)

A

Common in dogs
Chronic intermittent bilious vomit
Typically early morning on an empty stomach

52
Q

List clinical signs associated with gastric disease in dogs and cats

A

Vomiting, salivation, burping, retching, reflux, poor appetite, melaena, weight loss, halitosis, abdominal pain (lethargy, depression, praying position), bloating

53
Q

What are the clinical signs for chronic gastritis?

A

chronic intermittent vomiting - food or bile
loss of appetite
diarrhoea
Clinical signs wax and wane, may gte occasional flare ups

54
Q

What are the clinical signs for GDV?

A

acute onset in dogs
unproductive retching
distended and painful abdomen
if prolonged will get circulatory problems leading to a crisis

55
Q

What are the clinical signs for gastric ulceration?

A 
Seen in dogs more than cats
Poor appetite
Salivation
Abdominal pain
Haematemesis
Melaena
Weight loss
Anaemia
56
Q

Outline the investigations for gastric disease

A

Signalment, full clinical history, thorough physical examination then screening tests e.g. blood, urine and imaging

57
Q

What are the clinical signs and diagnostic test findings of pyloric outflow obstruction?

A

Vomiting 6-8 hours after food
Hypocaloraemia, hypokalaemia, metabolic alkalosis
Distended food filled stomach on radiograph

58
Q

Briefly desribe the key points of a diet trial

A

Must try for at least 6 weeks
Use a single source of protein and single source of CHO
Use novel or hydrolysed protien

59
Q

Name examples of gastroprotectants

A

Polyaluminium sucrose sulphate
Bismuth subsalicylate
Kaolin products

60
Q

When are antacids used and list examples

A

USed for gastric ulceration, chronic gastritis and reflux oesophagitis
Proton pump inhibitors - omeprazole
H2 blocker - ranitidine
Aluminium hydroxide

61
Q

When are corticosteroids considered for therapy for gastric disease?

A

For chorinc gastritis or IBDwhen there has been no response to diet and gastroprotectants

62
Q

What is feline triaditis?

A

Multiorgan inflammatory disease affecting the liver, pancreas and small intestine

63
Q

When is surgical intervention indicated for gastric disease?

A

Pyloric outflow obstruction
FB (if can’t be removed endoscopically)
Perforated ulcers
Tumour resection e.g. leiomyoma

64
Q

What are the advantages of radiography for the GIT?

A 
Gives global overview
Can assess adjacent thorax and skeleton
Good for detecting gas or mineralisation
Useful for acute conditions
Cheap and widely available
65
Q

What are teh disadvantages of radiography for the GIT?

A 
Superimposition of structures
Lack of inherent radiographic contrast (cr thorax)
Soft tissue and fluid appear the same
Magnification
Less useful for chronic conditions
66
Q

List challenges of radiography and how to avoid them

A

Low inherent constrast (soft tissue/fluid/fat) –> low kV
Minimising scatter –> low Kv, collimation, use of grid
Movement blur –> chemical and physical restraint
PAtient prep –> fasted for 24 hrs, empty bladder

67
Q

What are the uses of contrast studies in the GIT?

A

Document function by taking sequential still images or using real time readiography (fluoroscopy)

68
Q

List examples of contrast studies for the GIT and liver

A

GIT: barium swallow (fluroscopy), gastrography (air, barium or double contrast), barium series, barium enema, pneumocolon
Liver: mesenteric portovenography (water soluble iodine)

69
Q

What structures can you see on radiography?

A

Liver, stomach, spleen, kidneys, small intestine, caecum, colon, urinary bladder, prostate gland, diaghragm, body wall, sublumar musculature, thoracolumabar/lumbar vertebrae, caudal ribs, part of bony pelvis

70
Q

What can you not see on radiography (normally)?

A

Adrenal glands, gall bladder, ovaries, uterus, mesentary, meseteric LN, omentum, pancreas, abdominal aorta, abdominal vena cava

71
Q

What are teh advantages of GIT ultrasonography?

A 
Assess internal architecture and vasculature
Real time assessment
Good soft tissue definition
Accurate measurement
FNA/biopsy guidance
72
Q

What are the disadvantages of GIT ultrasonography?

A

Limited field fo view
Difficult if large amounts of gast present
Very equipment and operator dependent

73
Q

What is the order of radiopacites (from most lucent structures to most opaque)?

A 
Gas - most lucent (black)
Fat
Soft tissue/fluid
Bone/mineral
Metal (most opaque)
74
Q

Describe the radiographic appearance of the liver

A

Roughly triangular with smooth distinct margins
Soft tissue opacity
Demarcated by the diaphragm cranially and stomach caudally
Ventral lobe has a fairly shape angle and is contained in the costal arch

75
Q

How does hepatomegaly appear radiographically?

A

projection of caudoventral margin well beyond costal arch
rounding of caudoventral angle
caudal displacement of stomach axis

76
Q

How does a small liver appear radiographically?

A

Cranial displacement of the stomach

Absence of caudoventral angle

77
Q

Describe ultrasonography of the liver (technique and what you see)

A

Majority of the liver is examined from the ventral abdomen immediately caudal to the xiphisternum
Fan the probe from left to right and cranial and caudal
Reference point is the diaphragm (hyperechoic line)
Portal veins are ventral to hepatic veins and have hyperechoic walls (hepatic veins don’t have hyperechoic walls)
Cannot normally see hepatic arteries or bile ducts
Will see gall bladder - hypoechoic

78
Q

Describe ultrasonography of the spleen (technique and what you see)

A

Splenic head lies on the left and is triangular - fairly fixed
Tail is more mobile - often on the left in cats but may extend to the right in dogs
More densely textured that the liver (more echogenic)
Well defined capsule with a smooth outline
Anechoic vessels can be seen entering hilus

79
Q

How does the stomach appear radiographically?

A

Variable size and shape due to variable amounts of gast/fluid/ingesta
Rugal folds often seen as parallel lines
Gastric axis should be parallel to the ribs and perpendicular to the spine

80
Q

Where goes gas and fluid sit in the stomach in RLR, LLR, VD and VD views?

A

RLR: fluid in pylorus
LLR: gas in pylorus
DV: gas in fundus
VD: fluid in fundus

81
Q

How does the small intestine appear radiographically?

A

Duodenum identifiable by location - fixed
Cats tend to have less intestinal gas than dogs
Roughly even diameter throughout - no more than 1.6x height of L5 in dogs

82
Q

How does the colon and rectum appear radiographically?

A

Often easy to identify because they are filled with faeces

83
Q

What are the 5 layers seen in the GIT wall with an ultrasound?

A 
Lumen
Mucosa
Submucosa
Muscularis
Serosa
84
Q

What are two reasons of abnormal stomach wall thickening with ultrasound?

A

Neoplasia - loss of layering and decreased echogenicity

Severe gastritis - obsuring layers, typically hyperechoic mucosa

85
Q

What are reasons for small intestinal wall thicking seen on ultrasound?

A

IBD - wall layers maintained

Can be normal

86
Q

What are the 4 views with an AFAST scan?

A

Diaphragmatico-hepatic
Spleno-renal
Cysto-colic
Hepato-renal

87
Q

What does AFAST stand for?

A

Abdominal Focused Assessment with Sonography for Trauma

88
Q

What are clinical signs of dysautonomia?

A 
Dry mouth and nose
Constipation and urine retention
Regurgitation
Dilated pupil
Bradycardia
89
Q

List clinical signs of oesophageal disease

A 
Anorexia
Dysphagia
Salivation (ptyalism)
Aspiration pneumonia
Weight loss
90
Q

Compare regurgitation and vomiting

A

Regurgitation - variable time after eating, passive process (no abdominal retching), froth/saliva, may just look like food compressed into tubular shapes
Vomiting - nausea, active process (abdominal retching), bilious fluid (yellow)

91
Q

Why should you take both lateral view when radiographing to check for aspiration pneumonia?

A

It has lobar distribution so may not show up on one view. You may not be able to see anything if the aspiration is within the recumbent lung

92
Q

What is the test of choice for Myasthenia Gravis?

A

Acetyl choline receptor antibody

93
Q

Where is a common site for foreign bodies to lodge in the oesophagus?

A

Thoracic inlet

94
Q

Why is fluoroscopy useful for investigating oesophageal disease?

A

Excellent technique for assessing swallowing and oesophageal motility disorders. It is a way to see real time motility of the oesophagus

95
Q

Oesophageal strictures are associated with…

A

reflux during anaesthesia and/or major surgery

severe persistent vomiting

96
Q

What is an iatrogenic cause of oesophageal stricture in cats?

A

Doxycycline

97
Q

What is the ‘normal’ clinical history for rabies?

A

Bite wound in the preceeding 3 weeks to 6 months

98
Q

What are early clinical signs of rabies?

A

Anorexia, depression, mild ataxia

99
Q

What clinical signs do you see as rabies progesses?

A

Hyperesthesia, hypermetria, regional pruritus, recumbency, coma, death

100
Q

What are the 3 forms of rabies?

A

Furious, dumb, paralytic

101
Q

What species if furious rabies common in and list clinical signs

A 
Most common form in dogs
Signs:
- recumbency
- biting and aggression
- convulsions
- exaggerated response to tactile stimuli
- vocalisation
102
Q

What species if dumb rabies common in and list clinical signs

A 
Most common form in horses
Signs:
- depression, febrile
- ataxia, drooped head
- profuse salivation, yawning, tongue falccidity
103
Q

What species if paralytic rabies common in and list clinical signs

A

most common form in cattle
Signs:
- lameness, paraparesis, recumbency, salivation

GI2 (27 decks)

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